The benefits of a discharge checklist to identify care needs after stroke

Stroke is the second and the third leading cause of death and disability worldwide, respectively. Having medical and nursing care after discharge from hospital is necessary to most older patients. The aim of this study was to develop a post stroke checklist detecting older patients who need follow up cares.

This checklist development study was conducted in Iran throughout 2023 to systematically screen older post-stroke patients requiring follow-up nursing care on discharge. A five-stage mixed-methods approach was employed: 1) initial checklist drafting based on a synthesis of 42 relevant studies; 2) interviews with home care nurses to identify clinical experiences and barriers; 3) interviews with patients and their families to determine care demands; 4) a multidisciplinary Delphi panel (n = 15) with experts in neurology, geriatrics, nursing, and social medicine to refine the checklist; and 5) clinical application over three months to evaluate detection rates compared to pre-checklist data. Content validity (CVI, CVR) and reliability (Cronbach's α) were assessed statistically.

The checklist structure was designed in eleven main domains, including nervous, respiratory, digestive, urinary systems, skin, movement disorders, psychological status, pain assessment, medical connections and equipment, underlying conditions, and others. The experts' opinions were analyzed through the validation form using the Content Validity Ratio (CVR) and Content Validity Index (CVI) indices. The results of the CVR analysis showed that all items had the necessary content validity with a score higher than 0.90. Also, the CVI index for each item was higher than 0.81, and the average CVI of the overall checklist was calculated to be 0.93, all of which indicate the desired content validity of the tool.

This study developed and validated an 11-item post-stroke checklist for screening older patients requiring follow-up care. The tool provides clinicians with a standardized method to initiate timely interventions, though future studies should assess its impact on long-term patient outcomes.

Clinical implementation demonstrated substantially improved identifying rates. Using the checklist enabled nurses to screen significantly more targeted older patients during follow-up than they did in the same period before its implementation (86% vs. 4.7%).