Abstract T MP105: Going to the Experts: Addressing Patients' Cognitive and Emotional Needs Before Discharge

Abstract

Background: To improve the patient experience and delivery of patient care, a Stroke Center Patient Advisory Board was created in April 2011. A theme that emerged was the need for psychological and emotional support as an inpatient and after discharge. Common symptoms associated with acute stroke include cognitive impairment, depression, anxiety, and reduced independence in daily activities. Per Advisory Board feedback, the subtle emotional and cognitive changes associated with stroke were not being identified and discussed during acute hospitalization. Literature suggests that 2/3 of patients have cognitive impairment after stroke, and similar rates of post-stroke depression are seen in first 3 months. Both cognitive impairment and mood disorders are associated with impaired function, increased mortality, and increased length of acute and rehabilitation stay after stroke. Purpose: Establish new best practice to better identify cognitive impairment and depression to more fully address patients’ needs prior to discharge. Methods: A Neuropsychological Continuum of Care was created. A routine neuropsychological (cognitive & emotional) screen was done for all patients admitted with an ischemic or hemorrhagic stroke, including those with TIA. After screening, psychoeducation is given to patients and/or families on cognitive strengths and weaknesses, emotional needs and expected recovery. Recommendations are made regarding discharge and compensatory strategies. The findings inform the need for outpatient services and referrals are made to Psychiatry for medication consultation if needed. Results: Over first 12 months, 849 patients with stroke/TIA were referred for inpatient neuropsychological consultation, as compared to 0 inpatient stroke referrals the prior 12 month period. Neuropsychologists provide psychoeducation and neuropsychological intervention during inpatient stay. Discussion: The development and implementation of this new standard of care has resulted in greater ability to educate and support patients and families in the critical acute stroke period. Early post-stroke cognitive and emotional concerns are identified to inform treatment and discharge planning.