it is the leading cause of acquired disability in adults and has a tremendous socioeconomic impact on patients , their relatives and health systems . in switzerland
, the incidence of stroke has been estimated to be 150/100,000 ( year 2000 ) . in 2004 ,
the overall stroke event rate was 296.3/100,000 ( 287.7/100,000 in women , and 305.6/100,000 in men ) .
the age - standardized event rate was 146/100,000 overall . during the same year , the age - standardized mortality rate was significantly higher for men ( 31.4/100,000 ) than for women ( 25.6/100,000 ) .
acute stroke care provided by stroke units ( su ) has been found to be more costly but also more cost - effective than conventional care .
, reported a mean cost of $ 3,200 ( usd ) for ischemic stroke patients . in comparison with care provided in regular neurological wards , this amount corresponds to a 7% increase of the mean cost per admission .
however , the modified rankin scale was improved and post - acute inpatient costs were decreased . the scope of this article is to illustrate the guidelines for establishing su as these have been recently ( 2012 ) proposed by the swiss stroke society .
these guidelines could be applicable not only in developed but also in developing countries worldwide , given sufficient resources .
according to the swiss stroke society , a distinction is to be made between su and stroke centers ( sc ) .
a su is effective for all grades and all age groups of patients with stroke .
it is equipped with monitored and non - monitored treatment beds . on the other hand ,
a sc comprises a su and extends the concept of su to specific structural , neuroradiological and neurosurgical services .
personnel : medical:10-hour presence of a neurologist in the hospital during the day . at night and on weekends call service available ( a consultant neurologist present within 35
minutes).the medical director is a neurologist with proven expertise in stroke treatment and at least 2 years of experience in cerebrovascular diseases.neurologist with proven expertise in neurosonology and treatment of cerebrovascular diseases.physician with at least 2 years training / work in a neurorehabilitation department.internist available in the institution on a 24/7 basis ( 24/7).cardiologist at the bedside ( < 60 minutes).nursing : specialized in stroke ( 24/7).therapy : physiotherapists : onset of therapeutic interventions within 24 hours , at least one treatment session per day ( weekends included).occupational and speech therapists : onset of therapeutic interventions within a day ( monday - friday ) in case of deficits , considering the therapeutic requirements ( ability of the patient to cooperate , clinically stable state).social workers : interventions that allow the patient to participate in social life and achieve the greatest possible independence in everyday life.diagnostic modalities : brain computed tomography ( spiral ct ) or magnetic resonance imaging ( mri ) ( visualization of head and neck arteries ) within 25 minutes.systematized and documented swallowing evaluation ( 24/7 ) possible.neurosonological investigation ( extra-/transcranial ) available within 24 hours.implementation of cerebral angiography in cooperation with a sc ( 24/7).etiologic diagnosis and differential diagnosis of stroke ( e.g. , transesophageal echocardiography , hemostasis , electroencephalography ) within the institution.neuropsychological investigation within two working days possible.monitoring:24/7 control ( in monitored beds ) of electrocardiogram ( ecg ) , oxygen saturation , temperature , blood pressure , pulse , respiration , glucose ( blood pressure measurements performed in a minimum of 15-minute intervals).control ( in non - monitored beds ) of ecg , oxygen saturation , temperature , blood pressure , pulse , respiration , glucose ( up to 4-hourly).at least 6-hourly monitoring of neurological findings ( early detection of stroke progression , relapse , and other complications ) .
after acute interventions : more frequent monitoring.specific acute treatment : immediate availability of intravenous thrombolytic therapy ( 24/7 ) ( the neurologist is responsible for the indications and the administration of thrombolysis).emergency neurosurgical and interventional neuroradiological interventions by neurosurgeons and radiologists ( diagnostic and invasive neuroradiology or equivalent expertise )
. transfer in 60 minutes according to a written agreement between the su and the sc.carotid endarterectomy by qualified surgeons ( neuro- or vascular surgeons ) within 24 hours in their own center or in a sc.infrastructure:locally defined unit ( su ) for stroke patients and treatment - defined path.minimum total number of beds : 6.minimum number of monitored beds for acute stroke patients in a certain locally defined unit : 3.non-monitored beds for acute stroke patients in a certain locally defined unit : 3.minimum number of admissions or evaluations of acute stroke patients per year ( further transfers from su to sc are also considered ) : 200.minimum number of acute thrombolyses or endovascular treatments per year : 20.available and sufficiently staffed emergency department within the institution.recognized multidisciplinary intensive care unit within the institution with invasive and non - invasive ventilation options.outpatients consultation availability by a neurologist with proven expertise in stroke treatment .
alternatively , this is done in a sc or in a su by a sc doctor.processes and quality assurance : standardized treatment and allocation protocols in coordination with local emergency services , acute care hospitals and other su / sc.the sc or the su physician is responsible for the beds disposal / planning.acute rehabilitation concept ( early initial assessment and rehabilitation within the acute care environment).swallow concept.collaboration with neurorehabilitation.defined treatment protocols and patient pathways for diagnosis , treatment , care , early rehabilitation , prevention , and transition to rehabilitation.stroke register.documentation of quantifiable quality indicators.training and research : further education and training programs concerning stroke patients .
medical:10-hour presence of a neurologist in the hospital during the day . at night and on weekends call service available ( a consultant neurologist present within 35
minutes).the medical director is a neurologist with proven expertise in stroke treatment and at least 2 years of experience in cerebrovascular diseases.neurologist with proven expertise in neurosonology and treatment of cerebrovascular diseases.physician with at least 2 years training / work in a neurorehabilitation department.internist available in the institution on a 24/7 basis ( 24/7).cardiologist at the bedside ( < 60 minutes).nursing : specialized in stroke ( 24/7).therapy : physiotherapists : onset of therapeutic interventions within 24 hours , at least one treatment session per day ( weekends included).occupational and speech therapists : onset of therapeutic interventions within a day ( monday - friday ) in case of deficits , considering the therapeutic requirements ( ability of the patient to cooperate , clinically stable state).social workers : interventions that allow the patient to participate in social life and achieve the greatest possible independence in everyday life .
10-hour presence of a neurologist in the hospital during the day . at night and on weekends
call service available ( a consultant neurologist present within 35 minutes).the medical director is a neurologist with proven expertise in stroke treatment and at least 2 years of experience in cerebrovascular diseases.neurologist with proven expertise in neurosonology and treatment of cerebrovascular diseases.physician with at least 2 years training / work in a neurorehabilitation department.internist available in the institution on a 24/7 basis ( 24/7).cardiologist at the bedside ( < 60 minutes ) .
10-hour presence of a neurologist in the hospital during the day . at night and on weekends call service available ( a consultant neurologist present within 35 minutes ) .
the medical director is a neurologist with proven expertise in stroke treatment and at least 2 years of experience in cerebrovascular diseases .
cardiologist at the bedside ( < 60 minutes ) . specialized in stroke ( 24/7 ) . specialized in stroke ( 24/7 ) .
physiotherapists : onset of therapeutic interventions within 24 hours , at least one treatment session per day ( weekends included).occupational and speech therapists : onset of therapeutic interventions within a day ( monday - friday ) in case of deficits , considering the therapeutic requirements ( ability of the patient to cooperate , clinically stable state).social workers : interventions that allow the patient to participate in social life and achieve the greatest possible independence in everyday life .
physiotherapists : onset of therapeutic interventions within 24 hours , at least one treatment session per day ( weekends included ) .
occupational and speech therapists : onset of therapeutic interventions within a day ( monday - friday ) in case of deficits , considering the therapeutic requirements ( ability of the patient to cooperate , clinically stable state ) . social workers : interventions that allow the patient to participate in social life and achieve the greatest possible independence in everyday life
. diagnostic modalities : brain computed tomography ( spiral ct ) or magnetic resonance imaging ( mri ) ( visualization of head and neck arteries ) within 25 minutes.systematized and documented swallowing evaluation ( 24/7 ) possible.neurosonological investigation ( extra-/transcranial ) available within 24 hours.implementation of cerebral angiography in cooperation with a sc ( 24/7).etiologic diagnosis and differential diagnosis of stroke ( e.g. , transesophageal echocardiography , hemostasis , electroencephalography ) within the institution.neuropsychological investigation within two working days possible
. brain computed tomography ( spiral ct ) or magnetic resonance imaging ( mri ) ( visualization of head and neck arteries ) within 25 minutes .
etiologic diagnosis and differential diagnosis of stroke ( e.g. , transesophageal echocardiography , hemostasis , electroencephalography ) within the institution .
24/7 control ( in monitored beds ) of electrocardiogram ( ecg ) , oxygen saturation , temperature , blood pressure , pulse , respiration , glucose ( blood pressure measurements performed in a minimum of 15-minute intervals).control ( in non - monitored beds ) of ecg , oxygen saturation , temperature , blood pressure , pulse , respiration , glucose ( up to 4-hourly).at least 6-hourly monitoring of neurological findings ( early detection of stroke progression , relapse , and other complications ) .
24/7 control ( in monitored beds ) of electrocardiogram ( ecg ) , oxygen saturation , temperature , blood pressure , pulse , respiration , glucose ( blood pressure measurements performed in a minimum of 15-minute intervals ) .
control ( in non - monitored beds ) of ecg , oxygen saturation , temperature , blood pressure , pulse , respiration , glucose ( up to 4-hourly ) .
at least 6-hourly monitoring of neurological findings ( early detection of stroke progression , relapse , and other complications ) .
specific acute treatment : immediate availability of intravenous thrombolytic therapy ( 24/7 ) ( the neurologist is responsible for the indications and the administration of thrombolysis).emergency neurosurgical and interventional neuroradiological interventions by neurosurgeons and radiologists ( diagnostic and invasive neuroradiology or equivalent expertise )
. transfer in 60 minutes according to a written agreement between the su and the sc.carotid endarterectomy by qualified surgeons ( neuro- or vascular surgeons ) within 24 hours in their own center or in a sc .
immediate availability of intravenous thrombolytic therapy ( 24/7 ) ( the neurologist is responsible for the indications and the administration of thrombolysis ) .
emergency neurosurgical and interventional neuroradiological interventions by neurosurgeons and radiologists ( diagnostic and invasive neuroradiology or equivalent expertise ) .
transfer in 60 minutes according to a written agreement between the su and the sc .
carotid endarterectomy by qualified surgeons ( neuro- or vascular surgeons ) within 24 hours in their own center or in a sc .
locally defined unit ( su ) for stroke patients and treatment - defined path.minimum total number of beds : 6.minimum number of monitored beds for acute stroke patients in a certain locally defined unit : 3.non-monitored beds for acute stroke patients in a certain locally defined unit : 3.minimum number of admissions or evaluations of acute stroke patients per year ( further transfers from su to sc are also considered ) : 200.minimum number of acute thrombolyses or endovascular treatments per year : 20.available and sufficiently staffed emergency department within the institution.recognized multidisciplinary intensive care unit within the institution with invasive and non - invasive ventilation options.outpatients consultation availability by a neurologist with proven expertise in stroke treatment .
alternatively , this is done in a sc or in a su by a sc doctor . locally defined unit ( su ) for stroke patients and treatment - defined path
minimum number of monitored beds for acute stroke patients in a certain locally defined unit : 3 .
non - monitored beds for acute stroke patients in a certain locally defined unit : 3 .
minimum number of admissions or evaluations of acute stroke patients per year ( further transfers from su to sc are also considered ) : 200
recognized multidisciplinary intensive care unit within the institution with invasive and non - invasive ventilation options .
alternatively , this is done in a sc or in a su by a sc doctor .
processes and quality assurance : standardized treatment and allocation protocols in coordination with local emergency services , acute care hospitals and other su / sc.the sc or the su physician is responsible for the beds disposal / planning.acute rehabilitation concept ( early initial assessment and rehabilitation within the acute care environment).swallow concept.collaboration with neurorehabilitation.defined treatment protocols and patient pathways for diagnosis , treatment , care , early rehabilitation , prevention , and transition to rehabilitation.stroke register.documentation of quantifiable quality indicators . standardized treatment and allocation protocols in coordination with local emergency services , acute care hospitals and other su / sc . the sc or
acute rehabilitation concept ( early initial assessment and rehabilitation within the acute care environment ) .
collaboration with neurorehabilitation . defined treatment protocols and patient pathways for diagnosis , treatment , care , early rehabilitation , prevention , and transition to rehabilitation .
training and research : further education and training programs concerning stroke patients . further education and training programs concerning stroke patients .
standardized treatment and allocation protocols along with an acute rehabilitation concept seem to be the core of the swiss stroke management system .
coordinated multidisciplinary care provided by specialized medical , nursing , and therapy staff is of utmost importance for achieving a significant reduction of dependency or death . to this end
, the swiss paradigm of su organization could serve as a benchmark for future health policy decisions .
 stroke represents the leading cause of acquired disability in adults and poses a tremendous socioeconomic burden both on patients and the society . in this sense , 
 prompt diagnosis and urgent treatment are needed in order to radically reduce the devastating consequences of this disease . 
 herein the authors present the new guidelines recently adopted by the swiss stroke society concerning the establishment of stroke units . 
 standardized treatment and allocation protocols along with an acute rehabilitation concept seem to be the core of the swiss stroke management system . 
 coordinated multidisciplinary care provided by specialized medical , nursing and therapy staff is of utmost importance for achieving a significant dependency and death reduction . 
 it is believed that the implementation of these guidelines in the stroke care system would be beneficial not only for the stroke patients , but also for the health system . 
Introduction
Stroke Units versus Stroke Centers
The Swiss Guidelines Concerning Stroke Units
Conclusions