With increased pressure to discharge stroke patients early from hospital community supports are now more essential than ever

It is vital that Early Supported Discharge (ESD) and community stroke services are maintained to prevent inappropriate readmissions to hospital and aid the recovery of people who have had a stroke during the coronavirus pandemic, a leading group of clinical experts in stroke from Ireland and the UK has said.

Early Supported Discharge or ESD, allows patients who have had a stroke to be discharged early from hospital once they are medically fit. They then continue their rehabilitation in their own homes, under the care of specialist therapists in the community.

A recent joint statement by the National Clinical Directors for Stroke in Ireland, Northern Ireland, England, Scotland and Wales as well as representatives of the ESD Programme, warned that stroke was a leading cause of death and disability in the UK and Ireland and that the incidence of stroke would occur at the same or even greater rate during the COVID-19 outbreak.

According to the statement, an increase in stroke presentations will lead to increased pressure to facilitate early discharge of stroke survivors from hospital.

However, it warned, that the benefit of early, safe discharge brings “a risk of unmet rehabilitation needs and potential for longer term disability and dependence.”

The UK/Ireland Statement on ESD in stroke during the Covid-19 pandemic said it was therefore “essential” that community stroke services were maintained.

As the protection of staff and stroke from covid-19 is a priority, the statement added that only patients with urgent needs or/and at high risk should be visited face-to-face by community stroke teams, in line with local infection control and Personal Protection Equipment guidance.

It recommended that during the COVID-19 pandemic ESD and community stroke services are encouraged to adopt a tele-rehabilitation approach (via video or telephone support) and while research was still on going regarding the benefits of tele-rehabilitation, it is currently the best alternative to face-to-face therapy.

Commenting Chris Macey, Head of Advocacy at the Irish Heart Foundation, said ESD services provided rehabilitation that is vital to enabling large numbers of patients make the best recovery possible after stroke.

“The consequences of losing them for the duration of the Covid-19 emergency would be dire both in terms of prolonged and severe disability for individual stroke survivors and the impact that resulting readmissions would have on overstretched hospital services,” he said.

“This could also be exacerbated by the sharp fall in stroke presentations fuelled by Covid fears that has been experienced in hospitals nationwide and the likelihood that the pandemic will result in an increase in the overall stroke rate.”

Therefore, we are urging the HSE to urgently prioritise ESD programmes and provide whatever resources are needed to deliver effective services through tele-rehabilitation and other appropriate approaches,” Mr Macey added.

The joint UK/Ireland statement also said that partnerships with the voluntary sector and online support services for stroke survivors were recommended to maximise on-going support.

According to the statement, “There will be developments and innovations over this period, which if implemented and evaluated well, could survive ‘post COVID’ and enrich the rehabilitation environment that we provide for our stroke survivors.”

One such innovation is a new telephone support service for stroke patients who have recently been discharged from hospital, which has been launched by the Irish Heart Foundation in conjunction with the HSE National Stroke Programme.

The phone service involves trained and experienced Irish Heart Foundation staff and volunteers making regular calls to stroke survivors who have been referred by acute hospital stroke teams to check on their health and wellbeing. They will also provide information and advice about recovery from stroke and ensure that patients’ practical needs are being met enabling stroke survivors to stay safe.

We are here for you

The Irish Heart Foundation’s nurse support line is available five days a week. Anyone living with heart disease and stroke who has concerns or questions about the coronavirus can contact the nurse support line on 01 668 5001 or support@irishheart.ie.

The Irish Heart Foundation’s new heart support group is on Facebook. Anyone who lives with heart failure or another heart condition or has a family member living with a heart condition can join here: www.facebook.com/groups/heartsupportnetwork/

The Irish Heart Foundation runs 21 stroke support groups and 5 heart failure groups around the country. All these groups have moved to telephone and online support. For more information, see https://irishheart.ie/get-support/.