Abstract 2480: Does Stroke Bridge Clinic Reduce Hospital Readmission Rates in Patients Who Have Suffered a Stroke?
Does Stroke Bridge Clinic Reduce Hospital Readmission Rates in Patients Who Have Suffered a Stroke?
Introduction: Approximately 795,000 people suffer a stroke every year. The complex health needs following a stroke requires a highly coordinated transition of care to the community. This transition often falls short, requiring re-hospitalization within 30 days. Re-hospitalization can result in significant lack of progress for the patient and loss of reimbursement for the hospital.
Purpose: The purpose of this study was to determine the effectiveness of a Stroke Bridge Clinic in preventing hospital readmissions following an acute hospitalization with a stroke.
Methods: A retrospective quasi-experimental design was employed to examine the re-admission rates of patients attending the Stroke Bridge Clinic with those that did not. The clinic “bridges” the patient’s inpatient care to the primary care physician. One week following discharge from acute care or from rehabilitation, the patient comes to the Bridge Clinic to be evaluated by a Stoke Interdisciplinary Team. The team consists of a nurse practitioner, nurse stroke navigator and a pharmacist. The team focuses on the individualized treatment plan, education of risk factors, stroke prevention and medication reconciliation and education. The visit findings are then communicated with the primary care physician and the patient to improve continuity of care. The team also schedules follow up appointments and arranges community resources as needed.
Results: Since opening the Bridge Clinic in October 2010 readmission rates have declined by 12.3%. The patients without Bridge Clinic visits had a readmission rate of 14.5%. Patients with Bridge Clinic visits had a readmission rate of 2.2%.
Conclusions: The initiation of the Stroke Bridge Clinic has resulted in a significant decline in readmissions for the patients that attend. We believe that by maintaining our connection to the patient post discharge, we can address every patient’s needs individually. The decline in hospital readmissions for this special patient population may be due to the increased education, support and preparation for their continued recovery addressed by our interdisciplinary approach.
- © 2012 by American Heart Association, Inc.