Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

A new rehabilitation approach could improve recovery for 54% of stroke survivors and save State up to €7m

15 September 2014
A new report published by the ESRI and the Irish Heart Foundation today, 15th September 2014, has found that implementing a policy of Early Supported Discharge (ESD) for stroke survivors requiring rehabilitation in Ireland could save between €2 million to €7 million annually and free up over 24,000 hospital bed days, while improving outcomes for patients.

Pictured (l-r) is Ms Siobhan Crichton, Kings College London; Dr. Paddy Gillespie, NUIG; Dr. Maev-Ann Wren, ESRI; Professor Anne Hickey, RCSI; and Dr. Frances Horgan, RCSI
The research, led by the Economic and Research Institute of Ireland (ESRI) and the Royal College of Surgeons in Ireland (RCSI), found that 54% of stroke survivors- more than 3,000 people a year - could benefit from early supported discharge programmes that would reduce hospital bed days by 24,000, resulting in annual net savings of from €2 to €7 million. Early Supported Discharge is an intensive approach to rehabilitation in the community used internationally but not generally available in Ireland.
According to the new report titled Towards Earlier Discharge, Better Outcomes, Lower Cost: Stroke Rehabilitation in Ireland, implementing Early Supported Discharge would require a substantial increase in the resourcing of community therapists (physiotherapists, occupational therapists, and speech and language therapists), community nurses and other community care above current levels in Ireland. However, savings from the reduced cost of acute bed days could fund this increase in resourcing. The research found that there is currently poor resourcing of and wide regional variation in community and inpatient rehabilitation for stroke survivors in Ireland.
Dr Maev-Ann Wren, lead author of the report and senior research officer at the ESRI, said: "The analysis in this report supports a move to international best practice in stroke rehabilitation in Ireland, with the potential for better outcomes for patients from better care in the community. This could be achieved at a net saving in national health expenditure by freeing up acute hospital beds.
"Translating acute care savings into community care resourcing requires shifting the balance from over-reliance on hospitals to greater delivery of care in the community. Allocation of resources to community care should prioritise those areas which are relatively under-resourced."
The study, which was commissioned by the Irish Heart Foundation (IHF) and funded by the IHF and the Health Service Executive (HSE), had four main objectives: to describe current rehabilitation for stroke patients in Ireland; to analyse best practice pathways of stroke rehabilitation; to compare costs, outcomes and cost-effectiveness implications of actual and best practice pathways of rehabilitation in Ireland; and to recommend how best to deliver stroke rehabilitation after the inpatient phase depending on age, severity of disability and type of stroke. The report's authors include researchers from the ESRI, NUIG, RCSI and King's College London. The report's steering group included clinicians engaged in stroke care.
Mr Barry Dempsey, Chief Executive of the IHF said: "Acute stroke services in Ireland have been transformed in the last three years, resulting in a 13% reduction in relative mortality and a 28% fall in the numbers being discharged to nursing homes . That means more people than ever are returning home after stroke, but community services to maximise their recovery have remained as bad as ever, with appalling quality of life consequences for discharged stroke patients.
"Stroke survivors currently face chronic service deficits - one in three have no access to physiotherapy and half can't get any speech and language therapy or occupational therapy. Just 11% have access to psychological services despite the often severe mental health impact of stroke and 36% pay privately for rehabilitation.
"The IHF believes this new research removes the cost barrier to better community services for stroke survivors and provides the evidence base for the development of a national rehabilitation infrastructure that will benefit Ireland's 50,000 stroke survivors and many others with neurological conditions."
The report also found significant regional variation in stroke rehabilitation services, such as physiotherapy and speech and language therapy, length of hospital stay, availability of nursing home places, community rehabilitation staffing and the intensity of therapy delivered in different locations. The report found that there are more referrals to nursing homes where more are located, whilst the average length of hospital stay for patients discharged to nursing homes ranges from 79 days in the HSE Dublin North-East Region to 24 days in the HSE West Region.
A survey of hospital stroke lead clinicians conducted by the researchers found that severe stroke patients may experience long waits for nursing home care and for specialist inpatient rehabilitation. Mr Dempsey added: "This research proves again that it is far more expensive to provide bad stroke services than services that maximise good outcomes. Despite Ireland's economic collapse health policymakers have had the courage to find extra funds to increase the lifesaving capacity of acute stroke services. Now they must act again to develop the community rehabilitation infrastructure that will improve the quality of life of thousands of stroke survivors and save the State money into the bargain."
The authors of the report are: Dr Maev-Ann Wren (ESRI), Dr Paddy Gillespie (NUIG), Dr Samantha Smith (ESRI), Ms Karen Kearns (ESRI), Ms Siobhan Crichton (KCL), Professor David Parkins (KCL), Professor Anne Hickey (RCSI), Dr Frances Horgan (RCSI), Professor David Williams, RCSI; and Professor Miriam Wiley (ESRI).