ESD: Our Virtual Transformation

The Early Supported Discharge (ESD) team in Cork provides specialised domiciliary stroke rehabilitation.

As an integrated stroke service, ESD constitutes a vital rehabilitation pathway for stroke survivors facilitating patient flow through acute stroke units in Cork University Hospital, the Mercy University Hospital and St Finbarr’s Stroke rehabilitation unit since starting in 2018.

The team includes Senior Occupational Therapist, Louise O’Regan, Senior Physiotherapist, Marie Condon, Senior Speech and Language Therapist, Anne Barrett. 

Together, the team supports stroke survivors to achieve a range of goals from increasing their independence in activities of daily living, supporting their communication, improving their mobility and returning to community activities or working life.

In this blog, we reflect on how the service rapidly adapted in the context of COVID-19.

In March, as the COVID-19 pandemic unfolded locally and nationally, face to face home visits were becoming a greater risk to stroke survivors, their families and to us, the ESD team members.

We realised that we needed to think on our feet and with the support of our managers, the acute stroke teams, the OoCIO, the National Stroke Programme and local CUH IT Team, we faced into the unknown and embraced a virtual transformation. We asked our patients to engage with an alternative service delivery model – telerehabilitation.

Factors that we needed to consider when adapting our service

We reviewed the current evidence and developed our knowledge base and competency in the approaches to providing safe and effective person-centred stroke rehabilitation via video calling platforms.

This included the development of policies and procedures, adapting documentation to support people with technology or communication difficulties to access their virtual rehabilitation.

We started engaging in cross sector collaborations and forming new working relations with colleagues within the HSE, the voluntary health sector and internationally with clinicians and academics alike.

Through conference calls with other national ESD teams and the National Stroke Programme, a national shared file was established to encourage discussion, collaboration and information sharing among teams.

Equally, international collaborations were established with stroke rehabilitation services in the UK to produce a joint UK and Ireland collaborative statement on the rational for maintaining ESD teams during the COVID-19 outbreak.

We worked in tandem with the acute stroke teams in the referring hospitals to develop virtual clinic schedules, collecting patient consent and commencing telerehabilitation with stroke survivors.

Example of Telerehabilitation in Action

At the beginning of June, almost three months later, the Cork ESD team is now able to offer a blended model of service delivery. As we enter phase two, face to face contacts are facilitated in an outpatient setting and at home where necessary along with telerehabilitation.

The pandemic may have forced us to work differently but it has also led us to develop a huge appreciation for the potential of telerehabilitation. We have continued to deliver effective rehabilitation to stroke survivors without compromising on the quality or frequency of input.

ESD services are limited to certain geographical areas in Ireland. From our experience, there is an opportunity going forward to increase ESD to wider populations through telerehabilitation.

Whilst telerehabilitation may not be suitable for everyone, we are optimistic there are some positive lessons for ESD and the wider healthcare services which can be carried forward as we adjust to a new reality for the Irish Health Services.

There is potential for telerehabilitation to provide broader access to evidence-based care, provision of more cost effective care and to remove barriers for patients.

It is vital to reflect on and evaluate the efficacy and effectiveness of telerehabilitation in the Irish context and drive further research into its long term health, financial and societal benefits. We need to be confident in its efficacy in terms of safe, effective care, reducing disability and enhancing wellness and recovery to progress telerehabilitation beyond the pandemic.

This Blog was written by Louise O’Regan, Senior OT, Marie Condon, Senior PT and Anne Barrett, Senior SLT from the Cork ESD Team.

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