5.4 Early supported discharge

There is an increasing trend to reduce the length of time that patients spend in hospital. Several countries discharge stroke survivors from hospital within 1-2 weeks (e.g. Austria, Bulgaria, Estonia, Slovakia[9]). However, rehabilitation in the community is limited in many countries and people may be discharged without follow up support.

Some countries have developed care pathways where mild to moderately affected stroke survivors are discharged when medically stable, and continue to get rehabilitation at home at a similar intensity to support on a rehabilitation unit (‘early supported discharge’).

One third of patients are typically eligible for early supported discharge[316]. When these early supported discharge services are well organised, patients can return home earlier and are more likely to regain independence in daily activities[316], and there is evidence of its cost-effectiveness compared with care on the general medical ward or on a stroke unit (without early supported discharge)[317].

In a few countries, early supported discharge is well established, if locally variable, and is included in national guidelines i.e. Sweden, with an average length of stay of 12 days[318], and the UK[319, 320]. In England, Wales and Northern Ireland, 81% of hospitals have a stroke skilled early supported discharge team and 35% of patients are treated by one of these teams[294, 321].

In most European countries, including in other high-income countries, early supported discharge has not been well developed. In around half of EU countries for which we have data it is non-existent or not nationally developed i.e. there have been local trials or pathways but not widespread implementation (Appendix 1, Table 4).