Evidence-informed discharge planning model for stroke rehabilitation
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Stroke is a leading cause of long-term disability (Benjamin et al., 2017) and patients with this diagnosis have been found to have higher incidences of inappropriately long hospital lengths of stay (McDonagh, Smith, & Goddard, 2000). Generalist training in occupational therapy curriculum coupled with variable research utilization (Dysart & Tomlin, 2002; McKenna et al., 2005) leads to inconsistent methods of evaluation and decreased communication between providers across settings. Furthermore, there are currently no standardized discharge planning models or guidelines for clinicians to follow when evaluating patients or making recommendations (Ilett, Brock, Graven, & Cotton, 2010). An evidence-informed discharge planning model was created to address these issues. This model utilizes a multidisciplinary approach, with guidelines for selecting and administering evaluations to quantify a patient’s functional status. Assessments are clustered into four domains: activities of daily living, balance and mobility, cognition, and other (i.e. visual inattention, motor control and spasticity). These assessments supplement a basic patient evaluation, and results are used to guide clinical decision making regarding recommendations for the next level of care. Stroke rehabilitation and care cannot be standardized, but the methods used to select measures and make discharge recommendations should have distinct guidelines. By choosing from a core set of measures, clinicians can use a common “language” to describe patient function and measure progress across settings over time. This will ensure patients are discharged to the appropriate level of rehabilitation to optimize their recovery, and it will also help prevent excessively long hospital admissions.