Background: Post stroke care can be complex and overwhelming for patients and their caregivers. As recommended by the American Stroke Association, discharge planning including appropriate referrals and stroke follow-up appointments can optimize the immediate recovery period for patients and their caregivers. The 2016 trend in our primary stroke center certified community hospital (with a 6 bed stroke unit) was lack of understanding regarding post stroke care and stroke clinic follow-up appointments. By increasing inpatient nursing focus on the key topics on the discharge instructions, our objective was to increase understanding of post stroke follow up planning.
Methods: Our approach for increased understanding of post stroke care included: the inpatient discharging nurse highlighting in yellow follow up appointments and referrals on the printed discharge instructions, and the placement of post-discharge phone calls by the stroke coordinator to patients discharged home. The stroke coordinator documented the level of understanding of follow up appointments, medications, and therapy needs defined by the patient and answered remaining questions.
Results: Pre-intervention (August - December 2016): 44% of 7-10 day post hospitalization calls resulted in concerns related to post stroke care. 31% of these concerns were related to lack of understanding of follow up appointments. Post-intervention (January - June 2017): only 19% of calls demonstrated post stroke care questions (56.8 % improvement). The lack of understanding of follow up appointments decreased to 25% (19.3% improvement). The 30 day stroke related readmission rate for the Medicare population has decreased in 2017 (1.9% compared to 3.6% in 2016), supporting an improvement in the understanding and implementation of post stroke care.
Conclusions: Inpatient nursing interventions can impact the patient and caregiver’s understanding of post stroke care needs. As the burden of this disease is felt beyond hospitalization, the increased focus on discharge planning/post stroke care should start in the acute phase of the stroke care continuum. Future work in this area may include more detailed discharge instructions to improve further patient understanding.