Stroke Patients Visit EDs Often After Discharge from Hospital

By Stacey Kusterbeck

About half of patients discharged from the hospital with a stroke diagnosis are sent straight home.¹ Managing the care of stroke patients after discharge to home can be a daunting challenge for all concerned parties.

“Many of the post-discharge events that occur once a stroke patient is sent home may not require hospitalization,” says Wayne Rosamond, PhD, a professor of epidemiology at the University of North Carolina Gillings School of Global Public Health.

Rosamond wanted to know what happens when these patients present to EDs, how often they presented, and their condition at arrival. In 2017, Rosamond and colleagues published the results of the COMprehensive Post-Acute Stroke Services (COMPASS) study, which was an examination of post-acute stroke care models.² More recently, working with a different research group, Rosamond and colleagues used COMPASS data to examine ED visits.³

More than 20% of stroke patients recorded three or more ED visits in the first year after they were discharged home from the hospital. Notably, about half of these frequent ED visits were not directly related to stroke.

“Patients were about as likely to present with an injury, such as a fall, or with non-specific signs or symptoms as they were to present with a stroke event,” Rosamond reports.

For ED clinicians, it is important to be aware that repeat visits to the ED are quite common, even for patients who experienced mild or moderate strokes and are managing their conditions at home. “This suggests that home care models for these complex patients are important to evaluate and modify, if needed, to improve long-term care outcomes,” Rosamond says.

REFERENCES

1. Jackson G, Chari K. National Hospital Care Survey demonstration projects: Stroke inpatient hospitalizations. National Health Statistics Reports. No.132, Nov. 13, 2019.
2. Duncan PW, Bushnell CD, Rosamond WD, et al. The Comprehensive Post-Acute Stroke Services (COMPASS) study: Design and methods for a cluster-randomized pragmatic trial. BMC Neurol 2017;17:133.
3. Rosamond WD, Kucharska-Newton AM, Jones SB, et al. Emergency department utilization after hospitalization discharge for acute stroke: The COMprehensive Post-Acute Stroke Services (COMPASS) study. Acad Emerg Med 2021; Oct 17. doi: 10.1111/acem.14401. [Online ahead of print].