Early supported discharge_for_stroke
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Early supported discharge_for_stroke

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Presentation by Dr Patrick Gompertz to the Discussion on ESD&CRT on 6th February 2012

Presentation by Dr Patrick Gompertz to the Discussion on ESD&CRT on 6th February 2012

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  • It was also agreed that the annual cost of the ESD team should be less or equal to the annual savings made by a reduction in length of stay in hospital. SPOC Gillian Stroke association – pathway thing
  • SPOC attending weekly ward round – where patients are indentified Single point of access mobile so information can be transferred to the CST Assessing patients with the key worker from the ASU with SW involvement Some times joint sessions OT to OT Physio to Physio for difficult patients – maybe on HV Attending FM if important or if time Joint DC planning – using RSW or carers to deliver care CST taking patient home on day of discharge to settle them in Documentation & verbal handover Service is dependent on what patient needs Communication with acute staff about what patient needs and what CST can offer
  • May June July Aug Number referrals Average LOS Bartel Perceived amount of time Difference between
  • Re: being seen by the same therapists: 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) Re: feeling ready for discharge home: “ I knew I wasn’t going to get anymore treatment in hospital – I knew I would be happier at home”

Early supported discharge_for_stroke Early supported discharge_for_stroke Presentation Transcript

  • Early Supported Discharge for Stroke
    • Patrick Gompertz
    • Stroke 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 www.ist3.com   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
  •  
  •  
  • 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 Team 100 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
  • Results 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
  • 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