Introduction
Early Supported Discharge (ESD) is a well-established best practice in stroke care that has been demonstrated to reduce adverse outcomes, improve activities of daily living, and reduce the length of hospital stay and system costs.  However, rural ESD programs have expressed challenges in providing care at the level of intensity required to be most effective.  This study aimed to develop operational guidelines for a newly proposed ESD program in rural Ontario to prospectively address these concerns. 
Methods
In partnership with local healthcare providers and stroke experts, operational guidelines were developed for a proposed ESD program in Stratford, Ontario taking a patient-first approach.  The project built on the ESD literature, surveys of established ESD programs, locally collected patient data, and patient/family survey information in a collaborative and iterative process. 
Results
The operational guidelines developed include minimum staffing requirements for physiotherapy, occupational therapy, speech language pathology, social work, recreation therapists, rehabilitation therapists, management, and administrative support to achieve a target of 3 hours of therapy per day, 5 days a week, for 2 weeks post discharge.  Targets for service provision were developed for each profession accounting for vacation and sick time, travel, documentation, and training.  Strategies to address volume surges were also developed. 
Conclusion
Early supported discharge is an effective care strategy post stroke, but only if provided in a timely manner at the right level of intensity.  These operational guidelines were developed to give patients admitted to our newly-proposed ESD program the best chance to receive this important care.

Developing Operational Guidelines for Early Supported Discharge Post Stroke in a Rural Canadian Setting