Early Discharge Services Reduce Hospital Stay, Disability After Stroke

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Patients who received ESD services were more likely to be independent and living at home 6 months after stroke.
Patients who received ESD services were more likely to be independent and living at home 6 months after stroke.

Early supported discharge (ESD) services, especially when managed by a coordinated multidisciplinary team of nurses, therapists, and physicians, help reduce duration of hospital stays and improve outcomes related to quality of life in patients recovering from stroke, according to a Cochrane Review on the topic.

Historically, individuals who experience stroke receive a large percentage of their rehabilitation in the hospital. ESD services, which have been designed to offer hospital patients an earlier return home and rehabilitation in a more familiar environment, are usually provided by a multidisciplinary team. 

The objectives of this review were to determine whether, compared with conventional care, ESD services can accelerate patients' return home, offer equivalent or better patient and caregiver outcomes, prove to be satisfactory to both patients and caregivers, and provide justifiable implications for resource utilization.

 

A total of 17 trials that recruited 2422 participants and for which outcome data were currently available were selected for review. The analysis included randomized controlled trials in hospitalized patients with stroke who received either conventional care or any service intervention known to provide rehabilitation and support in a community setting, in order to reduce length of hospital stay. The primary outcome was the composite end point of death or long-term dependency, as reported at the end of the scheduled follow-up.

Patients in the ESD group vs the conventional care group demonstrated reductions in length of hospital stay equal to approximately 6 days (95% CI, –3to –8 days; P <.0001). Overall, the odds ratio (OR) for the outcome of death or dependency at the end of the follow-up period (median, 6 months) was 0.80 (95% CI, 0.67- 0.95; P =.01), which is the equivalent of 5 fewer adverse outcomes per 100 patients with ESD. Notably, no substantial adverse effects were observed in any patients.

In addition, economic analyses found that the overall savings from hospital stays tended to be greater or equal to the cost of ESD services.

 

The researchers concluded that based on moderate evidence, appropriately resourced ESD services coordinated with multidisciplinary team input can reduce hospital stay and disability in a select group of patients with stroke. The utilization of ESD services may also offer an opportunity to better control demand for hospital beds.

Reference

Langhorne P, Baylan S; Early Supported Discharge Trialists. Early supported discharge services for people with acute stroke. Cochrane Database Syst Rev. 2017;7:CD000443. 

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