Previous audits of stroke care in 2002 and 2005 in our institution recommended organised and specialised care of stroke patients. A stroke unit was therefore established in June 2008.This audit assessed the impact of the establishment of an acute stroke unit on the care of stroke patients.A review of consecutive patients admitted and diagnosed with acute stroke between June 2008 and December 2008 was carried out. Comparison was made with 55 consecutive patients surveyed in 2005.Marked improvements in the management of acute stroke patients were noted, particularly time to computerised tomography of brain, aspirin administration and multidisciplinary involvement. Significantly, the average length of hospital stay was reduced by a mean of 10 days from 29.3 +/- A 28 in 2005 to 19.6 +/- A 20 following the establishment of a stroke unit (p = 0.018).The stroke unit has greatly improved the care of acute stroke patients. Further areas for improvement are highlighted.