Skip to main content

Research Repository

Advanced Search

Effect of stroke early supported discharge on length of hospital stay: analysis from a national stroke registry

Fisher, Rebecca J.; Byrne, Adrian; Chouliara, Niki; Lewis, Sarah; Paley, Lizz; Hoffman, Alex; Rudd, Anthony; Robinson, Thompson; Langhorne, Peter; Walker, Marion


Rebecca J. Fisher

Adrian Byrne

Lizz Paley

Alex Hoffman

Anthony Rudd

Thompson Robinson

Peter Langhorne

Marion Walker


Objective: The first observational study to investigate the impact of early supported discharge (ESD) on length of hospital stay in real-world conditions.

Design: Using historical prospective Sentinel Stroke National Audit Programme (SSNAP) data (1 January 2013–31 December 2016) and multilevel modelling, cross-sectional (2015–2016; 30 791 patients nested within 55 hospitals) and repeated cross-sectional (2013–2014 vs 2015–2016; 49 266 patients nested within 41 hospitals) analyses were undertaken.

Setting: Hospitals were sampled across a large geographical area of England covering the West and East Midlands, the East of England and the North of England.

Participants: Stroke patients whose data were entered into the SSNAP database by hospital teams.

Interventions: Receiving ESD along the patient care pathway.

Primary and secondary outcome measures: Length of hospital stay.

Results: When adjusted for important case-mix variables, patients who received ESD on their stroke care pathway spent longer in hospital, compared with those who did not receive ESD. The percentage increase was 15.8% (95% CI 12.3% to 19.4%) for the 2015–2016 cross-sectional analysis and 18.8% (95% CI 13.9% to 24.0%) for the 2013–2014 versus 2015–2016 repeated cross-sectional analysis. On average, the increased length of hospital stay was approximately 1 day.

Conclusions: This study has shown that by comparing ESD and non-ESD patient groups matched for important patient characteristics, receiving ESD resulted in a 1-day increase in length of hospital stay. The large reduction in length of hospital stay overall, since original trials were conducted, may explain why a reduction was not observed. The longer term benefits of accessing ESD need to be investigated further.

Trial registration number:


Fisher, R. J., Byrne, A., Chouliara, N., Lewis, S., Paley, L., Hoffman, A., …Walker, M. (2021). Effect of stroke early supported discharge on length of hospital stay: analysis from a national stroke registry. BMJ Open, 11(1), Article e043480.

Journal Article Type Article
Acceptance Date Dec 31, 2020
Online Publication Date Jan 20, 2021
Publication Date 2021-01
Deposit Date Jan 18, 2021
Publicly Available Date Jan 20, 2021
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 11
Issue 1
Article Number e043480
Keywords General Medicine
Public URL
Publisher URL