An exploration of the experience of early supported discharge from the perspective of stroke survivors

Collins, G. Edward; Breen, Ciara; Walsh, T. N.; McGrath, Margaret

doi:10.12968/ijtr.2016.23.5.207

Cited by 10 publications

(20 citation statements)

References 23 publications

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“…The 14 studies in this review reported on the experiences of 390 participants in total. The study with the smallest number of participants was Collins and colleagues (n = 4) [ 51 ] while the study with the largest number of participants was Fisher and colleagues (n = 147) [ 40 ]. The age range of participants with stroke ranged from 32 years [ 40 ] to 92 years [ 47 ].…”

Section: Resultsmentioning

confidence: 99%

“…The aim of five included studies aligned very closely with the focus of this synthesis. These five studies explored the experience of ESD from the perspective of the person after stroke and/or carers [ 40 , 42 , 44 , 51 , 54 ]. Fisher and colleagues [ 40 ] report articulated a more focused aim for exploring HCPs perspectives, namely, to understand the interaction between contextual influences, core intervention components and the reasoning and actions of ESD team members.…”

Section: Resultsmentioning

confidence: 99%

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A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals’ experiences of early supported discharge (ESD) after stroke

Connor

Horgan²,

Galvin³

et al. 2023

PLoS ONE

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Objective Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals. Method A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden’s three step approach for thematic synthesis. Results Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD. Conclusion The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals’ experiences of early supported discharge (ESD) after stroke

Connor

Horgan²,

Galvin³

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…The papers were published between 2000 and 2017, with two studies conducted in Australia, 46,47 six in Sweden [48][49][50][51][52][53] and the rest in the UK. 13,19,23,38,39,[54][55][56][57][58][59][60] Ten studies focused on stroke ESD services, 13,19,23,38,46,47,49,50,54,58 four investigated community stroke rehabilitation services 39,57,59,60 and six examined stroke patients' transition from hospital to home. 48,[51][52][53]55,56 Data collection methods mainly involved qualitative interviews; two studies conducted surveys, 46,56 two undertook observations, 19,59 two used consensus methods and one provided insights from a service development project.…”

Section: Resultsmentioning

confidence: 99%

“…Interviews with patients and carers highlighted the importance of having access to stroke-specialist information in appropriate formats. 38,49,55,58 Managing endings through timely and constant communication was identified as one of the factors contributing to a positive patient experience in a study by Cowles et al 54…”

Section: Communication With Patients and Carersmentioning

confidence: 99%

Large-scale implementation of stroke early supported discharge: the WISE realist mixed-methods study

Fisher

Chouliara

Byrne

et al. 2021

Health Serv Deliv Res

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Background In England, the provision of early supported discharge is recommended as part of an evidence-based stroke care pathway. Objectives To investigate the effectiveness of early supported discharge services when implemented at scale in practice and to understand how the context within which these services operate influences their implementation and effectiveness. Design A mixed-methods study using a realist evaluation approach and two interlinking work packages was undertaken. Three programme theories were tested to investigate the adoption of evidence-based core components, differences in urban and rural settings, and communication processes. Setting and interventions Early supported discharge services across a large geographical area of England, covering the West and East Midlands, the East of England and the North of England. Participants Work package 1: historical prospective patient data from the Sentinel Stroke National Audit Programme collected by early supported discharge and hospital teams. Work package 2: NHS staff (n = 117) and patients (n = 30) from six purposely selected early supported discharge services. Data and main outcome Work package 1: a 17-item early supported discharge consensus score measured the adherence to evidence-based core components defined in an international consensus document. The effectiveness of early supported discharge was measured with process and patient outcomes and costs. Work package 2: semistructured interviews and focus groups with NHS staff and patients were undertaken to investigate the contextual determinants of early supported discharge effectiveness. Results A variety of early supported discharge service models had been adopted, as reflected by the variability in the early supported discharge consensus score. A one-unit increase in early supported discharge consensus score was significantly associated with a more responsive early supported discharge service and increased treatment intensity. There was no association with stroke survivor outcome. Patients who received early supported discharge in their stroke care pathway spent, on average, 1 day longer in hospital than those who did not receive early supported discharge. The most rural services had the highest service costs per patient. NHS staff identified core evidence-based components (e.g. eligibility criteria, co-ordinated multidisciplinary team and regular weekly multidisciplinary team meetings) as central to the effectiveness of early supported discharge. Mechanisms thought to streamline discharge and help teams to meet their responsiveness targets included having access to a social worker and the quality of communications and transitions across services. The role of rehabilitation assistants and an interdisciplinary approach were facilitators of delivering an intensive service. The rurality of early supported discharge services, especially when coupled with capacity issues and increased travel times to visit patients, could influence the intensity of rehabilitation provision and teams’ flexibility to adjust to patients’ needs. This required organising multidisciplinary teams and meetings around the local geography. Findings also highlighted the importance of good leadership and communication. Early supported discharge staff highlighted the need for collaborative and trusting relationships with patients and carers and stroke unit staff, as well as across the wider stroke care pathway. Limitations Work package 1: possible influence of unobserved variables and we were unable to determine the effect of early supported discharge on patient outcomes. Work package 2: the pragmatic approach led to ‘theoretical nuggets’ rather than an overarching higher-level theory. Conclusions The realist evaluation methodology allowed us to address the complexity of early supported discharge delivery in real-world settings. The findings highlighted the importance of context and contextual features and mechanisms that need to be either addressed or capitalised on to improve effectiveness. Trial registration Current Controlled Trials ISRCTN15568163. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 22. See the NIHR Journals Library website for further project information.

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“…A number of primary qualitative research studies have also explored experiences and views of ESD from the perspective of persons with stroke, their family members, caregivers and healthcare professionals ( Chouliara et al , 2014 ; Collins et al , 2016 ; Lou et al , 2017 ). It is imperative to synthesise findings pertaining to the experiences and perspectives of persons with stroke, family members, caregivers and healthcare professionals of ESD in order to inform practice as well as policy development.…”

Section: Introductionmentioning

confidence: 99%

A protocol for a qualitative synthesis exploring people with stroke, family members, caregivers and healthcare professionals experiences of early supported discharge (ESD) after stroke

et al. 2020

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Early supported discharge (ESD) facilitates a person with a stroke to be discharged from the acute hospital environment earlier than conventional care to continue their rehabilitation within the home with members of the multi-disciplinary team. A number of quantitative studies have highlighted benefits of ESD including a reduction in the length of inpatient stay, cost savings, as well as reducing long term dependency. This systematic review and qualitative synthesis explores the perspectives and experiences of those involved in ESD including people with stroke, family members, caregivers as well as the healthcare professionals involved in the delivery of the service. A comprehensive literature search will be completed in the following databases CINAHL, PubMed Central, Embase, Medline, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journals, The Cochrane Library, PsycARTICLES and Scopus. Qualitative or mixed methods studies that include qualitative data on the perspectives and experiences of people with stroke, family members, caregivers and healthcare professionals of an ESD service will be included. Methodological quality will be appraised using the ten-item Critical Appraisal Skills Programme checklist for qualitative research by two independent reviewers with a third reviewer involved should differences of opinion arise. Findings will be synthesised using thematic synthesis. It is anticipated that the qualitative synthesis will provide a deeper understanding of the experiences of ESD which may serve to inform practice as well as assist in the development of new ESD services. PROSPERO registration: CRD42020135197 – 28/04/2020

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An exploration of the experience of early supported discharge from the perspective of stroke survivors

Cited by 10 publications

References 23 publications

A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals’ experiences of early supported discharge (ESD) after stroke

A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals’ experiences of early supported discharge (ESD) after stroke

Large-scale implementation of stroke early supported discharge: the WISE realist mixed-methods study

A protocol for a qualitative synthesis exploring people with stroke, family members, caregivers and healthcare professionals experiences of early supported discharge (ESD) after stroke

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