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Early supported discharge following mild stroke: a qualitative

study of patients

and their partners

experiences of rehabilitation

at home

S. Lou


, K. Carstensen


, M. Møldrup


, S. Shahla


, E. Zakharia



C. Nielsen




CFK- Public Health & Quality Improvement, Central

Denmark Region, AarhusN,


Department of Rehabilitation, Horsens

Regional Hospital, Horsens,


Department of Internal Medicine/Geriatrics,

Randers Regional Hospital, Randers,


Department of Neurology, Viborg

Regional Hospital, Viborg,


Department of Public Health, Aarhus

University, AarhusC, Denmark


Early supported discharge (ESD) allows mild-to-moderate

stroke patients to return home as soon as possible and continue

rehabilitation in familiar surroundings and at their own pace. Thus, the

main responsibility for further rehabilitation is put in the hands of

patients and their partner, who must collaborate to adjust to post-

stroke everyday life. However, couples

joint experiences of stroke,

early discharge and rehabilitation at home remains poorly inves-

tigated. Aim: To investigate how mild-to-moderate stroke patients

and their partners

experience and manage everyday life in a context

of ESD.


Qualitative interviews were performed with a purposive

sample of 22 ESD patients and 18 partners. Interviews were per-

formed 3

6 weeks after stroke and data was analysed using thematic



The analysis identified three themes:

Home as a healing


involved the couples

experiences of a well-informed discharge

from hospital. They trusted the health professionals

assessment that

the patient was ready to come home. Home was described as a

comforting and calm place, where recovery could meaningfully take


Flow of everyday life

comprised the experiences of adapting

to and continuing everyday life. Most interviewees had relatively

little physical and cognitive impairment and at this point patients

and partners were hopeful of full recovery in a foreseeable future.

Professional safety net

involved the much appreciated stroke

team. Though most participants had only had one visit from the

team, knowing that they were an accessible resource was of great

importance for the couples.


ESD was experienced as a meaningful and adequate

rehabilitation service that allowed patients and partners to collabora-

tively re-invent and re-build their flow of everyday life by jointly

adjusting routines, activities and their relationship.


Patient-centred goal setting in geriatric rehabilitation: a feasibility


E.B. Smit, H. Bouwstra, H. van der Wouden, L. Wattel, C.M.P.M. Hertogh.

Department of General Practice & Elderly Care Medicine, VU University

Medical Center, Amsterdam, the Netherlands


Goal setting is considered essential in geriatric rehabili-

tation. It can result in higher levels of motivation, self-efficacy and

health related quality of life. Currently, no standardmethod is available

for geriatric rehabilitation which combines patient-centred goal

setting with the use of valid measurement instruments. Objective:

To determine the feasibility of a new goal setting intervention with

active patient participation and evaluation of rehabilitation goals by

means of standardized functional measurement instruments.


This qualitative study assessed the feasibility of the interven-

tion on two geriatric inpatient rehabilitation wards. Both patients and

professionals participated in open interviews. Patients were inter-

viewed once their rehabilitation period was finished and the

professionals at the end of the study period. Interview transcripts

were analysed qualitatively using a framework analysis according to

six pre-established feasibility criteria: acceptability, demand, imple-

mentation, practicality, adaptation and integration.


A total of eight stroke patients and three professionals

participated in the study. Both patients and professionals expressed a

need for patient-centred goal setting. The content and the design of

our intervention was considered appropriate by both groups. No

adverse effects were reported. The professionals reported that they did

not consistently carry out the intervention. The main reasons for this

were lack of time and falling back in old patrons. Finally, professionals

found it difficult to apply this method to patients with communication



Adaptions are needed before the intervention can be

successfully implemented in current practice. Recommendations for

implementing this new goal setting intervention will be presented at

the conference.


Preventing falls in the rehabilitation setting

M. Smith, T. George, J. Papa, E. Chytilova, M. Mc Mahon, C. Tiernan,

L. Cogan.

The Royal Hospital Donnybrook


Systematic reviews suggest that multifactorial assess-

ment and intervention can reduce falls by 20

30%. A quality

improvement initiative was implemented on four hospital rehabi-

litation units. The initiative involved an implementation of the key

components of multifactorial interventions. The aim of the initiative

was to reduce falls by 20% over 12 months and further 20% by 10



Quality initiative was implemented in 4 rehabilitation units.

The project included application of falls care bundle to all patients.

The falls leads nurses used PDSA cycle to implement and to sustain the

falls care bundle. Data on falls were collected from incident reports.

Data on falls care bundle compliance were collected each month by

falls lead nurses.


In June 2014, the falls rate was 7.1 falls per 1,000 bed days.

In April 2015, the falls rate decreased to 4.2 falls per 1,000 bed days

and in April 2016 the falls rate decreased to 2.5 falls per 1,000 bed

days. Concurrently, the compliance with the fall care bundle in June

2014 was 11%, in April 2015 was 56% and in April 2016 was 73%. Overall,

the initiative lead to increased awareness of falls among staff and

patients, improved falls risk assessment and falls care planning.

Additionally, a falls huddle was introduced as a part of the post-fall



Introducing evidence-based fall care bundles of multi-

factorial assessment and intervention using a quality improvement

approach resulted in improved delivery of multifactorial assessment

and intervention and a significant reduction in the fall rates.


Reducing pressure ulcer development and increasing patient

engagement in an elderly rehabilitation population

M. Smith, T. George, M. Betamor, M. Mc Mahon.

The Royal Hospital



The development of a pressure ulcer is a serious

complication not only in terms of patient safety but also in terms of


overall experience. Collaborative quality improvement

initiative was introduced to one of the hospital

s rehabilitation units

(n = 27 beds). The goal was set to reduce the incidence of avoidable

pressure ulcers to 0% within 6 months.


The quality improvement initiative collaborative is centred

on the introduction of the SSKIN (surface, skin inspection, keep

moving, incontinence, nutrition) care bundle, which is an evidence-

based tool to prevent pressure ulcers. PDSA cycles were used by the

nurse lead to implement the SSKIN care bundle with patients who

were at risk of developing a pressure ulcer and were also used to

increase patient engagement in preventing pressure ulcers. Data on

the incidence of pressure ulcers and patient engagement was collected

each month from incident reports and from the safety cross calendar.


The results from this collaborative showed a 75% reduction in

pressure ulcers development. The compliance with the SSKIN care

bundle increased to 80% in 6 months. Furthermore, screening of

patients for the risk of pressure ulcer development increased in 6

Poster presentations / European Geriatric Medicine 7S1 (2016) S29