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Abstract

Purpose: To investigate staff compliance with discharge planning clinical guideline recommendations in an acute stroke unit, and its relationship with post-discharge experiences of stroke patients and their carers. Subjects: Fifty acute stroke patients were systematically recruited for a retrospective patient record audit of staff compliance with clinical guideline recommendations related to discharge planning. Methods: Semi-structured interviews were conducted over six months post-discharge on patients’ actual community support needs and experiences. Audit and patient experience data were integrated to seek evidence of 1) characteristics of patients receiving guideline-compliant care, 2) relationships between staff compliance with discharge planning recommendations and patient’s post-discharge experiences, and 3) whether patient’s post-discharge experiences of shortfalls in support related to hospital discharge planning. Results: Not all patients received guideline-based care. There was a trend that patients with more complex strokes received guideline-compliant care than other patients. Compliance with providing an occupational therapy (OT) home assessment was significantly related to discharge directly home from hospital. There was a shortfall with 40% of patients between community supports predicted by hospital staff and actual post-discharge support requirements. Community support requirements increased over time for 32% of patients, whose six-month post-discharge needs were actually greater than their needs at six weeks. Conclusions: Staff compliance with discharge planning recommendations was variable and did not always relate to improved post-discharge patient experiences. The post-discharge experiences of many stroke patients could not have been predicted whilst they were in hospital. Discharge planning and support systems thus need to be flexible and responsive to short and long-term needs.

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