Outcome evaluation

At the present time 'better health care' is one of the two main government objectives for the National Health Service. Since this implies future improvement it is essential to be able to describe current practice. This article describes the outcome (current practice), principally in terms of Barthel score, for stroke patients receiving rehabilitation on a specialized ward and puts forward a suggestion for a minimum data set which could be used to describe current practice on all rehabilitation wards.

Length of hospital stay and discharge delays in stroke patients

BACKGROUND AND PURPOSE

In The Netherlands, many stroke patients stay in the hospital for some time merely waiting for discharge placement. This indicates an inefficient use of hospital resources, as well as a possible deficiency in the quality of care, because hospitals are not adequately equipped to care for these patients. In this study, we tried to quantify this "waiting problem."

METHODS

Six hospitals and 29 neurologists participated in this prospective study. The neurologists were asked during weekly interviews to specify for 154 patients the reason for retention in the hospital on a day-to-day basis. The reasons were noted on a list specified by the authors in advance.

RESULTS

The mean length of hospital stay was 28 days. On average, there were "hard" medical reasons for 15 days (54%) and "soft" medical reasons for 3 days (10%), whereas the remaining 10 days (36%) were explained by nonmedical reasons (most frequently, waiting for placement in a nursing home).

CONCLUSIONS

The length of hospital stay for stroke patients in The Netherlands can be reduced considerably without compromising the quality of care. This might be realized by increasing the capacity of long-term care facilities, improving the efficiency of the discharge procedures, or creating "stroke services."

Implications for nurses in approaches to the management of stroke rehabilitation: a review of the literature

There is as yet no general agreement on how best to manage stroke rehabilitation in terms of the approaches to the management of this client group. Approaches include the Stroke Rehabilitation Unit (SRU), applying the principles of SRU management to general medical wards and the use of peripatetic stroke therapy teams. Each of these approaches has implications for nurses yet the contribution of nurses to the rehabilitation of stroke patients receives only scant attention in the literature. It is suggested that understating and undervaluing nursing leads to under use of this essential resource.