Transforming Stroke Care in London: The story so far Tony Rudd Clinical Director for Stroke in London
In 2004 the Sentinel Stroke Audit showed that stroke services in London were poor… Physiotherapist assessment within 72 hours of admission % Emergency brain scan within 24 hours of stroke % 90% 90% Patients treated in a Stroke Unit % 90% Case for change
More strokes occurred in outer London but most providers were in inner London GAPS GAPS GAPS OVERLAPS The more intense the red the greater number of providers available to provide service to the area.
Story so far The development of the strategy was subject to wide engagement with the model of care agreed by clinicians and user groups
Provide immediate response
Specialist assessment on arrival
CT and thrombolysis (if appropriate)
within 30 minutes
High dependency care and
Length of stay less than 72 hours
High quality inpatient rehabilitation
in local hospital
On-going medical supervision
On-site TIA assessment services
Length of stay variable
30 min LAS journey* After 72 hours Discharge from acute phase Community Rehabilitation Services * This was the gold standard maximum journey time agreed for any Londoner travelling by ambulance to a HASU New acute model of care
Between February and July the proportion of patients admitted directly to a HASU increased from 33% to 69% . Since July over 90%
The average journey time from home to a HASU is 14 minutes. The HASU with the longest average transfer time was Kings at 17 minutes. The average time from LAS taking the call to arrival at a HASU is 55 minutes
The number of stroke patients taken by London Ambulance Service to a HASU has been increasing as implementation progresses
587 patients thrombolysed in the 5 months between Feb 2010 and June 2010 compared to 174 in the same 5 months in 2009
The thrombolysis rate for patients brought by LAS to hospital in London is 14%. If use the incidence data of 11,000 strokes per year in London then the thrombolysis rate is 12%. These rates are higher than any reported for a large city in the world
Average length of stay in a HASU is 3 days. Average length of stay overall has fallen e.g. 24 to 17 days at UCLH
% of patients discharged home directly from HASU about 40% (predicted 20%)
Performance data shows that London is performing better than all other SHAs in England Thrombolysis rates have increased since implementation began to a rate higher than that reported for any large city elsewhere in the world % of patients spending 90% of their time on a dedicated stroke unit % of TIA patients’ treatment initiated within 24 hours 12% 10% 3.5% Feb – Jul 2009 Feb – Jul 2010 AIM
Efficiency gains are also beginning to be seen Average length of stay HASU destination on discharge
A 73 year old male from Harrow was one of the first patients to be taken to the Northwick Park Hospital HASU after suffering a stroke at home.
He describes the experience as “miraculous”.
He collapsed at home at 2.30am feeling sick and dizzy with weakness in his legs. His wife called an ambulance and paramedics took him to Northwick Park Hospital A&E. He was immediately given a CT scan and subsequently thrombolysis.
The patient recalls “It was very serious…My care at the hospital was superb. My speech was slurred before I had the injection but afterwards I was word perfect .It was incredible. After being given the treatment I came round straight away and the next day I woke up and was almost back to normal, had breakfast and went home. I am now completely back to normal and go to the gym twice a week.”
The patient was not unfamiliar with stroke. He had one three years previously following a triple heart bypass and was in hospital following complications for three and a half months. So the experience this time – in and out of hospital in less than two days – was a revelation for him.