EARLY SUPPORTED DISCHARGE FOR STROKE PATIENTS NICOLA SAVAGE Physiotherapy Clinical Team Leader

Definition The provision of home based rehabilitation service following early discharge from acute hospital setting

Why Reduced length of stay. Improved reintegration into the community setting. No detrimental effect on patient outcome. Supported by current published evidence by RCP, Cochrane review, NSF older person.

Who Will Deliver Supported by current teams Occupational Therapists Physiotherapists Supported by current teams Nursing Staff Medical Staff Social Workers SALT

Referral and Inclusion Criteria Open referral through current teams Criteria Live within geographical area Care givers support Pre CVA functional level Medically fit for Discharge

Who Will Benefit Patient Return Home Quicker. Continuity of Treatment in Home Setting. Seamless Transition to Home Environment

Who Will Benefit Organisation Reduced Length of Stay Reduced Costs Improved Discharge Process

Patient Journey Patient identified on Acute Ward setting Assessed for appropriateness Liaise with Multi Disciplinary Team Joint Goal Setting

Patient Journey Discharge Planning Treatment Continued within Home Setting Transfer of Care to Other Community Teams Discharge from Service

Patient Data 2010 Bersham Ward ESD Patients Number of Patient 274 90 Length of Stay 48 24.5

Patient Data 2011 Bersham Ward ESD Patients Number of Patients 257 74 Length of Stay 23 18.8

Patient Data 2012 Bersham Ward ESD Patients Number of Patients 250 82 Length Of Stay 19.5 13.7

Patient Data -Barthel Score of Patients supported by ESD

Patient Satisfaction Survey “You learn to do the things you need to do on a daily basis in your own home” “My Partner appreciated the help and support” “It was a great comfort”. “The speed they sorted my discharge was very impressive”

Reasons for Discharge from the Team Patient goals met and discharged from therapy. Patient goals for discharge met and referred to other therapy services for continued intervention. Change in medical condition.

Service Developments Access to Care Packages/Social Services Access to SALT Use of Generic Support Staff

Conclusion ESD Team is an effective way of discharge Stroke patients home promptly. The team being based in the hospital allows for seamless transition of care. Patient and Care-givers felt supported.

Questions