Historic Perspective

Conceived in the 1960s, ASUs originally were developed with the goals of cost containment and improved outcomes (11,12). The first ASUs were simply wards in which patients were placed for the purpose of observation (13,14). The goal was to establish a single, designated location for patients with a set of diagnoses for the purposes of cost reduction, administrative simplification, and standardization of care. Soon, the ASU became a place for the implementation of early rehabilitation, and it was observed that this specialized care resulted in improved outcomes (15,16). In these units, complications, such as deep vein thrombosis, urinary tract infections, and aspiration pneumonia, were more easily identified and treated (17,18). However, many hospitals were forced to combine these units with general neurology wards, as the number of neurology inpatients declined. Economic forces that required increased efficiency and cost containment presented incentives to reduce beds (19,20). At the same time, in Europe, literature emphasizing the care of patients in an ASU had been growing since the 1960s (15,20).

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