Reducing Readmissions After Stroke With a Structured Nurse Practitioner/Registered Nurse Transitional Stroke Program

Stroke. 2016 Jun;47(6):1599-604. doi: 10.1161/STROKEAHA.115.012524. Epub 2016 Apr 28.


Background and purpose: Our aim was to determine whether a standardized Transitional Stroke Clinic (TSC) led by nurse practitioners could reduce 30-day and 90-day readmissions for stroke or transient ischemic attack patients discharged home.

Methods: Phase I consisted of nurse practitioners calling only high-risk patients discharged home within 7 days and performing an office visit within 2 to 4 weeks of discharge. Phase II consisted of all patients discharged home receiving both a 2-day follow-up phone call by a registered nurse and a follow-up visit with a nurse practitioner within 7 to 14 days. Differences in process metrics and readmissions across the 2 phases and overall were assessed. Increasing complexity with multiple chronic conditions (diabetes mellitus, coronary artery disease, and congestive heart failure) was represented in a continuous variable from 0 to 3. Multivariable logistic regression models for 30-day and 90-day readmissions were performed with adjustment for National Institutes of Health Stroke Scale (NIHSS) and previous hospitalizations.

Results: From October 2012 through September 2015, 510 patients were enrolled. From phase I to II, a higher proportion of follow-up calls were made and days from discharge to TSC decreased. Patients readmitted within 30 days were less likely to show for TSC visits (60.85% versus 76.3%; P=0.021). Multivariable modeling showed that TSC visit was associated with a 48% reduction in 30-day readmission (odds ratio, 0.518; 95% confidence interval, 0.272-0.986), whereas multiple chronic conditions and previous stroke/transient ischemic attack increased the risk. TSC visit did not impact 90-day readmissions.

Conclusions: Evaluation in a nurse practitioner-led structured clinic is a model that may reduce readmissions at 30 days for stroke patients discharged home.

Keywords: nurse practitioners; patient discharge; patient outcome assessment; patient readmission; quality improvement; risk factors; secondary prevention; stroke; transitional care.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Ischemic Attack, Transient / therapy*
  • Male
  • Middle Aged
  • Nurse Practitioners / statistics & numerical data*
  • Outcome and Process Assessment, Health Care / statistics & numerical data*
  • Patient Discharge / standards
  • Patient Discharge / statistics & numerical data*
  • Patient Outcome Assessment
  • Patient Readmission / statistics & numerical data*
  • Quality Improvement / statistics & numerical data*
  • Secondary Prevention / statistics & numerical data*
  • Stroke / therapy*
  • Transitional Care / organization & administration*