Abstract
Introduction / Background: Early Supported Discharge (ESD) after Stroke is an evidence-based service model which enables an accelerated discharge home after acute stroke by providing specialist rehabilitation and support within the community setting, most typically the person’s own home. This paper outlines the formation and development of the National ESD Network, a community of practice which enables teams to achieve and sustain successful implementation of the ESD model through professional development, standardisation of approach, peer support, shared values, and connectivity across professions, sites and stakeholders.
Who: While ESD has been embedded within a small number of sites in Ireland since 2012, the pandemic was a catalyst for the development of the network for two reasons. One, there was increased expansion in Early Supported Discharge services, many of whom were rapidly established using transient funding streams, and secondly, there was a lack of opportunity to meet informally at conferences or other learning events. There are currently eleven ESD teams in Ireland, with a total workforce of approximately 50 people. These make up the network, together with the members of the national clinical programme for stroke and imminently people with stroke.
Design, Implementation & Monitoring: The network meet quarterly for three hours, with the first hour devoted to either an invited guest speaker, or a journal club. Invited speakers are decided through consultation with the group, with all members inputting via an annual questionnaire, but are often Irish researchers, suggested by the ESD lead or stakeholders and service providers within the third sector. This enables relationships to be built up between researchers and the ESD team members, and ESD team members have also used this forum to themselves conduct research. The journal club articles are selected with a specific emphasis on developing interprofessional competencies, and are carried out in randomly assigned breakout groups with a central discussion at the end. Often this article chimes with an item on the main meeting discussion and so serves not only to expand professional development, but also to harmonise language, terminology and common understanding across professions and sites, enabling discussion to be easily facilitated among the network.
Results & Impact: The network has been evaluated highly by the members as seen informally by the growing attendance, lively engagement, and also as seen in more deliberate evaluation. The network has facilitated a number of further developments, including building consensus on datasets, an implementation guide, and the inclusion of people with stroke in the network from early 2024. In relation to workforce in particular, network members report that the provision of a supportive community of practice has increased satisfaction and retention in this area of practice.
Learning & Next Steps: The number of ESD teams in Ireland is planned to double by 2026. The current network model has scalability built in, through inclusion of both small group and larger group discussion. An exciting next step will be the inclusion of people with stroke, particularly as we begin to further define our shared values.