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Additional file 5. Forest Plots for Secondary Outcomes.

Additional file 2. PRISMA Flow Diagram.

Additional file 3. Characteristics of Included Studies.

Additional file 4. Cochrane Risk of Bias Tool 2.0.

Additional file 1. PRISMA Checklist.

Stroke remains the third leading cause of death in Ireland and Western Europe, and the leading cause of severe, adult-onset physical disability. We report on patients aged 17 years and over who were treated in the 24 public hospitals that provide acute stroke care in Ireland and that admit more than 25 stroke cases annually. Data are typically collected by stroke services on behalf of the participating hospitals. In order to be included in the audit report, hospitals must have collected data on more than 80% of patients with a stroke. This year’s report incorporates data from the 23 participating hospitals that met the mandatory 80% coverage threshold; overall, despite the effects of the coronavirus disease 2019 (COVID-19) pandemic, coverage improved from 83% to 93% across the hospital system for patients with a stroke identified through the Hospital In-Patient Enquiry (HIPE) system as having been admitted with acute stroke, either ischaemic or haemorrhagic. The audit does not currently collect data on subarachnoid haemorrhage; however, we are exploring how these data may be effectively incorporated in future years’ audits. Because of the increased coverage, the number of individuals on whom data have been collected increased by more than 20% in 2020 from 2019. This important increase in coverage does appear to have led to substantial changes in proportional outcomes for most variables, but caution should be exercised in interpretation of minor changes from previous years.

Introduction Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home and continue to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. The concept has shown reduced length of stay and improved functional outcomes in stroke patients. This systematic review aims to explore the totality of evidence for the use of early supported discharge in older adults hospitalised with medical complaints. Methods A literature search of CINAHL in EBSCO, Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE and MEDLINE in EBSCO was carried out. Randomised controlled trials or quasi-randomised controlled trials were included. The Cochrane Risk of Bias Tool 2.0 was used for quality assessment. The primary outcome measure was hospital length of stay. Secondary outcomes included mortality, function, health related quality of life, hospital readmissions, long-term care admissions and cognition. A pooled meta-analysis was conducted using RevMan software 5.4.1. Results Five studies met the inclusion criteria. All studies were of some concern in terms of their risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (REM, MD = -6.04, 95% CI -9.76 to -2.32, I2 = 90%, P = 0.001). No statistically significant effects favouring ESD interventions were established in secondary outcomes. Conclusion ESD interventions can have a statistically significant impact on the length of stay of older adults admitted to hospital for medical reasons. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.

INTRODUCTION Stroke is the third leading cause of death in Western Europe and is the leading cause of severe long-term adult disability (The Stroke Alliance for Europe, 2020). Stroke is an important health issue for people in Ireland, with approximately 5,500 adults admitted to hospitals with a stroke in 2019. Stroke can affect people physically, emotionally and socially. It has a significant impact on Health Service Executive (HSE) resources, accounting for up to 4% of total health expenditure annually (Health Information and Quality Authority, 2017a). Although the economic costs of stroke in terms of lost employment and the cost of support in the community are significant, the impact on family members or friends who care for stroke survivors is massive. It is therefore important that all hospitals providing acute stroke services deliver high-quality and equitable stroke care.