Stroke

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Stroke

  1. 1. Redesigning stroke services - specialising care and improving rehabilitation Chris Streather - Clinical Director HfL Stroke Project
  2. 2. The case for change 25 25 24 21 21 19 19 14 12 12 9 9 8 6 6 5 4 4 2 1 0 -1 -3 -3 -4 -4 -5 -7 -9 -12 91 90 89 88 88 86 84 83 80 80 77 76 76 75 72 71 71 71 70 70 68 68 66 65 65 62 61 60 55 51 49 45 90 Target Below Target Above Target London Stroke Providers against Sentinel Audit 12 key indicators 2006 Change in London Stroke Providers against Sentinel Audit 12 key indicators 2006 vs 2004 scores London stroke units sentinel audit comparison 2004 and 2006
  3. 3. Current situation Aspirations – raising standards Door to needle time < 30mins CT scan within 24 hours of admission – 95% Physio assessment within 72 hours of admission – 100% Patients admitted to Stroke Unit on day of admission - 90% Units will need to demonstrate how and when they will meet the required standard Project objective - raise standards and improve outcomes 202225 30 36394345505152545658606163636465656770 77798081828384 17 49 28 53 85 57 64 70 88 96 83 76 64 91 77 8891 8278 72 78 6667 49 75 93 88 97 85 98 58 73 37 4650 42 58 68 7981 69 59 53 87 16 7882 99 72 27 96 72 5354 7882 73 95 8786 90% 90% 90% CT within 24 hours Physio assessment within 72 hours Patients treated in a stroke unit
  4. 4. Sentinel audit
  5. 5. Scope – end-to-end pathway PreventionPrevention AcuteAcute RehabRehab PreventionPrevention AwarenessAwareness Initial Assessment Initial Assessment On-going Assessment On-going Assessment Transfer of Care Transfer of Care On-going Care On-going Care
  6. 6. Scoping education along the stroke pathway • Successful bid for funding from NHS London for a Project Team to: – Undertake a needs assessment for the skills and knowledge required along the Stroke Pathway for all healthcare professionals – Devise a leadership programme to develop leadership skills across the stroke community – Development of a core syllabus to deliver the skills and knowledge required to bridge the theory-practice gap. – Identify and commission potential providers to undertake provision of training for the syllabus – Develop a standardised competency framework for all professional groups working with stroke patients
  7. 7.  Educated workforce and public able to recognise the symptoms and risk factors for stroke/TIAs  More patients presenting to acute care within 2 hours of symptom onset  Public/patients make lifestyle choices to reduce their stroke risk  All health and social care organisations take prevention seriously Prevention - what are we trying to achieve?
  8. 8. Stroke awareness
  9. 9. Rehabilitation and community care For rehabilitation and community care, we are not commissioning a new service model but would like to improve the current models of care: • Focus on a set of performance standards that all care settings can refer to • High level understanding of need and service costs
  10. 10. Patient pathways into community therapy - currently Stroke unit No therapy End of life care Inpatient specialist rehab Voluntary services GP and community nursing Community therapy Early supported discharge Community stroke team Intermediate care Generic team Neuro team Social care Vocational rehab Psychology Hyper-acute stroke unit (HASU) therapy long term Outside project scope Service gaps Long-term Care
  11. 11. Patient pathways into community therapy – new model Stroke unit No therapy End of life care Inpatient specialist rehab Hyper-acute stroke unit (HASU) In-reach or Out-reach Access to lifelong care
  12. 12. Stroke patient and carers views What made things worse after your stroke? • No continuous support e.g. a key-worker • People felt “passed around” • Services did not share information • Not giving people time • Time – not given enough
  13. 13. Suggestions for improvement: key themes identified in the responses Experience of care 0 5 10 15 20 25 30 35 40 45 Therapy Peer/group/carersupport Supportafterhospital Staffskills Specialiststaffand equipm ent Public aw arenessM edication info Finance/benefits info/help C om m unication resources Info aboutStroke/prognosis/caring Theme Frequencyofmention
  14. 14. Long Term Care • Separate piece of work will be carried out • Area identified by stroke patients, carers and variety of others as vital to improving service • Links with social services need to be explored • Need to understand process of regular review – who does it?
  15. 15. Long term care strategy Stroke unit No therapy End of life care Inpatient specialist rehab Voluntary services GP and community nursing Community therapy Early supported discharge Community stroke team Intermediate care Generic team Neuro team Social care Vocational rehab Psychology Hyper-acute stroke unit (HASU) therapy long term Outside project scope Service gaps Long-term Care
  16. 16. Long term care – patient and carers views For patients : “it takes years – we need emotional and mental support” “having my own wheelchair has helped me and my carer” “a month ago I could only use my lawnmower for ½ hour. Yesterday I used it for 1 ½ hours”
  17. 17. Long term care – patient and carers views For carers: “the sense of complete loneliness –fear” “no adequate provision for respite care” “It was like having a bereavement”
  18. 18. Role of the stroke networks Network Board Innovation Audit Clinical Leadership Education and Training Quality R & D Research Networks Service Redesign Technology Stroke registry Opportunities across network Evaluation of Performance Patient and Carer Involvement Commissioners Service Providers Network Connections
  19. 19. “They have helped me get back to my old self again” (Stroke Survivor)

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