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Health services research
Original research
Effect of stroke early supported discharge on length of hospital stay: analysis from a national stroke registry
  1. Rebecca J Fisher1,
  2. Adrian Byrne1,
  3. Niki Chouliara1,
  4. Sarah Lewis2,
  5. Lizz Paley3,
  6. Alex Hoffman3,
  7. Anthony Rudd3,
  8. Thompson Robinson4,
  9. Peter Langhorne5,
  10. Marion Walker1
  1. 1Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
  2. 2Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
  3. 3Department of Population Health Sciences, King's College London, London, UK
  4. 4Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
  5. 5Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Rebecca J Fisher; rebecca.fisher{at}nottingham.ac.uk

Abstract

Objective The first observational study to investigate the impact of early supported discharge (ESD) on length of hospital stay in real-world conditions.

Design Using historical prospective Sentinel Stroke National Audit Programme (SSNAP) data (1 January 2013–31 December 2016) and multilevel modelling, cross-sectional (2015–2016; 30 791 patients nested within 55 hospitals) and repeated cross-sectional (2013–2014 vs 2015–2016; 49 266 patients nested within 41 hospitals) analyses were undertaken.

Setting Hospitals were sampled across a large geographical area of England covering the West and East Midlands, the East of England and the North of England.

Participants Stroke patients whose data were entered into the SSNAP database by hospital teams.

Interventions Receiving ESD along the patient care pathway.

Primary and secondary outcome measures Length of hospital stay.

Results When adjusted for important case-mix variables, patients who received ESD on their stroke care pathway spent longer in hospital, compared with those who did not receive ESD. The percentage increase was 15.8% (95% CI 12.3% to 19.4%) for the 2015–2016 cross-sectional analysis and 18.8% (95% CI 13.9% to 24.0%) for the 2013–2014 versus 2015–2016 repeated cross-sectional analysis. On average, the increased length of hospital stay was approximately 1 day.

Conclusions This study has shown that by comparing ESD and non-ESD patient groups matched for important patient characteristics, receiving ESD resulted in a 1-day increase in length of hospital stay. The large reduction in length of hospital stay overall, since original trials were conducted, may explain why a reduction was not observed. The longer term benefits of accessing ESD need to be investigated further.

Trial registration number http://www.isrctn.com/ISRCTN15568163.

  • stroke medicine
  • rehabilitation medicine
  • health policy
  • stroke

Data availability statement

Data may be obtained from a third party and are not publicly available. Data access requests should be directed to the Healthcare Quality Improvement Partnership as the data controller and the Sentinel Stroke National Audit Programme as the data provider.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2020-043480

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data access requests should be directed to the Healthcare Quality Improvement Partnership as the data controller and the Sentinel Stroke National Audit Programme as the data provider.

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    Footnotes

    • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

    • Contributors All named authors made a substantial contribution across a number of areas including study design, data analysis, interpretation of findings, drafting/revising the manuscript and approving the final version for publication. All authors agree to be accountable for respective aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RF (principal investigator) led in the original design of the study protocol, with input from MW, SL, TR, PL, AB and NC. LP, AH and AR are SSNAP collaborators and advised on access to audit data and appropriate use for research purposes. RF led running of the study, with AB and SL leading on statistical methodology, obtaining data from SSNAP, data analysis and interpretation, and article writing and approval; NC, MW, TR and PL advised RF on overall study design, data interpretation, article writing and approval; LP, AH and AR are SSNAP collaborators and were involved in data sharing agreements, advice on data handling, analysis, article writing and approval.

    • Funding This research was funded by the National Institute for Health Research (NIHR), Health Services and Delivery Research (HS&DR) Programme (16/01/17). RF is funded by the Stroke Association (TSA LECT 2016/01 Stroke Association HRH the Princess Margaret Senior Lecturer Award). TR is an NIHR senior investigator. The SSNAP is commissioned by the Healthcare Quality Improvement Partnership and funded by National Health Service England and the Welsh Government.

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.