Deans' stroke musings: Early Discharge Services Reduce Hospital Stay, Disability After Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, September 21, 2017

Early Discharge Services Reduce Hospital Stay, Disability After Stroke

To me this is only possible by cherry picking the survivors for the ESD program
http://www.neurologyadvisor.com/stroke/early-supported-discharge-services-for-stroke-reduce-hospital-stay-disability/article/690141/

Sheila Jacobs

September 21, 2017

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.