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

Abstract

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: http://www.isrctn.com/ISRCTN15568163.

Citation

Fisher, R. J., Byrne, A., Chouliara, N., Lewis, S., Paley, L., Hoffman, A., Rudd, A., Robinson, T., Langhorne, P., & 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. https://doi.org/10.1136/bmjopen-2020-043480

• 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
• DOI: https://doi.org/10.1136/bmjopen-2020-043480
• Keywords: General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/5242715
• Publisher URL: https://bmjopen.bmj.com/content/11/1/e043480