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

Tyson, S; Turner, G

Abstract

Objective: To assess the quality of the process of discharge from hospital
and 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 the
service.
Setting: All units treating stroke patients in a health care district including an
acute and a community NHS trust, and 23 participating GP practices.
Subjects: Process audit: documented notes of 98 stroke patients admitted
and discharged over a four-month period. Patient satisfaction survey: 93
surviving stroke patients. Staff opinion survey: general practitioners, hospital
doctors, therapists and nurses treating stroke patients throughout the district.
Results: A poor level of service was found. The main shortcomings were
poor communication and liaison and a narrow focus of rehabilitation which
concentrated on the assessment and provision of basic home care and
activities of daily living (ADL) required to obtain discharge. There was a
paucity of provision beyond this most basic level and little follow-up after
discharge. Pass rates against agreed criteria were: communication between
staff and patients/carers 47%, liaison between staff 44%, assessment of
home-based needs 48%, assessment of domestic skills 15.5%. Fifty-one per
cent of patients were referred for follow-up therapy and of these 72% started
follow-up therapy within six weeks of discharge, only 27% had any follow-up
assessment of activity levels and well-being. Patients were dissatisfied with
the information, support services and therapy they received. The main
reasons for the shortcomings were lack of awareness of the services
provided, professionals’ low expectations of patients’ abilities, and limitations
of community-based therapy services.
Conclusions: Evidence from other publications suggests that these results do
not indicate a service that is any worse than other districts, rather it
represents the poor deal offered to stroke patients. By comprehensively
assessing several aspects of the service together this methodology has been
able to reveal these inadequacies and the reasons for them.

Citation

what happens and why. Clinical Rehabilitation, 14, 381-392. https://doi.org/10.1191/0269215500cr331oa

• Journal Article Type: Article
• Publication Date: Jan 1, 2000
• Deposit Date: Mar 23, 2010
• Journal: Clinical Rehabilitation
• Print ISSN: 0269-2155
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Pages: 381-392
• DOI: https://doi.org/10.1191/0269215500cr331oa
• Publisher URL: http://dx.doi.org/10.1191/0269215500cr331oa