Improving Transition of Care for Stroke Survivors with Hospital and Post-Acute Education

Abstract

Background: Transitioning from the hospital to home is linked with emotional, social, and health-related problems (Reeves et al., 2017). These transitions are ultimately and importantly linked to the safety of post-acute stroke survivors A basic strategy in improving challenges related to transitional care is providing better stroke education to patients and caregivers (Sanders et al., 2014; Reeves et al., 2017). Purpose: The purpose of this project is to evaluate stroke knowledge retention among Transient Ischemic Attack (TIA), stroke survivors or caregivers when they return home (14-30 days after discharge). Specifically, this project analyzed selected demographics (age, gender, type of stroke, discharge location) and assessed 1) stroke knowledge (stroke type and risk factors) and 2) the impact of the stroke education book (did they remember receiving the book and if so did they refer to it and was it helpful) that was provided to the patient and caregivers by the Comprehensive Stroke Center. Design and Methods: A quality improvement project which performed a secondary analysis of data that has been previously collected by a Comprehensive Stroke Center Transition of Care program +/- 30 days post hospital discharge. Data that has been collected included patient demographics, stroke knowledge and usefulness of a newly developed stroke education book. Results: Reponses of patients and caregivers (N=105) were included. The sample included mostly ischemic stroke and TIA patients. Less than half of the participants said they received stroke education or the newly developed stroke education book even though, according to the stroke coordinator, there is nearly 100% compliance in providing stroke education book documented in patients’ charts. Further, more than half of the participants who said they received a stroke education book did not refer to the book for any reason. Some of the participants who read the book reported not understanding it. Conclusion: There is lack of knowledge regarding stroke diagnosis and risk factors despite having educational material provided to patients/caregivers. A stroke education book is likely necessary but is not sufficient. There is a need for developing active, individualized in-hospital education as well as a need for early discharge follow up to reinforce education in order to ensure safe transitions when patients return home after experiencing stroke.