Community Stroke Discharge Team

The Community Stroke Discharge Team provides specialist early stage rehabilitation and discharge support for people who have had a stroke.

The team helps stroke patients return home from hospital earlier by enabling them to continue their specialist stroke rehabilitation in their own home. 

Working with other agencies including social services the Community Discharge Stroke Team will be able to provide patients with a seamless service from hospital to home. 

What is the referral criteria for the service?

Patients are referred from the Stroke Wards at York Hospital.  Patients must reside in the City of York locality and be registered with a Vale of York GP.

Patients that are referred into the community stroke team will be assessed in their own homes.

A treatment plan will be provided for patients to work on independently or with family and carer support.  Following the assessment the community stroke team will provide information on frequency of  follow-up appointments, which will be delivered both from qualified therapists and therapy assistants.  Patients are encouraged to set goals with support from the team to direct their therapy.

Patients will be supported via the team to the point of discharge from the service.  Advice and a self-management plan will be provided for patients to aim for further recovery where appropriate on discharge.

Benefits for patients include:

• Reduction in the length of hospital stay
• Patient-centered care delivered within a home environment
• Improvements in long term recovery
• Independence in daily activities
• Reduction on others for support
• Seamless transfer for hospital to home
• Improved satisfaction

The team consists of:

• Consultant
• Administrator
• Physiotherapists
• Occupational therapists
• Speech and Language therapist
• Dietician
• Rehabilitation assistants
• Nursing input

Contact  

Please contact the Community Stroke Team by calling 01904 725382.