Promotion of community reintegration through clinical pathway for hemorrhagic stroke patients

Abstract Description

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Authors (including presenting author) :

Chan YF(1),Poon CY(1),Cheng BW(1),Man HK(1),Leung WM(1),Fook SM(1),Lau KK(2),Choy PC(3),Cheng TH(4),Au LF(5),Chu YC(6),Chan TM(7),Poon WS(7)

Affiliation :

(1)Department of Surgery,Shatin Hospital,(2)Department of Physiotherapy, Shatin Hospital,(3)Department of Occupational Therapy, (4)Department of Speech Therapy,(5) Department of Dietetics,(6)MSSU, Shatin Hospital,(7) Department of Neurosurgery, Prince of Wales Hospital

Introduction :

In NTEC cluster Shatin Hospital Surgical Department provides multidisciplinary rehabilitation program for moderate and severe hemorrhagic stroke patients. The recovery process depends on individual severity and some patients take time to overcome the deficits and social issues. The average length of stay is 93days. Surgical rehabilitation team formulated an integrated clinical pathway for hemorrhagic stroke to promote early discharge to community in 1Q 2018. A Pilot trial was implemented from May 2018 to December 2018.

Objectives :

A clinical pathway for hemorrhagic stroke patients was designed to facilitate early community reintegration.

Methodology :

The surgical rehabilitation team divided the pathway into four phases including assessment day, rehabilitation phase, pre-discharge phase and discharge phase. The pathway was implemented under the collaboration of doctors, nurses, physiotherapists, occupational therapists, speech therapists, dietitians and medical social workers. Regular rehabilitation round, family meeting and weekly review were executed to accomplish the targets. The outcome measure and length of stay were evaluated.

Result & Outcome :

The pathway had a beneficial effect on the length of stay. A total of 20 patients were recruited in the trial period. 7 were female and 13 were male. 12 of them received neurosurgical operation and 8 did not. The age ranged from 30 to 91. The mean age was 59.6. 80% of the patients showed improvement in mobility. The rest 20% of the patients remained hospitalization because of tracheostomy. The length of stay ranged from 20 days to 115 days the mean was 38 days. This was significantly reduced when comparing with the similar group before the program, which the average length of stay was 55 days. The newly introduced care pathway exhibited significant length of stay reduction. This may be reflected by closer monitoring of the progress and more frequent update and review on the care plan, early intervention on the preparation of community integration by the whole team.