26th July 2019, Volume 132 Number 1499

Stephanie Thompson, Annemarei Ranta, Karen Porter, Naomi Bondi

Stroke affects approximately 9,000 New Zealanders annually1 and in 2016/2017 there was a prevalence of 1.5% or approximately 57,000 adults.2 Stroke is the leading cause of long-term disability in the…

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Summary

New Zealand community stroke rehabilitation guidelines identify how often and how soon after hospital discharge community rehabilitation should start. This service audit looked at how quickly after hospital discharge patients with stroke were seen by a Wellington-based community rehabilitation team, and how much rehabilitation they received in the first four weeks and three months after discharge. We compared this to the guidelines and have made suggestions to improve the service.

Abstract

Aim

Stroke rehabilitation often needs to continue following discharge from hospital. The New Zealand Stroke Network recommends community team review within seven calendar days of discharge and a minimum of three hours of therapy per specialty per week. International stroke guidelines make similar recommendations. The Wellington Community Older Adults, Rehabilitation and Allied Health team aimed to determine current local community stroke rehabilitation practice and compare this to guideline recommendations.

Method

A prospective cohort of 50 patients with a new diagnosis of stroke, referred to a community rehabilitation team in Wellington, were included in this service audit. The amount of rehabilitation patients received in the first four weeks and first three months following hospital discharge was measured, as well as time to first appointment. In addition, a service satisfaction questionnaire was sent to the patients.

Results

The median (interquartile range, IQR) number of days from hospital discharge until first appointment with the community team was 10 (6.3–14.8) calendar days. In the first four weeks after hospital discharge, patients received from all health professionals an average (SD) of 1.1(0.4) rehabilitation sessions and 34.2 (43.6) minutes of rehabilitation per week. The average (SD) in the first three months or to point of discharge, whichever occurred first was 1.1 (1.1) sessions and 42.2 (49.3) minutes of rehabilitation per week.

Conclusion

There were delays in providing an initial community rehabilitation appointment and insufficient therapy intensity when comparing audit results to New Zealand Guideline expectations. As a result of this audit, recommendations for service improvements have been made.

Author Information

Stephanie Thompson, Study Coordinator, Clinical Trials Unit, Capital and Coast District Health Board, Wellington; Annemarei Ranta, Associate Professor and Head of Department, Department of Medicine, University of Otago, Wellington; Consultant Neurologist, Department of Neurology, Wellington Hospital, Wellington; Karen Porter, Physiotherapist, Wellington Community Team, Older Adults, Rehabilitation and Allied Health Service, Capital and Coast District Health Board, Wellington;
Naomi Bondi, Speech and Language Therapist, Wellington Community Team, Older Adults, Rehabilitation and Allied Health Service, Capital and Coast District Health Board, Wellington.

Correspondence

Stephanie Thompson, Clinical Trials Unit, Capital and Coast District Health Board, Level 8 WSB, Wellington Regional Hospital, Private Bag 7902, Wellington 6242.

Correspondence Email

stephanie.thompson@ccdhb.org.nz

Competing Interests

Nil.

References

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