Early Supported Discharge for Stroke

Patrick GompertzStroke Physician

BLT

Why bother about stroke?

• It's common - one every five minutes

• It's serious

• 11% of all deaths

• 900,000 survivors (half disabled)

• It's expensive - £2.8 billion pa

• It's treatable

Benefits of stroke treatment

 Number

treated per year

Benefit per 1000 treated

Number who avoid death or dependency

Aspirin 80% 104000 13 1350

Stroke Unit 60% 78000 56 4370

Thrombolysis 2% 2080 63 130

Thrombolysis 30% 31200 47 1470

www.ist3.com

Stroke in London

Over 400 new nurses and 87 new therapists

Thrombolysis rate is 14%

higher than any other large city in the world

US 1.3 to 3%

587 in the first 5 months (up from 174)

Journey time 14 minutes

Length of stay has fallen from 15 days to 11.5 daysn

35% of patients are discharged home from HASU

Mortality is 20% less than the rest of England

Characteristics of ESD

Lancet 2005;365:501

The “Typical “ESD Team100 patients a year

• Medical 0.1 WTE• Nursing 0 WTE (0-1.2)• Physio 1 WTE• OT 1 WTE• SLT 0.4 WTE• Assistant staff 0.25 WTE• Also SW and admin

Patients

• Mean age 68-78• 13-68% eligible (median 41%)• Barthel 14

Death or Dependency

Other Outcomes

•One team• Coordinator• OT• Physio• Nurse• SLT• Physician• SW• Admin support• Rehab Support Workers

The Tower Hamlets Community Stroke Team

•3 Functions• Early supported

discharge• Rehabilitation• Resettlement

•Joint assessment.•Joint discharge planning.•ESD service settling patient in on day of discharge.

•Documentation & verbal handover

In-reach

Month No. referrals

Average LOS

Bartel Average ESD Intervention time

May 6 6 15 39 days

June 9 6 13 48 days +

July 8 4 17

August 12 3 18

Results

Patient Quotes•“It was important for me to be seen by the same people – they were the ones that knew me”

•“People are nicer when they know you from before”

•“It was good to be able to communicate with the same people; responding to questions” (carer)

•“I knew I wasn’t going to get anymore treatment in hospital – I knew I would be happier at home”

Conclusion

• ESD gives better outcomes• Many patients may benefit• It’s cost-effective