Included: all patients are included in this indicator, except those who went directly to ITU/CCU/HDU during their stay in hospital and those who died on the same day as arrival/onset of symptoms.
| Excluded: patients who were admitted to ITU/CCU/HDU and/or those who died on the same day as arrival/onset of symptoms are excluded from this indicator |
Numerator = patients who spent at least 90% of their stay on a stroke unit.
Denominator = all patients in the cohort (apart from the patients who were admitted to ITU/CCU/HDU and those who died on the same day as arrival/onset of symptoms).
To calculate the number of patients who spent at least 90% of their stay on a stroke unit, the length of stay must first be calculated.
The length of stay is calculated as the difference between the date and time of discharge/death and either date and time of arrival for newly arrived patients or onset of symptoms for inpatient strokes.
To identify date and time of discharge/death for patients:
who were discharged alive, use:
- Q 7.3 Date and time of discharge/ transfer from team
who died on a stroke unit (Q 7.1.2 is Yes), use:
- Q 7.1.1 What was the date of death? with an assumed time component of 23:59
who died in hospital but not on a stroke unit (Q 7.1.2 is “No”) and were discharged from the stroke unit on the same day as death (Q 7.2 and Q 7.1.1 is the same date), use:
- Q 7.2 Date and time of discharge from stroke unit
who died in hospital but not on a stroke unit either because they were not admitted to a stroke unit at that team (Q 4.3 is Did not stay on a stroke unit) or because they were discharged from the stroke unit before the date of death (Q 7.1.2 is “No” and Q 7.2 is before Q 7.1.1), use:
- Q 7.1.1 What was the date of death? with an assumed time component of 00:00
who were transferred to another inpatient team (Q 7.1 is “Was transferred to another inpatient care team”), use:
- Q 7.3 Date and time of discharge/ transfer from team
| For team-centred | For patient-centred |
| The length of stay at each team is the difference between the date and time of team discharge/death as calculated above and either the date and time patient arrived at this hospital team (Q 4.1), or the date and time of symptom onset (Q 1.11) for patients already in hospital (Q 1.11 is only used for the first team). |
The length of stay across the whole inpatient stay is the difference between the date and time of final inpatient discharge for each patient and either date and time of arrival (Q 1.13), or date and time of symptom onset (Q 1.11) for patients already in hospital. |
| 4 hours is then taken away from the length of stay, as this makes the inclusion of patients with short lengths of stay feasible for this indicator. | |
Next, the length of stay on a stroke unit must be calculated.
To identify the length of stay on a stroke unit for patients:
discharged/transferred alive:
- the length of stay on a stroke unit is the difference between Q 4.3 (the date and time the patient arrived on stroke unit at this hospital) and Q 7.2 (date and time of discharge from stroke unit)\
who die on a stroke unit (Q 7.1.2 is “Yes”):
- the length of stay on a stroke unit is the difference between Q 4.3 (date and time the patient arrived on stroke unit at this hospital) and the date component given in Q 7.1.1 (What was the date of death?) with a time component of 23:59
who die in hospital but not on a stroke unit (Q 7.1.2 is “No”):
- the length of stay on a stroke unit is the difference between Q 4.3 (date and time the patient arrived on stroke unit at this hospital) and Q7.2 (date and time of discharge from stroke unit)
who did not stay on a stroke unit at a given team (Q 4.3 is “Did not stay on a stroke unit”):
- the length of stay on the stroke unit is 0 min
| For team-centred | For patient-centred |
| As calculated above | overall length of stay is calculated by adding length of stay on the stroke unit per team as calculated above |
To calculate the percentage of a patient’s stay on a stroke unit:
overall length of stay on a stroke unit x 100
length of stay in hospital
If the percentage of a patient’s stay on a stroke unit is greater than or equal to 90% the patient has achieved this indicator.
Cohort percentage:
Example
Patient A arrived (clock start) at hospital at 12:57 on 1st January. They were admitted to the stroke unit at 22:18 that same day. They stayed at the stroke unit until they were discharged home at 16:18 on 3rd January.
Patient B arrived (clock start) at hospital at 09:15 on 3rd January. They were admitted to the stroke unit at 11:16 that same day. They died on the stroke unit on 16th January.
Patient C arrived (clock start) at hospital at 13:08 on 10th January. They were not admitted to the stroke unit. They stayed on a medical ward. They were discharged home at 17:00 on the 15th January.
Patient D arrived (clock start) at hospital at 03:15 on 20th January. They were admitted to the stroke unit at 10:15 on the 21st January. They were transferred to another inpatient team at 09:30 on 25th January. They were discharged to a care home at 09:30 on 26th January.
Patient E arrived (clock start) at hospital at 23:33 on Friday. They were admitted to the HDU.
Step 1) Identify the date and time of discharge/death:
Patient A – discharged alive so 16:18 on 3rd January
Patient B – died on stroke unit so 16th January with assumed time of 23:59
Patient C – discharged alive so 17:00 on 15th January
Patient D – transferred to another team at 09:30 on 25th January (team-centred) and discharged to alive so 09:30 on 26th January (patient-centred)
Patient E – excluded because they were admitted to HDU
Step 2) Calculate the length of stay in hospital
Patient A – clock start 12:57 on 1st January and discharged home so 16:18 on 3rd January
The length of stay is 4521 min – 240 min (4 hours) = 4281 min.
Patient-centred will be the same as team-centred as the patient was only at one team.
Patient B – clock start 09:15 on 3rd January and died on stroke unit so 16th January with assumed time of 23:59.
The length of stay is 19574 min – 240 min (4 hours) = 19334 min.
Patient-centred will be the same as team-centred as the patient was only at one team.
Patient C – clock start 13:08 on 10th January and discharged home so 17:00 on 15th January.
The length of stay is 7432 min – 240 min (4 hours) = 7192 min.
Patient-centred will be the same as team-centred as the patient was only at one team.
Patient D – Patient-centred: clock start 03:15 on 20th January and discharged to a care home so 09:30 on 26th January.
The length of stay is 9285 min – 240 min (4 hours) = 9045 min.
Team-centred: clock start 03:15 on 20th January and transferred to another team on 09:30 on 25th January.
The length of stay is 7845 min - 240 min (4 hours) = 7605 min.
Step 3) Calculate the length of stay on the stroke unit
Patient A – admitted to stroke unit 22:18 on 1st January and discharged home from stroke unit at 16:18 on 3rd January.
The length of stay on the stroke unit is 2520 min.
Patient-centred will be the same as team-centred as the patient was only at one stroke unit.
Patient B – admitted to stroke unit 11:16 on 3rd January and died on the stroke unit on 16th January with assumed time of 23:59.
The length of stay is 19449 min.
Patient-centred will be the same as team-centred as the patient was only at one stroke unit.
Patient C – was not admitted to the stroke unit so length of stay is 0 min.
Patient-centred will be the same as team-centred as the patient was only at hospital.
Patient D – admitted to stroke unit 10:15 on the 21st January and transferred to another team on 09:30 on 25th January.
The length of stay is 5760 min.
Patient-centred will be the same as team-centred as the patient was only at one stroke unit.
Step 4) Calculate the percentage of time the patient spends on the stroke unit
Patient A = 2520 x 100 = 59% Patient-centred and team-centred will be the same value
4281
Patient B = 19449 x 100 = 101% Patient-centred and team-centred will be the same value
19334
Patient C = 0 x 100 = 0% Patient-centred and team-centred will be the same value
7192
Patient-centred: Team-centred:
Patient D = 5760 x 100 = 64% = 5760 x 100 = 76%
9045 7605
Therefore only patient B has achieved this indicator.
The percentage of patients who spend at least 90% of their stay on a stroke unit is 0.25 or 25%
or 
Note that since patient B was admitted to a stroke unit within 4 hours of clock start, the percentage stay on stroke unit is greater than 100%.
