Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
FUNG HO(1), Clancey JCT(1), LUI NFJ(1)
Affiliation :
(1) Department of Occupational Therapy, Queen Elizabeth Hospital
Introduction :
Early Supported Discharge Program (ESD) program in acute stroke unit started in 2012 which aims at facilitating early safe discharge after stroke attack. Occupational therapists will arrange early home visit, home-based training and out-patient rehabilitation according to patients’ need. With the application of tele-training supported by HAGO platform, the patient journey becomes more comprehensive by providing rehabilitation opportunities for those who cannot access hospital-based training. Occupational therapists target to assist stroke patients to participate in daily activities as much as possible, in hope that they can return to normal living and reintegrate to the community promptly.
Objectives :
The aim of the study is to review the effectiveness of the ESD program in the functional outcome and facilitating stroke patients in home and community re-settlement.
Methodology :
This was a retrospective study performed between 2021 to 2023. Those referred to ESD were conveniently sampled. Patient’s demographic data, functional status, Home Discharge Readiness Scale (HDRS), Home Settlement Scale (HSS) and Reintegration of Normal Living Index (RNLI) were collected. T-test was used to compare the differences of the Modified Barthel Index (MBI) before and after discharge, Home discharge and settlement scales, and RNLI for pre and post ESD program.
Result & Outcome :
Results
136 cases were recruited within the period. The mean age was 77 years, and 54.8% are women.
The mean difference in MBI upon and after discharge was statistically significant (p<0.05). Patients who were settled at home showed significant differences between the HDRS and HSS (p<0.05), with an increase from 30% to 70% in achieving ‘High’ competency of home settlement. There was also an upward shift from ‘Moderate’ level to ‘High’ level for all three factors for home readiness and settlement, which included the competency and attitude of patient’s or carer’s and home environment safety. Home safety assessment (97%), home-based training (84%), ADL training (45%), functional balance training (49%) and home modifications (39%) are the most provided services in the ESD program. Significant difference was found in pre and post ESD program RNLI (p=0.008) scores, suggesting effective re-integration to community, both in daily functions and perception of self.
Conclusion
The ESD program is an effective service that promotes patients to be directly discharged early from acute stroke unit. Occupational therapists ensure that patients can be settled at home according to their psycho-social-environmental factors. There are post discharge improvements in the ADL and functional performances. Patients are satisfied with returning home safely and are capable to re-integrate into the community smoothly. Further study to evaluate which domains may hinder community re-integration will help better identify future interventions for post stroke patients who are directly discharged home.
