The stroke pathway for ABUHB patients was redesigned over 3 years through a process that engaged stakeholders. Key milestones included workshops from 2013-2014 to model options, an early supported discharge pilot in 2014, and implementation of the full redesign in December 2015 including a hyper-acute stroke unit. Additional changes were made to radiology, staffing, and therapy assessments to further improve stroke care outcomes. The redesign process focused on continually engaging stakeholders, modeling the clinical pathway, assessing feasibility, and identifying benefits to make the case for change and implement the new pathway.

1. Th t k th f ABUHB t d i d i d f 3
ABUHB
The stroke pathway for ABUHB pa ents was re‐designed over a period of 3
ABUHB LEADING
p y p g p
d l ll k h ld h h h
ABUHB LEADINGyears, engaging and involving all stakeholders throughout the process
ABUHB LEADINGyears, engaging and involving all stakeholders throughout the process
ABUHB LEADINGKey MilestonesABUHB
S k TRANSFORMATIONAL
Key Milestones
Stroke TRANSFORMATIONAL
y
Stroke TRANSFORMATIONALStakeholder workshops modelling and op ons appraisal 2013 ‐ 2014
Stroke TRANSFORMATIONAL• Stakeholder workshops, modelling and op ons appraisal 2013 ‐ 2014
Stroke
C G
Modelling and feasibility assessment of chosen op on 2014 2015Stroke
S i CHANGE
• Modelling and feasibility assessment of chosen op on 2014 ‐ 2015
Services CHANGEP B i C d 21 t A il 2015
Services CHANGE• Programme Business Case approved 21st April 2015
Services CHANGEE l S d Di h (ESD) il d l O b 2014Services IN THE
• Early Supported Discharge (ESD) pilot and evalua on October 2014Services
R d i
IN THE
y pp g ( ) p
Re design
IN THE• Staff consulta on (3 months) May 2015
Re design
IN THE( ) y
Re-design STROKE PATHWAY
• Full ESD implementa on December 2015 (achieving 40% ESD in May 2016)
Re design STROKE PATHWAY
• Full ESD implementa on December 2015 (achieving 40% ESD in May 2016)
Re design STROKE PATHWAYRadiology changes July 2015 * STROKE PATHWAY• Radiology changes July 2015
Addi l St k C lt t i t d D b 2015*• Addi onal Stroke Consultant appointed December 2015*
SCANNINGSCANNING • HASU and front‐end stroke team established; Pathway changed 25th January 2016* SCANNING
Engage and continue to engage
SU a d o t e d st o e tea estab s ed; at ay c a ged 5t Ja ua y 0 6
Engage and continue to engageEngage, and continue to engage,
all stakeholders!all stakeholders!all stakeholders!
Define the clinical pathwayDefine the clinical pathwayDefine the clinical pathway
** *** * ** *
Outline optionsOutline options
STROKE UNIT AND THROMBOLYSIS
Outline options
STROKE UNIT AND THROMBOLYSISSTROKE UNIT AND THROMBOLYSIS
Appraise optionsAppraise optionsAppraise options
A f ibiliAssess feasibilityAssess feasibilityy
** *** *** * * * * * * * * * *
M d l th thModel the pathwayModel the pathway
Theoretical testingTheoretical testingH S k U i Theoretical testingHyper‐acute Stroke UnitHyper acute Stroke Unit
St k S l N l A dit PStroke Sen nel Na onal Audit Programme g
Practical testing(SSNAP) Standards Practical testing** * (SSNAP) Standards Practical testing ( )
STROKE CONSULTANT Quality Improvement/PDSAsSTROKE CONSULTANT Quality Improvement/PDSAsSTROKE CONSULTANT Quality Improvement/PDSAs
W kf d iWorkforce re-designWorkforce re-designo o ce e des g
Fi i l tFinancial assessmentFinancial assessment
** * ** *
Identify measurable benefitsIdentify measurable benefits
STROKE NURSE
Identify measurable benefits
STROKE NURSESTROKE NURSE
Model the benefitsModel the benefitsModel the benefits
Make the case for changeMake the case for changeMake the case for change
** * ** ** * * * * *
CConsult stakeholdersConsult stakeholders
THERAPY ASSESSMENTS
Consult stakeholders
THERAPY ASSESSMENTS (formally and informally)THERAPY ASSESSMENTS (formally and informally)(formally and informally)
Implement pathwayImplement pathwayImplement pathway
Monitor and realise the benefits** * ** * Monitor and realise the benefits** * * * * * * * Monitor and realise the benefits
Ab llEARLY SUPPORTED DISCHARGE Above allEARLY SUPPORTED DISCHARGE Above allEARLY SUPPORTED DISCHARGE
COMMUNICATE!COMMUNICATE!COMMUNICATE!
Mar n Lane, Senior Planning Manager mar n.lane@wales.nhs.ukMar n Lane, Senior Planning Manager mar n.lane@wales.nhs.uk
Dr. Yaqoob Bhat, Stroke Clinical Lead yaqoob.bhat@wales.nhs.ukDr. Yaqoob Bhat, Stroke Clinical Lead yaqoob.bhat@wales.nhs.uk
Alison Shakesha , Execu ve Director of Therapies and Health Science alison.shakesha @wales.nhs.ukAlison Shakesha , Execu ve Director of Therapies and Health Science alison.shakesha @wales.nhs.uk
Kylie Crook, Clinical Nurse Specialist for Stroke kylie.crook@wales.nhs.ukKylie Crook, Clinical Nurse Specialist for Stroke kylie.crook@wales.nhs.uk