ESD Report 2019

Question 1

What are the 4 aims of ESD?

Answer 1

1. Reduce overall hospital bed days
2. Improve patient outcomes
3. Deliver rehab closer to patient’s home
4. Improve the quality of stroke rehab

Question 2

Why is ESD so important in the coming years?

Answer 2

The Scottish Stroke Care Audit is going to start auditing the intensity of in-patient and community therapy delivered. We need to look at the at our current delivery of services and design new services in order to satisfy the demand for improved patient flow through the stroke pathway and improve the overall intensity of our therapy input.

e.g. Pt experience: Patricia Branch - early d/c due to covid but she proved that she can be provided the same quality of rehab in the community as in hospital. Had a severe PACS with RSW of both UL>LL. Stayed until her walking was improving and she was able to self-manage this but was still only achieving small gains on her right arm. Her long term-goal was to get back to work and achieve her ADLs independently. After 5 months she was able to return to work and was achieving ADLS independently.

Question 3

What were the findings of the Fearon et al (2012) systematic review that compared ESD stroke services against conventional services?

Answer 3

It concluded that ESD stroke services significantly reduced hospital bed days by an average of 7 days and that those discharged with an ESD service were more likely to be independently living at home 6 months post stroke compared to those receiving conventional care.

Question 4

In the ESD Audit where were the majority of patients suitable for ESD identified?

Answer 4

The majority of patients were from the acute stroke ward and RVH stroke rehab.

Question 5

Which disciplines were required for the patients identified?

Answer 5

All of the patients required OT, the majority required PT and half required SLT.

Question 6

What were the bed days saved results in the ESD Audit?

Answer 6

Bed days were saved for all patients in the audit but the biggest savings were from the rehab units due to their increased complexity. Those that required ESD from the acute stroke ward had milder strokes.

Question 7

What role would MDT discussions play in an ESD service?

Answer 7

There is a need for increased and regular MDT discussions once a service is set up in order to:

• clinically reason patient goals and predicted outcomes
• establish the patient’s wishes around the delivery of rehab

Question 8

What would the purpose be in starting a pilot model of an ESD neuro service that could be accommodated with current staffing levels? (6)

Answer 8

1. Test a selection criteria
2. Trial new documentation
3. Record patient outcomes
4. Collect patient and carer feedback
5. Identify any equipment needs
6. Establish MDT working patterns

Question 9

What longer term needs would need discussed? (3)

Answer 9

1. The need for SLT presence in the service
2. The need for rehab assistants (but not necessarily specialised towards either PT/OT)
3. Pooling OT and PT resources e.g. UL class