Improving continuation of physiotherapy post hospital discharge
Acute and Hyperacute Stroke Rehabilitation:
In light of the COVID-19 pandemic there was increased pressure on inpatient teams to discharge patients as soon as safety allowed. This coupled with community teams limiting face to face therapy sessions led to significant uncertainty regarding rehabilitation for stroke patients leaving hospital. To help alleviate this, inpatient teams provided increased documented advice, including home exercise programmes and positioning charts for patients being discharged from hyperacute and acute wards.
Objectives & Aims
Context
• Reduced ability for the community teams to complete face to face rehabilitation sessions with limitations of remote therapy especially for those with the most severe disabilities following stroke.
• Increased pressure to discharge inpatients when safe to do so.
• Potential for compensations to occur or reduced recovery due to a significant break in rehabilitation.
Aims
• To educate patients (and / or carers) on discharge from acute inpatient rehabilitation to continue with some form of physiotherapy exercises to aid their ongoing recovery whilst community teams were unable to attend face to face.
• To empower patients to undertake their own rehabilitation safely at home.
Implementation
• Patients nearing discharge from acute hospitals were provided with an individually tailored exercise programme prior to discharge. This was completed with the patient at least once prior to discharge. Where necessary, for example for patients with cognitive impairment or where family support was required, this session involved the family over Whatsapp video or FaceTime (on hospital devices) so demonstrations could be shown with the patient.
• Where necessary positioning charts were provided for patients with severe disabilities. Photos of the patient in for example a chair were taken with consent, these were then digitally annotated, printed and laminated and included within discharge packs to help with replications in the community either by family or carers.
Top Tips
• Make time especially in hyperacute environments
• Focus on safety simple exercises done well rather than complex ones practised incorrectly.
• Involve the family using technology where possible
Outcomes
• Improved patient satisfaction reducing anxiety for their discharge.
• Aid the patient’s recovery, encouraging patient autonomy and return to independence.
• With those with severe disability who are particularly vulnerable, help reduce deterioration (for example, pneumonia or spasticity) through incorrect positioning in the community when no face to face guidance was available.
• This also had a secondary outcome of improving staff anxiety, high levels of stress are involved with discharging patients whose ongoing rehabilitation plan was unclear as a result of the COVID-19 pandemic despite demonstrating significant recovery potential.
