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Patients & Public > Research using SSNAP data > Plain English Summaries > Are bigger stroke services better at giving clot-dissolving drugs than smaller services?

Lay summary: Are bigger stroke services better at giving clot-dissolving drugs than smaller services?

Blood clots can cause a stroke if they block blood supply to the brain. A treatment for this type of stroke is the injection of a blood-clot dissolving drug (thrombolysis). Blood-clot dissolving drugs work best when given within 4.5 hours of the stroke. Therefore, it is important that blood clot-dissolving drugs are given to patients as soon as possible after they arrive at the hospital. This study found that it took longer for patients to receive blood clot-dissolving drugs in smaller hospitals. Patients were also more likely to receive blood-clot dissolving drugs in larger hospitals.

This research was important for informing the delivery of stroke care in England, where many hospitals have been running small stroke services with fewer than 400 admissions a year. Clear data showing that bigger can be better has allowed difficult decisions to be made about the need to focus care in a smaller number of larger units. In London, stroke services were reconfigured to reduce the number of hospitals that admit stroke patients from 32 to 8 larger stroke units. This reconfiguration has showed better processes of care and lower numbers of deaths.

About the paper:
Paper title: 'Bigger, faster? Associations between hospital thrombolysis volume and speed of thrombolysis administration in acute ischemic stroke.' 
Year published: 2013
Authors: Benjamin Bray, James Campbell, Geoffrey C Cloud, Alex Hoffman, Pippa J Tyrell, Charles D A Wolfe, Anthony G Rudd, Intercollegiate Stroke Working Party Group.

A summary of this paper was published in the article '20 years of researching stroke through audit'.
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