Clinical Question: Do patients with stroke benefit from early supported discharge services?

Setting: Various (meta-analysis)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: The authors used Cochrane Review methods to identify 11 randomized trials (1,597 patients) of early supported discharge—services that aim to accelerate the discharge of patients already admitted to the hospital. They contacted the original researchers and obtained the individual patients’ data to perform a pooled analysis. The main outcome was the combination of death or dependency (defined as a Barthel index of less than 19 out of 20 or a Rankin score of more than 2). The authors also categorized each program according to the degree and comprehensiveness of the services provided by each early supported discharge program: early supported discharge that was coordinated and delivered by a team; early supported discharge that was coordinated by a team; no early supported discharge team.

Among all patients randomized to early supported discharge, 359 (45 percent) of 804 patients were dead or dependent after 12 months compared with 398 (50 percent) of 793 patients in the control group (number needed to treat = 18; 95 percent confidence interval [CI], 10 to 156). Additionally, the length of stay was an average of nearly eight days shorter in all patients in the early supported discharge groups (7.7 days; 95 percent CI, 4.2 to 10.7). The trials with a coordinated early supported discharge team performed better than those without. Additionally, five studies analyzed cost and all demonstrated a cost savings of approximately 20 percent. Finally, although early supported discharge did not benefit patients with severe stroke with respect to death and dependency, this subgroup was released from the hospital 28 days earlier; the subgroup with mild to moderate stroke was released four days earlier.

Bottom Line: In patients admitted to the hospital with mild to moderately severe stroke, early supported discharge services provided by special teams reduces the likelihood of death or disability and can reduce the length of hospitalization by one week. (Level of Evidence: 1a)