Every patient with a stroke should be treated in a stroke unit

Stroke is a worldwide problem with high incidence, mortality, disability rates, and costs. 1 2 Stroke units are knownto improve outcome by concentrating patients in a unit with appropriate expertise.3 The United Kingdom has some of the worst outcomes for stroke.2 With a national service framework laying out milestones for the NHS to deliver a better service by April 2004,4 the publication ofthe third national sentinel stroke audit for 2001-2 by the Royal College of Physicians is welcome, as it gives an overview of progress to date.5

Unfortunately, it makes for desolate reading. Two hundred and thirty five hospitals participated in this audit of the organisation and processes of stroke care. The outstanding feature of the report is the failure of the NHS to provide adequate numbers of beds in stroke units. Although the mean number of patients with stroke in hospitals on a specific day was 30, the mean number of acute stroke beds was four and the median number zero. For rehabilitation beds for stroke the mean number was 15 and the median 14. From this lack of capacity to admit patients flows most …