Exploring Successes and Challenges of Stroke and TIA Patients 28 Days Following Discharge from Hospital

Abstract

Aim: To identify the readmission diagnoses of patients readmitted to hospital within 28 days of an acute stroke over a two-year period. To explore the successes and challenges of stroke/transient ischemic attack (TIA) patients in the first month following hospital discharge, and the impact of healthcare services on these experiences. Design: Descriptive mixed-methods design, including a quantitative and qualitative data analysis. Setting: A large New Zealand District Health Board (DHB) in the North Island. Interviewed participants were recruited from an acute stroke unit. Methods: Data were obtained from existing DHB databases and readmission diagnoses determined from patient discharge summaries. Twelve stroke/TIA patients discharged to their own homes were then recruited for semi-structured interviews, and the resulting data were subjected to a thematic analysis. Results: Of the 1,575 stroke patients admitted between 1st January 2013 and 1st January 2015, 151 (9.58%) were readmitted within 28 days of discharge. Secondary stroke or TIA were the most prevalent readmission diagnosis accounting for 19.87% of readmissions. Interviews from the 12-recruited stroke/TIA participants’ yielded seven overall themes; hospital experience, follow-up, recovery, health, frustration, support and other challenges. The care reported by participants varied greatly, with some reporting excellent care and others feeling disillusioned. Conclusion: Stroke patients are at risk of hospital readmission within 28 days of discharge due to secondary events. This readmission rate could be reduced by management of risk factors. The variation of care among the interviewed participants demonstrates that appropriate care is possible, but is inconsistently provided. The implementation of a single point-of-care discharge service could aid both the management of secondary stroke prevention and provide consistent post-stroke services.