London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 479 365 Management and economics Early supported discharge and length of stay in contemporary stroke care S.J. Kavanagh1, M. Roughton2, J.T. Campbell3, B. Bray4, A.M. Hoffman5, G,C. Cloud6, P. Tyrrell7, A.G. Rudd8 On behalf of the Intercollegiate Stroke Working Party Royal College of Physicians, London, UNITED KINGDOM1, Royal College of Physicians, Lon-don, UNITED KINGDOM2, Royal Collegeof Physicians, London, UNITED KINGDOM3, Roy-al College of Physicians, London, UNITED KINGDOM4, Royal College of Physicians, London, UNITED KINGDOM5, St George’s Healthcare NHS Trust, London, UNITED KINGDOM6, Uni-versity of Manchester, Manchester, UNITED KINGDOM7, Guy’s and St Thomas’ NHS Foundation Trust, London, UNITED KINGDOM8 Background Previous studies demonstrated that Early Supported Discharge (ESD) for stroke reduced length of stay and improved patient outcomes. However, changes in acute stroke care over recent years and falling length of stay may mean that the benefit of ESD in current stroke practice may be less marked. We aimed to describe the provision, use and effect on length of stay of ESD in a national cohort of contemporary stroke patients Methods Data were obtained by the National Sentinel Stroke Audit 2010 of all 200 hospitals in England, Wales and Northern Ireland treating patients with acute stroke . Data were collected on the organisa-tion and staffing of services and the process of care received by consecutive admissions over a three month period. Results In 2010, 88 (44 %) hospitals reported having an ESD team, an increase of 7% from 2009. Of 11 353 patients admitted with stroke, 1 158 (10.2%) received ESD. A greater proportion of patients receiving ESD were treated for >90% of their admission on a stroke unit (72.6% versus 67.9%, p <0.001). Median length of stay was 1 day lower in stroke units with an ESD team (9 days, IQR 4-24), compared to those without an ESD team (10 days, 4-29), p<0.001. Conclusions The number of stroke units with an ESD has increased in England, Wales and Northern Ireland. De-spite the large reductions in length of stay in recent years, ESD care is still associated with signifi-cantly reduced length of stay in units with ESD provision and remains an important component of stroke care. 366 Management and economics From acute care to a primary care-led post stroke service for patients residing at home: Doing away with ‘blanket-referrals’! N.A. Aziz1, A.F. Abdul Aziz2, M.F. Ali3, B.S. Saperi4, S.M. Aljunid5 Department of Family Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kua-la Lumpur, MALAYSIA1, United Nations University IIGH & Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MALAYSIA2, Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MALAYSIA3, Department of Health Information, University Kebangsaan Malaysia Medical Centre, Kuala Lum-pur, MALAYSIA4, United Nations University IIGH; International Centre for Casemix & Clinical Coding, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MALAYSIA5 Introduction Delivery of post stroke care has been mostly fragmented in developing countries. Lack of access to limited specialised stroke care pose greater problems after discharge from tertiary care. ‘Blanket re-ferrals’ at discharge generally contain generic instructions to manage stroke risk factors (i.e. hyper-tension, diabetes mellitus) per se, neglecting long-term care plans and goals for post stroke patients. To empower a primary care coordinated post stroke service, a transfer of care discharge protocol was derived among Specialist Stroke Care providers. Method An expert panel discussion conducted among Specialist Stroke Care Providers, was rep-resented, by Family Physicians, Neurologists, Rehabilitation Physicians and therapists, and Nurse Managers from both Ministry of Health and Acadaemia. Solutions to identified transfer of care is-sues were discussed. Variances in practice were resolved by consensus, using the modified Delphi technique. Results Transfer of care problems from Specialist Stroke service to primary care occurred mainly at discharge, while at community level, patients diagnosed at primary care during subacute or long-term phase were managed with minimal Specialist support. ‘Young stroke’ patients aged <40 years , with concurrent cardiovascular disease, chronic renal failure and carotid artery stenosis >50% should not be managed at primary care. Patients were best transferred to primary care at six months or more after stroke, regardless of stroke type or severity. Essential information during transfer of care included details of acute stroke management, stroke risk factor(s) screening, rehabilitation sta-tus (i.e. functional status at discharge) and goals. Treatment targets for risk factor(s) management were as per local clinical practice guidelines. Conclusion The transfer of care checklist consolidated relevant information necessary to guide the primary care team to optimise post stroke care in areas lacking access to Specialist Stroke services.
Karger_ESC London_2013
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