‘Better stroke services would save millions’

If half of stroke patients were released from hospital earlier with greater support in the community, millions of euro could be saved annually as there would be up to 24,000 less overnight stays.

Up to 3,000 stroke patients, with mild or moderate disability, could benefit from an early supported discharge (ESD) programme, according to research from the Economic and Social Research Institute and the Royal College of Surgeons.

But such a project would require a substantial increase in physiotherapists, occupational therapists, and speech and language therapists and community nurses.

According to the Irish Heart Foundation, which commissioned the study, stroke services have transformed in recent years but community services remain enormously under resourced and need major investment.

The authors of ‘Towards Earlier Discharge, Better Outcomes, Lower Cost: Stroke Rehabilitation in Ireland’ argue that this investment of €5m-€10m can be justified by the Department of Health as the expenditure would be offset by having fewer stroke patients in hospital beds overnight which would save up to €12m. The research also found regional differences in the levels of community and inpatients rehabilitation services in place around the country.

Lead author of the report, Dr Maev-Ann Wren said supported early discharge in the community is “best international practice” but not generally available in this country.

“Translating acute care savings into community care resourcing requires shifting the balance from over-reliance on hospitals to greater delivery of care in thecommunity. Allocation of resources to community care should prioritise those areas which are relatively under-resourced,” she said.

The study, which was commissioned and funded by the IHF and the HSE, analysed best practice pathways of stroke rehabilitation; comparing costs, outcomes and cost-effectiveness implications of actual and best practice pathways of rehabilitation in Ireland.

IHF chief executive, Barry Dempsey said there has been a 13% reduction in relative mortality from strokes and a 28% reduction in the numbers being discharged to nursing homes in the past three years.

“But community services have remained as bad as ever, with appalling quality of life consequences for discharged stroke patients. Stroke survivors currently face chronic service deficits with one in three having no access to physiotherapy and half can’t get speech and language therapy or occupational therapy.

“Just 11% have access to psychological services despite the often severe mental health impact of stroke and 36% pay privately for rehabilitation,” he said.

There are up to 50,000 stroke survivors in Ireland. The research found sharp variations between the length of hospital stay, availability of nursing home places, and the intensity of therapy delivered in different locations.

“This research proves again that it is far more expensive to provide bad stroke services than services that maximise good outcomes,” said Mr Dempsey.