Early supported discharge services for people with acute stroke

Abstract

Background People with stroke conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed that offer people in hospital an early discharge with rehabilitation at home (early supported discharge: ESD). Objectives To establish if, in comparison with conventional care, services that offer people in hospital with stroke a policy of early discharge with rehabilitation provided in the community (ESD) can: 1) accelerate return home, 2) provide equivalent or better patient and carer outcomes, 3) be acceptable satisfactory to patients and carers, and 4) have justifiable resource implications use.

Fast‐track versus long‐term hospitalizations for patients with non‐disabling acute ischaemic stroke

“…The rate of 8.9% for unplanned rehospitalization or mRS 3-6 observed in the fast-track arm in our study is in stark contrast with the published rate of 27% for rehospitalization and 40% mRS 3-6 after discharge from services with ESD [13]. Several factors probably contribute to these differences.…”

“…With ESD, average LOS was shorter by 5.5 days, as shown by a Cochrane meta-analysis on 17 clinical trials with 2433 stroke patients. However, even in the ESD arms, the shortest mean LOS was 9.7 days in a trial published 17 years earlier, contrasting with the current trend of decreasing LOS [13,14]. Moreover, not all hospitalized stroke patients need ESD services, and many hospitals even in developed countriesdo not provide ESD.…”

Action Plan for Stroke in Europe 2018–2030

“…İnmede en maliyet etkin yaklaşım hemen beyin görüntülemesinin gerçekleştirilmesi olduğundan, tüm hastaneler inme şüphesi bulunan hastalara vasküler görüntüleme dahil olmak üzere hızlı şekilde beyin görüntülemesi yapılmasını sağlayabilmelidir (33). Multidisipliner bir ortamda destekli erken taburculuk (ESD), hafif ila orta şiddette inme olan hastalar için yararlıdır ve bu hastaların inme birimlerinde yatış süresini anlamlı derecede düşürmesi muhtemeldir (34,35).…”

Olle Höök Lectureship 2019: The changing world of stroke rehabilitation

“…Early supported discharge (ESD) (52) is an innovative approach to rehabilitation, in which services are provided at home by a mobile rehabilitation team, and should be regarded as a part of the stroke treatment path way. Multidisciplinary, specialist stroke ESD teams should plan and co-ordinate discharge from hospital and provide rehabilitation in the community (53).…”

“…The target audience is mainly patients with mild or moderate stroke symptoms, which includes approximately 30% of the stroke population in most settings. Meta-analyses (52) show that reduces the length of hospital stay and reduces the odds of dying due to stroke or being dependent after stroke by 20%. However, another study evaluated the real-world aspects (ecological validity) of ESD (54) and the results were similar, with significantly shorter lengths of hospital stay and reported significantly higher levels of satisfaction with services received (54).…”