Original Research

Factors affecting length of hospital stay in stroke survivors in South Africa: A call for a stroke unit

Stephanie C. Pillay, Roxann Redant, Nadia Umuneza, Azra Hoosen, Fiona Breytenbach, Sameera Haffejee, Zvifadzo Matsena-Zingoni, Kganetso Sekome
African Journal of Disability | Vol 11 | a1065 | DOI: https://doi.org/10.4102/ajod.v11i0.1065 | © 2022 Stephanie C. Pillay, Roxann Redant, Nadia Umuneza, Azra Hoosen, Fiona Breytenbach, Sameera Haffejee, Zvifadzo Matsena-Zingoni, Kganetso Sekome | This work is licensed under CC Attribution 4.0
Submitted: 02 May 2022 | Published: 12 December 2022

About the author(s)

Stephanie C. Pillay, Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Roxann Redant, Department of Occupational Therapy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Nadia Umuneza, Department of Physiotherapy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Azra Hoosen, Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Fiona Breytenbach, Department of Occupational Therapy, University of the Witwatersrand, Johannesburg, South Africa
Sameera Haffejee, Department of Physiotherapy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Zvifadzo Matsena-Zingoni, Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
Kganetso Sekome, Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa

Abstract

Background: Stroke in Africa is a growing and neglected crisis with the incidence more than doubling in low- to middle-income countries in the last four decades. Despite this growing threat, implementation of stroke models of care in hospitals is lacking. Stroke units as a model of care have been shown to decrease mortality, reduce length of hospital stay (LOS) and improve outcomes in stroke survivors.

Objectives: To determine the profile of stroke survivors and identify factors contributing to LOS at Chris Hani Baragwanath Academic Hospital (CHBAH) in South Africa to support stroke unit implementation.

Method: This study involved a retrospective record review of stroke survivors admitted to CHBAH between September 2018 and May 2019. Factors associated with LOS were determined using linear regression models; univariate and multiple regression models were fitted.

Results: A total of 567 participants’ data were included. Overall, 51.85% of the participants required services from all rehabilitation disciplines. The median LOS was 9 days (interquartile ranges [IQR]: 5–11 days) with each discipline providing an average of six sessions. Participants who were referred to the rehabilitation team 3 days after admission to hospital stayed 6 days longer compared with those participants who were referred earlier (p < 0.001).

Conclusion: Delayed referral to the rehabilitation team resulted in increased LOS. This study supports the need for dedicated stroke units to decrease hospital LOS and improve patients’ outcomes by ensuring early, well-coordinated rehabilitation intervention and discharge planning.

Contribution: The study highlights the urgency for re-evaluation of stroke care infrastructure within Gauteng to streamline and provide accessible stroke models of care.


Keywords

stroke; rehabilitation; length of stay; stroke unit; South Africa.

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