A transitional stroke clinic developed by
doctors and nurse practitioners at Wake Forest Baptist Medical Center reduced
30-day readmission rates by 48 percent, according to a study published in the
April 28 online issue of the journal Stroke.
The study’s goal was to determine if a structured
transitional stroke clinic led by nurse practioners could reduce 30-day and
90-day hospital readmission rates.
“The needs of patients discharged directly home after
suffering a stroke are often complex,” said Cheryl Bushnell, M.D., director of
the Stroke Center at Wake Forest Baptist and lead author of the study.
“Patients are faced with physical and cognitive limitations,
complex medication regimens, new diagnoses of chronic conditions and lack of
social support. These barriers challenge independence and stroke recovery and
leave patients at high risk for readmissions.”
The study evaluated 510 stroke or transient ischemic
attack patients who had been discharged to their homes over a three-year
period. The Wake Forest Baptist transitional care model included follow-up
phone calls within a week of discharge and follow-up clinic visits within two
to four weeks of discharge.
The researchers found that a visit to the stroke clinic
was associated with a 48 percent lower risk of 30-day readmissions compared to
patients who did not attend the follow-up clinic visit. A clinic visit did not
affect 90-day readmission rates. A limitation of the study was that only
readmissions at Wake Forest Baptist were included.
“A lot of stroke programs are doing follow-up phone calls
to patients, but our data shows that phone calls alone are not good enough to
reduce readmissions,” Bushnell said. “It is really important for patients to be
engaged in their own stroke recovery, and part of that involves coming to
clinic and making sure they get all the services they need.”
Bushnell also said that primary care doctors caring for
stroke patients should be alert to changes that are hallmarks of stroke:
patients not thinking as clearly as they used to, memory problems, limited
ability to use their hands or overall mobility issues, as well as depression
and social isolation.
“We are at the forefront of a trend that really
emphasizes the initial transition phase in post-stroke care,” Bushnell said. “The
next steps include expanding our model to include community services and
individualized electronic-care plans.”
A clinical trial is now being implemented across the
state of North Carolina to determine if this model of care will improve stroke
patients’ functional status and reduce caregiver burden 90 days post-stroke,
Bushnell said. The trial is funded by the Patient-Centered Outcomes Research
Co-authors are: Christina Condon, M.S.N., N.P., Sarah
Lycan, M.S.N., N.P., and Pamela Duncan, Ph.D., of Wake Forest Baptist.