“The team understand how important it is for patients to be able to leave hospital, return to the comfort of their home, while still receiving regular tailored care,” said Gemma Foley, Senior Physiotherapist in Stroke Early Supported Discharge. The St James’s Hospital ESD programme involves rehabilitation for patients who have had a stroke. Members of the ESD team visit patients in their homes to deliver physiotherapy, occupational therapy, speech and language therapy and social work support. This work is well established in New Zealand and the UK, and St James’s Hospital is the latest Irish hospital to advance this initiative. “St James’s Hospital ESD launched in March 2021, with the team consisting of physiotherapist Gemma Foley, social worker Juliet Herbst, occupational therapist Conor Keady, speech therapist Laura Murray - who has been succeeded by Kelly Doherty - and therapy assistant Christy Kelly. The team visit patients in ones and twos to deliver the specified treatment and as some visits permit travel by foot or bicycle, it’s a health winner all round,” she said. “In the first two months of the service the team facilitated discharge for 18 patients, many of whom would otherwise have required several weeks more inpatient rehabilitation. The response from the patients and their families so far has been overwhelmingly positive.” Initial feedback certainly bears out, with one patient saying, “I cannot express how important this service is for us”, while another commented “we’re so grateful for all the input we’re receiving. It is making a huge difference”.
EARLY SUPPORTED DISCHARGE FOR STROKE PATIENTS Home is where the heart is, that is why the new outreach team in St James’s Hospital have set up a new Early Supported Discharge (ESD) programme.
BACK ROW, LEFT TO RIGHT: Christy Kelly, therapy assistant; Kelly O’Doherty, speech therapist; Conor Keady, occupational therapist. FRONT ROW, LEFT TO RIGHT: Juliet Herbst, social worker; Gemma Foley, physiotherapist.
IRELAND’S NATIONAL STROKE STRATEGY
There is substantial evidence that ESD programmes are associated with reduced hospital costs, fewer bed-days used and greater patient satisfaction. Ireland’s National Stroke Strategy envisions a big expansion of such programmes, and plans a rollout of ESD to cover 75% of the population. ESD teams will operate from 15 hospitals nationally; hospitals which have the greatest number of stroke patients. Professor Ronan Collins, clinical lead with the HSE Stroke Clinical Programme, said money saved on hospital beds could amount to €4.6m over three years, whereas the costs of the ESD rollout are less than €1.6 million. The St James’s Hospital new ESD team meets daily to discuss patients’ progress. Care will continue in the home for up to six weeks for each patient. The HSE and the National Stroke Clinical Care Programme view this as ‘best practice’ care; and both are planning to increase the amount of ESD teams nationwide. The team has been funded by the National Treatment Purchase Fund for one year; after which they hope for the programme to become permanent in the hospital.
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