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Furness General Hospital Royal Lancaster Infirmary Westmorland General Hospital Dr Pradeep Kumar, Consultant Physician 12 th.

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Presentation on theme: "Furness General Hospital Royal Lancaster Infirmary Westmorland General Hospital Dr Pradeep Kumar, Consultant Physician 12 th."— Presentation transcript:

1 Furness General Hospital Royal Lancaster Infirmary Westmorland General Hospital Dr Pradeep Kumar, Consultant Physician 12 th October 2012

2 University Hospitals of Morecambe Bay NHS Foundation Trust  Furness General, Royal Lancaster Infirmary, Westmorland General Hospital (an hours drive from FGH – RLI)  Three outpatient centers  Population of 350,000 approx.  Geographical area of over 1,000 square miles  6000 staff About our hospital

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4 How we acted on the results: The results were disseminated to various stakeholders Presented at the cross-bay medical audit meeting Cardiac & Stroke network meeting Trust Board

5  These were some of the results of the 7 th round of the sentinel audit (2010)  Bearing in mind the audit was retrospective and only looked at some case notes  Therefore quality of the audit was debatable  Yet important learning points

6 National (median) FGHRLI 90% of stay in stroke unit 62.2%67%41% Swallowing disorder screen <24 hours since admission 84.1%94%87% Brain scan <24 hours since stroke 70.5%63%67% SUMMARY OF PROCESS OF CARE - Key 9 process indicators

7 National (median) FGHRLI Aspirin by 48 hours since stroke 94.1%95%88% Physio assessment <72 hours 93.0%98%80% OT assessment <4 working days since admission 87.1%95%73% SUMMARY OF PROCESS OF CARE - Key 9 process indicators

8 National (median) FGHRLI 90% of stay in stroke unit 62.2%67%41% Swallowing disorder screen <24 hours since admission 84.1%94%87% Brain scan <24 hours since stroke 70.5%63%67% SUMMARY OF PROCESS OF CARE - Key 9 process indicators

9 Sequence of events: Took part in the 90:10 Northwest stroke project, subsequently also entered the next round of the national sentinel stroke audit 2010 Figures significantly fell in that round (chart) We won’t go into the reasons behind it as it was due to a variety of factors

10 Where are we now since the peer review:

11  Our key indicators started falling well below national average  There were a number of reasons behind this  Perhaps best not dwell on it  Best if I start to say how we started progressed What went wrong

12  Health care across the country is involved  Improve the quality of clinical care for patients  Improve patient outcomes  Prospective  Based on national clinical guidelines  Based on evidence  Includes patient involvement What is a national clinical audit

13 Next steps: Close working relationship with the cardiac & stroke network -Understanding the reasons for poor results -Put in place processes to improve performance -External peer review of stoke services presented by RCP & BASP

14  Close working with cardiac and stroke network.  Organised external peer review conducted by joint Royal College of Physicians and British association of Stroke Physicians  End of the review there was a presentation by the peer review – with recommendations  A comprehensive review and recommendations were sent to the Clinical Lead and the Trust chief executive and to the cardiac and Stroke Network External stroke peer review

15 Key recommendations from external peer review: 1.Better engagement of the management team with the clinical team (service re-alignment) 2.Identify Executive Champion (Medical Director) 3.Review overall stroke care pathway 4.Robust high quality data capture system

16  A constructive and open dialogue with the commissioners – formulate a cohesive local strategy  Acute stroke care pathway with agreed goals and targets  time frames  Establish an acute stroke unit for the first 72 hours as a matter of urgency  Identification of a “stroke champion at the board level  Forming a strategic working group to focus on key priorities and recommit to the provision for acute stroke as a “core business” Key recommendations

17  As a priority a task group was established  This involved key stakeholders from the Trust and the commissioners  At the Trust board level –Programme Management Office for stroke set up  Identified key stake holders to represent this Office  Highlighted the key recommendations of the peer review  Established the key performance indices (KPIs) Steps to implement the process

18  Incorporated all these info into the SharePoint  Clear time frames and targets and ways to progress  Traffic light system  Share point updated on a weekly basis by the members of the task group Steps to implement the process

19  Weekly meetings  Discuss the progress of the project  Highlight areas of concern or where no progress made and have clear action plans and time scales  celebrate the achievements within the group and all the staff involved in the delivery of the stroke care  engage the senior management team at the board level and constantly updating our progress of the project  Communicate! Communicate!! Communicate!!! Steps to implement the process

20  In previous years it was retrospective National sentinel audit  We are now into SINAP ( Stroke Improvement Programme) – real time data for the first 72 hours of care  The results of the data are published on a quarterly basis  Public domain Data issues

21  An area of serious concern was the data quality and coding  Inconsistent  Poor quality  Incomplete  Poor grasp and focus on the pressing priorities for improvement of stroke service Data issues

22  Team effort  Clinical audit team  Information and technology  Clinical lead for stroke  Senior manager  Senior nurse from the stroke unit  Coding managers Steps to implement the process

23 Where are we now?

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27  5 bedded acute stroke unit  Dedicated stroke data collection clerk  Business case for early supported discharge  An executive “champion” at board level-medical director  Regular audit meetings to discuss stroke mortality Operational changes

28  National clinical audit  Helped to implement local delivery process  Have clear communication and discussions with the senior executives and better working relationship to improve service delivery  Monitor progress and implement change  Business planning  Service development and service redesign Summary and conclusions

29  Evidence based quality care  Benchmark against national standards  Has hugh influence in the future direction of the services  Provide information on re-commissioning  Value for money  CEQUIN  AQ (North west) Summary and conclusions

30  Upmost satisfaction for the staff knowing that the local population are getting the best care  Patient and public confidence as the results are now in public domain Summary and conclusions

31 We have a long way to go but it is a huge step in the right direction and the National Clinical Audit has been the key mechanism to drive change


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