Early discharge after stroke: A Belgian experience

In Belgium, the health care financing system puts a pressure to reduce as much as possible the length of stay in all the acute care hospitals. Unfortunately, this system is mainly based on diagnoses (All Patients Refined Diagnostic Related Groups) and does almost not take into account the functional ability of the patients. Consequently, the neurologists try to discharge their stroke patients as soon as possible. The neurologists working in the acute hospital have then to collaborate with other facilities, usually independent from their institutions. If the patient returns to home, collaboration with the community-based care is required. If the patient is unable to return to home, he will be discharged to rehabilitation facilities or to a nursing home. Since several years, our Physical Medicine and Rehabilitation department have developed a close collaboration with the Neurology departments for two purposes. For one hand, to provide an early rehabilitation after stroke when the patient stay in the stroke unit. On the other hand, to help the neurologist to discharge the stroke patients by organizing their inpatient or outpatient rehabilitation. To optimize this organisation, we are trying to develop a Clinical Pathway. During this round table, I will share our daily clinical practice experience in this field