Early supported discharge_for_stroke
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Transcript of Early supported discharge_for_stroke
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