In recent years there has been increasing evidence to support rehabilitation of stroke patients. The early intervention of rehabilitation in stroke units has been shown to reduce death and disability for patients (Langhorne et al 2001). The evidence shows that rehabilitation of patients in the community after stroke improves ability in activities of daily living (ADL) and reduced odds of deterioration in ADL. (Outpatient stroke trailists 2004)
The NSF for long term conditions (2005) reports that community rehabilitation with a comprehensive multidisciplinary team centred on the patient home provides cost effective services to reintegrate people into their communities. The increase in independence reduces the cost of long term care and the overall improvement in well being reduced the burden on carers and reliance on services.
Key features of community rehabilitation
Common features present in all the community teams reported in the evidence are:
- They provide an enabling service where the patient is involved in goal setting.
- The rehabilitation is delivered in the patient’s home.
- Equipment and care needs are assessed and responded to by close working with social services.
- There is a single patient held record.
- The rehabilitation is interdisciplinary in philosophy.
- Regular meetings and communication between all stakeholders.
- Training of the team in all aspects of stroke care.
- Autonomy and control of resources.
(CSP 2002, Friend 1997, Shield 1998, NAO 2005)
North Cumbria Pilot
The aim of the pilot was to evaluate the impact of discharging patients from hospital beds into community rehabilitation earlier than was currently possible. These can be either acute hospital beds and/or community hospital beds.
Patients would receive multidisciplinary rehabilitation in their own homes of an intensity of that delivered in hospital. Criteria for access into the team were adopted from the literature and meant that patients living alone needed to be able to transfer independently or if they lived with someone they could transfer with one person. In order to generate sufficient numbers of patients to be able to assess the impact, Carlisle intermediate care team footprint was chosen as the designated area for the pilot.
The pilot also required the skills of existing staff appropriate for stroke management in the community. This pilot was largely a redesign of service with only a small amount of development money to enhance existing resources.
Close working processes were adopted between the identified community team and the acute trust stroke services. Adult Social Care Directorate staff were involved in these processes to enable timely and appropriate care services to be delivered. Intermediate care support staff were used to support the patient at home on discharge.
Evaluation of the pilot was based on patient clinical outcomes using standardised outcome tools already used in the acute setting, length of stay in hospital and the amount of care input required at the end of the rehabilitation episode. Patient satisfaction will also be monitored.
Results achieved in the first 3 months
Nineteen patients had been admitted onto the scheme. Approximately 2 patients per week are being referred. Referrals were being received mainly from Elm A and C at Cumberland infirmary but 3 referrals had been received from others sources.
Four patients have completed their rehab and been discharged. All clinical/functional goals set by the team are being achieved by patients. Input varies from one visit per week to intensive rehab with 4 calls daily from the team.
Bed days saved are estimated as 14 per person, a total of 266 days. This results in 4 people not in hospital at any one time who would have been previously.
Full analysis will be completed when the pilot ends at the end of March 2007 including patient satisfaction.