Discharge and follow-up for people with stroke:what happens and why

Objective: To assess the quality of the process of discharge from hospitaland follow-up services for people with stroke.Design: A criterion-based process audit and basic outcome measures,combined with surveys of patients’ satisfaction and staff opinion of theservice.Setting: All units treating stroke patients in a health care district including anacute and a community NHS trust, and 23 participating GP practices.Subjects: Process audit: documented notes of 98 stroke patients admittedand discharged over a four-month period. Patient satisfaction survey: 93surviving stroke patients. Staff opinion survey: general practitioners, hospitaldoctors, therapists and nurses treating stroke patients throughout the district.Results: A poor level of service was found. The main shortcomings werepoor communication and liaison and a narrow focus of rehabilitation whichconcentrated on the assessment and provision of basic home care andactivities of daily living (ADL) required to obtain discharge. There was apaucity of provision beyond this most basic level and little follow-up afterdischarge. Pass rates against agreed criteria were: communication betweenstaff and patients/carers 47%, liaison between staff 44%, assessment ofhome-based needs 48%, assessment of domestic skills 15.5%. Fifty-one percent of patients were referred for follow-up therapy and of these 72% startedfollow-up therapy within six weeks of discharge, only 27% had any follow-upassessment of activity levels and well-being. Patients were dissatisfied withthe information, support services and therapy they received. The mainreasons for the shortcomings were lack of awareness of the servicesprovided, professionals’ low expectations of patients’ abilities, and limitationsof community-based therapy services.Conclusions: Evidence from other publications suggests that these results donot indicate a service that is any worse than other districts, rather itrepresents the poor deal offered to stroke patients. By comprehensivelyassessing several aspects of the service together this methodology has beenable to reveal these inadequacies and the reasons for them