Stroke Patients: Where Are They Treated In Hospitals?

Stroke patients are initially admitted to the hospital's emergency department, where the type of stroke (a clot or a broken artery) is determined through a series of tests and scans. The patient is then transferred to a specialised stroke unit, which is a dedicated hospital unit for stroke patients. Here, they receive treatment and rehabilitation to stabilise their condition and prevent further complications. The length of stay in the stroke unit varies depending on the patient's needs and can range from a few days to a few weeks. Once the patient is medically stabilised, they may be discharged from the hospital or transferred to a rehabilitation facility for further recovery.

Acute stroke units

The core interdisciplinary stroke team should consist of healthcare professionals with stroke expertise, including:

• Physicians
• Nurses
• Occupational therapists
• Physiotherapists
• Speech-language pathologists
• Social workers
• Dietitians
• Patients
• Family members

Additional members of the interdisciplinary team may include:

• Hospital pharmacists
• Discharge planners or case managers
• (Neuro)psychologists
• Palliative care specialists
• Recreation and vocational therapists
• Spiritual care providers
• Peer supporters
• Stroke recovery group liaisons

All professional members of the interdisciplinary stroke team should have specialized training in stroke care and recovery. The team should assess all patients as soon as possible after admission to the hospital, ideally within 48 hours, and formulate a management plan. Assessments should cover areas such as dysphagia, mood and cognition, mobility, functional assessment, temperature, nutrition, bowel and bladder function, skin breakdown, vision, apraxia, neglect, and perception.

The benefits of acute stroke unit care compared to less organized forms of care include:

• Reduced odds of death
• Reduced odds of a poor outcome
• Reduced odds of death or dependency
• Reduced likelihood of death, death and disability, and death or the need for institutionalization
• Improved patient outcomes
• Reduced complications
• Earlier rehabilitation

In summary, acute stroke units are an essential component of stroke care, providing specialized, coordinated, and personalized care to patients with stroke through an interdisciplinary team approach.

Inpatient rehabilitation facilities

IRFs provide hospital-level care to stroke survivors, ensuring they receive the necessary medical attention and therapy to aid their recovery. The length of stay in these facilities depends on the patient's progress and needs, with some offering a maximum length of input, such as three months. The intensity of rehabilitation care can vary depending on the setting and the patient's requirements.

A typical IRF will have an interdisciplinary team of healthcare professionals, including:

• Rehabilitation physicians or physiatrists
• Nurses and nursing assistants
• Physical, occupational, and speech therapists
• Social workers
• Chaplains
• Case managers
• Dietitians

IRFs aim to provide personalised care, focusing on the patient's specific impairments and limitations while also addressing their mental health and overall quality of life. The team works together to create a coordinated treatment plan, with good communication and shared decision-making with the patient and their family being key to the process.

IRFs are an important step in the recovery journey for those who need intensive care and 24-hour medical supervision. They bridge the gap between hospitalisation and returning home or transitioning to a less intensive rehabilitation program.

Long-term acute care hospitals

Long-term care hospitals are residential facilities for patients who no longer need full hospital care but still require round-the-clock access to nursing support. These facilities may offer rehabilitation services to patients who qualify.

Post-stroke patients who require long-term care may also be admitted to a long-term care institution if community-based support is unavailable. These patients may have severe functional deficits and require assistance with basic activities of daily living (ADL). They may also have varying degrees of disability and need specific post-stroke rehabilitation.

The decision to admit a post-stroke patient to an in-hospital rehabilitation program depends on the severity of their condition. Patients with mild or moderate disabilities are good candidates for intensive rehabilitation, while those who have experienced a severe stroke may not be able to participate in intensive multidisciplinary rehabilitation.

Rehabilitation for post-stroke patients should include access to specialised stroke services such as physiotherapy, occupational therapy, and speech-language therapy. This can take place in a community living setting or as an outpatient at a hospital or clinic.

The transition to long-term care can be emotionally challenging for post-stroke patients and their families. It is important that they receive support and education to help them adjust to their new roles and changed abilities.

Home and outpatient rehabilitation programs

Stroke rehabilitation should begin in the hospital as soon as possible after a stroke occurs. This can help to improve the chances of recovery and reduce the impact of brain cell damage, which may be temporary and may resume functioning over time. In some cases, the brain can reorganise its functioning, with one region "taking over" for a damaged area.

More than two-thirds of stroke survivors in the U.S. receive rehabilitation services after hospitalisation. Rehabilitation can be continued at home or on an outpatient basis, with the support of a healthcare team and family members. This can include physical therapy, occupational therapy, and speech therapy, depending on the individual's needs. For example, if an individual has difficulty walking or balancing after a stroke, physical therapy may focus on improving strength, coordination, and balance.

Outpatient rehabilitation allows individuals to receive therapy services while living at home or in a community setting. This can be a good option for those who have made sufficient progress in the hospital but still require additional support. Outpatient rehabilitation programs typically offer a range of therapies, such as physical, occupational, and speech therapy, and may also provide access to specialised equipment and technologies to aid in recovery.

For those who prefer or require remaining at home, home-based rehabilitation programs can be arranged. These programs bring therapy services directly to the individual's home, eliminating the need for travel. Home-based programs can be tailored to the individual's environment and may include a combination of professional therapy services and family-assisted care. This option can be particularly beneficial for those who have limited access to transportation or who prefer a more familiar and comfortable setting for their recovery.

Discharge planning

Timing of Discharge Planning

The timing of discharge planning for stroke patients can vary. Some guidelines recommend initiating the process within 24-48 hours of admission, while others may not specify a particular timeframe. However, it is crucial to start discharge planning as early as possible to ensure a seamless transition and address the patient's needs effectively.

Interdisciplinary Collaboration

Assessment of Needs and Development of a Comprehensive Plan

A crucial step in discharge planning is assessing the patient's needs and developing a tailored plan to address them. This involves evaluating the patient's functional abilities, such as mobility, communication, and activities of daily living. Additionally, the patient's support system, caregiver involvement, and home environment should be considered to ensure they have the necessary resources and modifications for a safe and smooth transition.

Patient and Caregiver Education

Providing education to both the patient and their caregivers is an essential component of discharge planning. This includes instructing them on self-care or caregiving techniques, medication management, exercise routines, dietary recommendations, and other aspects of the patient's ongoing care. Educating and empowering patients and their caregivers can enhance their ability to manage their health effectively.

Follow-up and Outpatient Care

Addressing Psychological and Emotional Needs

The psychological and emotional impact of a stroke on patients and their families cannot be overlooked. Discharge planning should include strategies to address these needs, such as providing counselling, connecting them to support groups, or offering resources for managing stress, anxiety, or depression. Psychological support is an integral part of the recovery process and can enhance the patient's overall quality of life.

In conclusion, effective discharge planning for post-stroke patients involves a multidisciplinary approach, early initiation, comprehensive needs assessment, patient and caregiver education, coordination of follow-up care, and addressing psychological and emotional needs. By considering these key elements, healthcare providers can facilitate a smooth transition, improve patient outcomes, and enhance the overall quality of life for stroke survivors.

Frequently asked questions