Model of Hospital-Supported Discharge After Stroke

Abstract

Background and Purpose-Readmission rate within 6 months after a stroke is 40% to 50%. The purpose of the project was to evaluate whether an interdisciplinary stroke team could reduce length of hospital stay, readmission rate, increase patient satisfaction and reduce dependency of help. Methods-One hundred and ninety-eight patients with acute stroke were randomized into 103 patients whose discharge was supported by an interdisciplinary stroke team and 95 control patients who received standard aftercare. Baseline characteristics were comparable in the 2 groups. The patients were evaluated after 6 and 12 months regarding functional status and need for help. Results-Length of hospital admission was insignificantly shorter in the intervention compared with the control group (35.2 versus 39.8 days). There was no significant difference in readmission, GP-visits, and primary health care services. Furthermore, there was no significant difference in functional scores or patient satisfaction. Conclusions-In this setting we could not show benefit of an interdisciplinary stroke team supporting patients at discharge perhaps because standard aftercare was very efficient already. (Stroke. 2006;37:1514-1520.)

A review of the early discharge experiences of stroke survivors and their carers

“…Although European guidelines serve to direct the standard of acute hospital stroke healthcare provision across Europe (Brainin et al. 2000), there is still no consensus concerning the follow‐up care of patients in the community (Torp et al. 2006).…”

Going home to get on with life: Patients and carers experiences of being discharged from hospital following a stroke

“…Despite some success with these initiatives, they are largely 'clinician' led and do not always give clear understandings of the principles underlying a good discharge for patients and their families following a stroke. Further, the outcome measures do not always demonstrate a significant improvement in the new service [7,10]. This may because there is no improvement for the patient and their family; or that there is improvement, but that it is not captured by the outcome measures used.…”

“…The discharge process following stroke has been explored by researchers to see if it can be made more effective by developing several new services such as hospital supported discharge [7], early supported discharge [8], outreach services [9] and intensification of support [10]. These developments have been led by clinicians and the success of these developments has been assessed using patient and family physical and psychological outcomes.…”

Health policy and future planning for survivors of critical illness

“…Under an early-supported discharge model, instead of patients receiving rehabilitation in the hospital they are rapidly discharged to home under the care of a multidisciplinary team that includes physicians, advance practices nurses and rehabilitation specialists. Multiple randomized trials indicate that earlysupported discharge reduces lengths of hospital stay, costs, disability and mortality following stroke [38][39][40]41 ]. Early-supported discharge is an excellent example of how clinicians can use the principles of disease management successfully to transition patients with acute illness to chronic care, ultimately improving long-term outcomes.…”