Understanding the role of the stroke physician in early supported discharge services. Collaborative Leadership in Applied Health rRsearch and Care (CLAHRC), Nottinghamshire, Derbyshire and Lincolnshire, UK

Our recent research, using expert consensus with trialists who had contributed to the Cochrane systematic review, has helped to establish key components of effective Stroke Early Supported Discharge (ESD) services. One essential element is that the ESD multidisciplinary team should have access to specialist stroke knowledge. However, how this is organised and put into working practice is less well-defined. The current qualitative phase of our study investigates such questions about ESD team composition and roles. The stroke physician’s (SP) involvement may start with commissioning and strategic representation of the service. The SP can then be pivotal to the early identification of eligible patients, and ensuring their medical stability prior to transfer. Within the ESD multidisciplinary team, the SP role includes goal review, goal setting, and giving specialist medical guidance. By providing reassurance to the team on their choice of actions, the SP may also help avoid hospital readmission. Another key component of the SP role has been informal and formal education for the ESD team, on such issues as secondary prevention, and common medical problems post stroke. Finally, SP liaison with the acute stroke team, other hospital specialists and primary care physicians facilitates successful cross-boundary working and can aid patient adherence to secondary prevention measures. These preliminary findings and experiences suggest that the SP role is critical to effective ESD functioning, and may also offer some useful insights into how to cultivate an integrated and co-ordinated care system for stroke patients.