Deans' stroke musings: Effect of an Interdisciplinary Stroke Consult Service on the Transition to Post-Acute Rehabilitation

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.

Monday, March 28, 2022

Effect of an Interdisciplinary Stroke Consult Service on the Transition to Post-Acute Rehabilitation

I considered the weekly consults with the doctor and therapists to be totally worthless. NOTHING SPECIFIC to get me recovered was ever discussed.

https://doi.org/10.1016/j.apmr.2022.03.005 Get rights and content

Abstract

Objective

To evaluate the effect of a Physiatry-led Stroke Consult Service on access and time to intensive post-acute rehabilitation.

Design

Prospective observational study

Setting

Urban Joint Commission Comprehensive Stroke Center.

Participants

Adult (> 18 years) acute stroke hospital discharges between 1/1/2018-12/31/2020 (n=1190).

Interventions

Weekday Huddle Rounds were interdisciplinary, which created a pathway to ensure stroke patients received comprehensive rehabilitation care followed by a Virtual Rounding Tool, allowing clinicians to evaluate plan of care facilitation using the Electronic Medical Record.

Main Outcome Measures

Proportion of acute stroke discharges to either home, inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) and onset days to IRF transfer.

Results

During the three-year study period, sociodemographic characteristics, stroke severity at admission and mortality rates did not change significantly.

Acute stroke patient discharges to IRFs increased 5.9%, from 24.2% in 2018 to 30.1% in 2020. 11% of patients were discharged to SNF in 2018, compared to 8.7% in 2020. Proportion of acute stroke patients discharged to home decreased 4.9%, from 49.6% in 2018 to 44.7% (P=0.0325). For ischemic stroke patients, the average onset days to IRF transfer decreased 7.5% between 2018 and 2020, from 8 days to 7.4 days. For hemorrhagic stroke patients, the average onset days decreased 17.5%, from 12 days in 2018 to 9.9 days in 2020. The decrease in onset days were not statistically significant for either stroke type (P=0.3794).

Conclusions

Implementation of Huddle Rounds and a Virtual Rounding Tool by a Physiatry-led Stroke Consult Service significantly increased referrals to IRFs, with a concomitant decrease in referrals to SNFs or directly home. Next steps include validating model efficacy, with the goal of implementation at stroke centers in the United States.(So you didn't measure 100% recovery at all? THE ONLY GOAL IN STROKE!)