Enhanced Early Supported Discharge for Stroke in Camden (EESD)

This is an interventional treatment trial for Stroke. Read More

Inclusion Criteria:

Only those with capacity to consent will be admitted into the study.

• • Patient must be registered with a Camden GP to be offered Enhanced ESD. Must be registered with a Camden or Islington GP for the collection and analysis of routine data.

  • Patient must be over eighteen years old
  • Patient has a confirmed diagnosis of stroke from a Stroke Consultant
  • Patient consent provided (assistance given from speech and language therapists where stroke survivor has significant language and communication impairment);
  • Patient is medically stable and fit to be managed at home as assessed by Acute Stroke Consultant as part of the MDT. This includes the utilisation of measures such as NHISS score and GCS to determine the medical status of a patient.

The criteria to make this decision is defined in the Community Care (Delayed Discharges) Act, 2003 as: A clinical decision has been made that the patient is ready for transfer AND a multi-disciplinary team (MDT) decision has been made that the patient is ready for transfer AND the patient is safe to discharge/transfer.

• Patient is intending to return home or to supported accommodation following hospital stay (in line with current ESD guidance;)
• Patient is safe to transfer home with provision of equipment (e.g. Hospital bed, chair, telecare devices etc.) and a care package if required. This means at least the following is conducted prior to discharge where it is appropriate - home visit risk assessment, manual handling risk assessment, cognitive assessment (e.g. mental capacity assessment form (to be provided with referral) and own safety awareness);
• Patient has active nursing / therapy goals and has potential to participate and respond to a rehabilitation / disability management programme;
• Toileting needs can be managed within available care, support and/or equipment (commode, pads and bottle) either at the point of discharge home or within ≤ 2 weeks of returning home;
• Patient is able to transfer with assistance of 2 people and/or equipment;
• Patient's dysphagia, nutrition and hydration can be safely managed in the community, as assessed by stroke consultant and/or medical team responsible for individual's hospital care, ward nursing staff, Enhanced ESD nurses, the referring and receiving SLTs and dietitians. Risk of malnutrition assessed by MDT using standardised nutritional screening tool (eg MUST).

Exclusion Criteria:

• Patient has failed a Mental Capacity Act Assessment (2005) and is deemed not to have capacity to consent to participation in the study.
• Patient is not medically fit to be managed at home (any of medical exclusion criteria - see Appendix 2);
• Patient is not able to engage with or respond to a rehabilitation programme, for example, where a significant cognitive impairment / behavioural problem limits their ability to effectively engage in rehabilitation;
• Patient is not safe to be transferred home despite provision of equipment and a care package
• Patient requires help of more than 2 person to transfer, and/or does not have sufficient space within their home to safely accommodate equipment (such as a hoist) required for a safe discharge
• Clients requiring constant supervision over 24 hours which is anticipated not to resolve within seven days. The need for supervision may be secondary to impaired concentration/attention/safety awareness/impulsivity/visual impairment/reduced insight/severe aphasia/need for prompts and hands on assistance to maintain safety when standing, transferring and washing etc.
• Clients whose prognosis for functional improvement is poor and who do not have functional goals that can be achieved within 8 weeks.
• Not able to manage medications with carers dispensing from blister pack and prompting client to take medications.
• Patients whose normal place of residence is a Nursing or Residential home. This cohort of patients are likely to have ongoing long term issues whose needs are best met via the community pathway for long term rehabilitation needs.
• Patients who have a NasoGastric tube in situ and therefore do not have established nutrition. Those who have long term PEGs will not be excluded as their nutritional needs can be met non-orally.