288 EARLY SUPPORTED DISCHARGE AFTER STROKE IN THE COVID-19 PANDEMIC: A CONTAGIOUS SERVICE-DELIVERY MODEL

Abstract

Abstract Background Early Supported Discharge (ESD) after stroke is an internationally recognised model of best practice for patients with mild to moderate functional deficits after stroke. By end of 2021 there were nine stroke-specific ESD teams in operation in Ireland. This paper outlines the analysis of annual reports submitted by each site to the National Stroke Programme. Methods We completed data analysis of the 2020 and 2021 clinical activity of ESD teams, the functional outcomes achieved using the Functional Independence Measure/Functional Assessment Measure (FIM/FAM), and qualitative reporting from patients. Teams were also asked to report on team composition and service developments. Results Team composition and size varied, but all had some combination of Occupational Therapy, Physiotherapy, and Speech and Language Therapy. 764 patients received ESD after acute stroke in 2021, representing 24.7% of all patients discharged with stroke in participating sites. Activity increased by 39.9% from 2020 (n = 546), which was in turn an increase of 48% on the 2019 figure (n = 370). Although new sites were added in each year, the increased capacity alone does not account for the growth. All sites reported patient improvement on the extended FIM/FAM. Patient feedback was positive, with many reporting particularly on the benefits of receiving intervention in the home at a time when hospital visiting was restricted. Many sites also reported introducing telehealth to support delivery of ESD. Conclusion ESD after stroke continues to grow at pace in Ireland, proving resilient to the pressures of operating in a pandemic. It remains a highly acceptable model to patients, and growth during the pandemic may have been supported by increased capacity, new ways of working, and patients' desire for earlier discharge. Although all teams reported functional improvement among their patients, some sites are achieving greater gains, suggesting that further research into patient selection, treatment intensity and further embedding of telehealth is warranted.