Quality standard

Quality statement 4: Early supported discharge

Quality statement 4: Early supported discharge

Quality statement

Adults who have had a stroke are offered early supported discharge if the core multidisciplinary stroke team assess that it is suitable for them. [new 2016]

Rationale

Early supported discharge is an intervention for adults after a stroke that allows their care to be transferred from an inpatient environment to a community setting. It enables people to continue their rehabilitation therapy at home, with the same intensity and expertise that they would receive in hospital. This may not be suitable for all adults with stroke or in all circumstances. The decision to offer early supported discharge is made by the core multidisciplinary stroke team after discussion with the person and their family or carer if applicable.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults who have had a stroke are offered early supported discharge if the core multidisciplinary stroke team assess that it is suitable for them.

Data source: Data can be collected from information recorded locally by healthcare provider organisations, for example, from clinical or service protocols.

Process

a) Proportion of adults who have had a stroke and are assessed as suitable for early supported discharge by the core multidisciplinary stroke team who receive it.

Numerator – the number in the denominator who receive early supported discharge.

Denominator – the number of adults who have had a stroke and are assessed as suitable for early supported discharge by the core multidisciplinary stroke team.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

b) Proportion of adults who have had stroke who are treated by an early supported discharge team.

Numerator – the number in the denominator who are treated by an early supported discharge team.

Denominator – the number of adults who have had a stroke.

Data source: National data is collected using the Sentinel Stroke National Audit Programme (SSNAP) clinical audit, which reports the percentage of patients treated by a stroke-skilled early supported discharge team.

Outcome

a) Length of hospital stay for adults who have had a stroke.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. NHS England's Hospital Admitted Patient Care Activity includes average length of stay by primary diagnosis.

b) Quality of life for adults who have had a stroke.

Data source: Data can be collected from information collected locally by healthcare professionals and provider organisations, for example, from patient surveys.

What the quality statement means for different audiences

Service providers (such as secondary care providers) ensure that systems are in place to offer early supported discharge to adults who have had a stroke if it is assessed to be suitable for them by the core multidisciplinary stroke team.

Health and social care practitioners in the core multidisciplinary stroke team are aware of discharge pathways and offer early supported discharge to adults who have had a stroke if it is suitable for them.

Commissioners ensure that they commission services that can provide early supported discharge services for adults who have had a stroke if it is assessed to be suitable for them by the core multidisciplinary stroke team.

Adults who have had a stroke are offered 'early supported discharge' if their stroke team decides that it is suitable for them. This means that they are supported to go home from hospital as early as possible and have the same rehabilitation care at home. This is only offered if the person is well enough and it can be done safely.

Source guidance

Stroke rehabilitation in adults. NICE guideline NG236 (2023), recommendation 1.1.9

Definitions of terms used in this quality statement

Early supported discharge

An intervention for people who have had a stroke that allows care to be transferred from an inpatient environment to a community setting to continue rehabilitation. The intensity of care and the expertise of those providing it is maintained. [Adapted from NICE's guideline on stroke rehabilitation in adults]

Suitable for early supported discharge

The core multidisciplinary stroke team will assess whether early supported discharge is suitable for adults who have had a stroke. The assessment takes into account the person's functional, cognitive and social circumstances. This may include, for example, the person's ability to move from bed to chair independently or with assistance, and whether a safe and secure environment can be provided at home. [Adapted from NICE's guideline on stroke rehabilitation in adults, recommendation 1.1.9, and expert consensus]

The core multidisciplinary stroke team

The team should comprise the following professionals with expertise in stroke rehabilitation:

  • consultant physicians specialising in stroke, or rehabilitation medicine

  • nurses

  • physiotherapists

  • occupational therapists

  • speech and language therapists

  • dietitians

  • clinical psychologists or clinical neuropsychologists

  • orthoptists

  • rehabilitation assistants

  • social workers.

[NICE's guideline on stroke rehabilitation in adults, recommendation 1.1.3]

Equality and diversity considerations

Early supported discharge is only suitable in a safe and secure environment. Therefore, it may not be suitable for some people because of their living arrangements, for example, if they are homeless, recent refugees, asylum seekers or migrant workers. It may not be suitable for people with significant cognitive and functional impairments.