Stroke continues to be one of the main causes of disability with substantial human and economic costs. The 2004 and 2006 National Sentinel Stroke Audits showed that the overall standard of stroke services in London were lower than in other parts of the UK. In order to address this issue, a major transformation of acute stroke services was felt to be necessary. Greater London has now undergone this dramatic reconfiguration of acute stroke services which began in February 2010. Eight Hyper Acute Stroke Units (HASUs) have now been set up across the capital, providing 116 monitored beds. The aim of this is to offer equitable, around-the-clock access to stroke specialists, investigations, imaging, and if indicated thrombolysis. Preliminary results have shown an increase in thrombolysis rates for the whole of London from 3.5% in February–July 2009 to 12% over the same period in 2010. Approximately 35% of patients are discharged directly home. In the 2010 National Sentinel Audit, five of the six top stroke services in the country were London HASUs. Patients requiring additional in-hospital care are being transferred to their local Stroke unit within 72 h. Throughout London the combined HASU and Stroke Unit length of stay for patients has fallen to a mean of 19.4 days compared to a UK average of 24 days. This reconfiguration of stroke services is the most ambitious to take place in any major metropolis and could act as template for other large cities elsewhere.
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