P22 Early supported discharge with Domiciliary Oxygen and Integrated Respiratory Team (DO-IRT) care for hospitalised SARS-CoV2 patients

Follow-up services for delirium after COVID-19—where now?

Age and Ageing ◽

10.1093/ageing/afab014 ◽

2021 ◽

Author(s):

Shibley Rahman ◽

Kit Byatt

Keyword(s):

Service Utilisation ◽

Sustainable Business ◽

Community Based ◽

Care And Support ◽

Early Supported Discharge ◽

Business Cases ◽

Older Inpatients ◽

The Impact

Abstract Delirium is a common presentation in older inpatients with coronavirus disease 2019 (COVID-19), and a risk factor for cognitive decline at discharge. The glaring gaps in the service provision in delirium care, regardless of aetiology, after a hospital admission pre-existed the pandemic, but the pandemic arguably offers an opportunity now to address them. Whilst a delirium episode in itself is not a long-term condition, the context of it may well be, and therefore patients might benefit from personalised care and support planning. There is no reason to believe that the delirium following COVID-19 is fundamentally different from any other delirium. We propose that the needs of older patients who have experienced delirium including from COVID-19 could be addressed through a new model of post-acute delirium care that combines early supported discharge, including discharge-to-assess, with community-based follow-up to assess for persistent delirium and early new long-term cognitive impairment. Such a drive could be structurally integrated with existing memory clinic services. To succeed, such an ambition has to be flexible, adaptable and person-centred. To understand the impact on resource and service utilisation, techniques of quality improvement should be implemented, and appropriate metrics reflecting both process and outcome will be essential to underpin robust and sustainable business cases to support implementation of delirium care as a long-term solution.

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Evaluation of an extended stroke unit service with early supported discharge for patients living in a rural community. A randomized controlled trial

Clinical Rehabilitation ◽

10.1191/0269215504cr752oa ◽

2004 ◽

Vol 18 (3) ◽

pp. 238-248 ◽

Cited By ~ 34

Author(s):

T Askim ◽

G Rohweder ◽

S Lydersen ◽

B Indredavik

Keyword(s):

Randomized Controlled Trial ◽

Rural Community ◽

Stroke Unit ◽

Controlled Trial ◽

Randomized Controlled ◽

Early Supported Discharge

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Implementing early supported discharge in stroke care

Nature Reviews Neurology ◽

10.1038/nrneurol.2011.128-c1 ◽

2012 ◽

Vol 8 (3) ◽

pp. 176-176

Author(s):

Rebecca J. Fisher

Keyword(s):

Stroke Care ◽

Early Supported Discharge

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Early supported discharge (ESD) services for stroke patients

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2014.03.068 ◽

2014 ◽

Vol 57 ◽

pp. e20

Author(s):

P. Langhorne

Keyword(s):

Stroke Patients ◽

Early Supported Discharge

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Using population-based routinely collected data from the Sentinel Stroke National Audit Programme to investigate factors associated with discharge to care home after rehabilitation

Clinical Rehabilitation ◽

10.1177/0269215517748715 ◽

2017 ◽

Vol 32 (8) ◽

pp. 1108-1118 ◽

Cited By ~ 7

Author(s):

Dipankar Dutta ◽

Daniel Thornton ◽

Emily Bowen

Keyword(s):

Care Home ◽

Univariate Analysis ◽

Population Based ◽

National Institutes Of Health ◽

National Audit ◽

Factors Associated ◽

Routinely Collected Data ◽

Early Supported Discharge ◽

Research Findings ◽

First Time

Objectives: We investigated factors associated with Care Home (CH) discharge following stroke using routinely collected data in unselected patients and assessed the relevance of previous research findings to such patients seen in routine clinical practice. Design: Retrospective analysis of data from the Sentinel Stroke National Audit Programme using univariate analysis and logistic regression. Setting: A large acute and rehabilitation UK stroke unit with access to early supported discharge. Subjects: All patients with stroke treated from 1 January 2014 to 1 January 2017. Main measures: National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Results: Of 2584 patients (median age 78 years, interquartile range (IQR) 69–86; 50.6% male; 86.7% infarcts; median admission NIHSS 4, IQR 2–9), 401 (15.5%) died in hospital and 203 patients (7.9%) were permanently discharged to CH for the first time. Most had pre-discharge mRS scores of 4/5. Factors (odds ratios; 95% confidence intervals) associated with CH discharge included age (1.07; 1.05–1.10), incontinence (11.5; 7.13–19.25), dysphagia (2.13; 1.39–3.29), severe weakness (1.93; 1.28–2.92), pneumonia (1.68; 1.13–2.50), urinary tract infection (UTI) (1.70; 1.04–2.75) and depression (1.65; 1.00–2.72). In a subgroup of all patients with a pre-discharge mRS of 4/5, age (1.04; 1.02–1.06), incontinence (4.87; 2.39–11.02), UTI (2.0; 1.09–3.71) and pneumonia (1.59; 1.02–2.50) were the only factors associated with CH discharge. Conclusion: Potentially modifiable variables like incontinence, UTI and pneumonia were associated with CH discharge, particularly in the severely disabled.

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Stroke early supported discharge: the impact of patients' characteristics and clinical profile on rehabilitation goal attainment and clinical outcomes

International Journal of Therapy and Rehabilitation ◽

10.12968/ijtr.2020.0009 ◽

2021 ◽

Vol 28 (3) ◽

pp. 1-11

Author(s):

Ehab Georgy

Keyword(s):

Clinical Outcomes ◽

Functional Outcomes ◽

Goal Attainment ◽

Clinical Profile ◽

Specific Patient ◽

Early Supported Discharge ◽

Significant Difference ◽

Clinical Profiles ◽

Goal Attainment Scale ◽

The Impact

Background/aims Stroke early supported discharge services were introduced to provide a comprehensive stroke specialist therapy input, while reducing cost of acute care. Early supported discharge services resulted in better health-related outcomes. A consensus has not yet been established regarding specific early supported discharge patient characteristics and clinical profile. The main aim of this study was to establish evidence to support the development of an early supported discharge patient profile (demographics and clinical) and eligibility criteria to enable early supported discharge services achieve their purposes of reducing post-stroke disability and institutionalisation rates. This article outlines the relationship between early supported discharge patients' clinical profiles and clinical outcomes, in terms of disability, goal attainment and institutionalisation rates. Methods A retrospective review of data was implemented to determine whether specific early supported discharge patients' clinical profiles and characteristics correlate with clinical outcomes. Data were collected for patients admitted to the Suffolk Stroke Early Supported Discharge Service between August and October 2016, comprising patients' demographics and clinical profiles, including stroke type, Barthel Index and Modified Rankin Scale. Performance data were collected at the end of the early supported discharge service including therapy frequency and intensity, as well as clinical outcomes including the Goal Attainment Scale. Results Data were collected for 53 patients. Data were analysed for all patients in three groups: goals not achieved; goals achieved; and goals achieved to a higher level), according to the Goal Attainment Scale. A Chi-square test showed no significant difference with regard to sex and stroke side (P=0.27). Analysis of variance revealed no significant difference in age. Conversely, results showed a significant association between goal attainment and the stroke subtype, severity and length of hospital stay. Conclusions Specific clinical characteristics and disease profiles correlate with functional outcomes and could influence goal attainment and functional status. A specific patient cohort seems to benefit the most from early supported discharge services in terms of optimised functional outcomes and recovery.

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