1. Supporting NHS Wales to Deliver World Class Healthcare Gwent Healthcare NHS Trust Royal Gwent Hospital Royal Gwent Hospital Task Group 4 th February 2009

2. Slide 2 All Wales Stroke Services Improvement Collaborative Royal Gwent Hospital Acute general hospital in Newport covering 5 boroughs 45 – 50 Stroke admits/month Patients admitted via A and E and MAU - - source of referrals Cross cover by Stroke Specialist Nurse Accepts/reviews referrals from all wards to assess if meets criteria for acute stroke unit Integrated stroke pathway 32 Bedded Ward (Acute Stroke Unit) No ring-fenced beds Multidisciplinary cover, including, Consultant with special interest in Stroke, medical team, physiotherapy, occupational therapy, speech therapy, pharmacy and dietetics

3. Slide 3 All Wales Stroke Services Improvement Collaborative The Task To data collect on the parameters of care for stroke patients To identify from the data our specific areas for improvement Difficult to establish/quantify its effect on patient care – rationale for data collection

4. Slide 4 All Wales Stroke Services Improvement Collaborative The Context Coordinated by the task group based on the ASU Collated data from all areas involved in stroke care throughout the patient’s journey All referred acute stroke patients to the RGH

5. Slide 5 All Wales Stroke Services Improvement Collaborative Task assessment and analysis Anecdotal evidence of gaps in knowledge, service and practice in stroke care CNS on review of patient or retrospectively, commenced data pro forma Physiotherapy, Occupational therapy, Speech and Language therapy attached to ASU completed data as required Adapted CNS pro forma to incorporate NLIAH criteria

6. Slide 6 All Wales Stroke Services Improvement Collaborative Strategy for Change Formal and informal meetings Multidisciplinary meetings Pro forma on paper kept in centrally located file easily accessible to all Dissemination of information and feedback of NLIAH meetings by project lead All data input by members of task group Two months, commenced mid-December

7. Slide 7 All Wales Stroke Services Improvement Collaborative Measurement of Effectiveness Daily review of data sheets by CNS Identified uncompleted data and liaised with appropriate member of MDT Approached ASU nursing staff to support in data collection Twice weekly review of file in MDT meetings

8. Slide 8 All Wales Stroke Services Improvement Collaborative Effects of Changes Provided hard evidence of where gaps in service lie Now an on-going tool for assessment - - established a baseline Identifies differing patient pathways Has not resolved problem but has given areas to focus on More aware of time scales and enables us to prompt certain assessments Getting people on board and completing the pro forma

9. Slide 9 All Wales Stroke Services Improvement Collaborative Effects of Changes- Negatives Lack of awareness of NLIAH project so task group required to encourage enthusiasm and motivation of additional staff Getting people on board and completing the pro forma Difficulty getting others to take ownership of NLIAH project Lack of consistent commitment from original team members Difficulty in getting the team together Difficulty in attaining full attendance for meetings Data set not detailed enough to give variables i.e. aspirin, thrombolysis Reliant on CNS input i.e. no data collection during CNS-leave Task group not fully representative of patient pathway i.e. no representation from A and E/MAU

10. Slide 10 All Wales Stroke Services Improvement Collaborative Lessons learnt Look towards what you have to use for data collection before reinventing the wheel Initial introduction to NLIAH for all relevant trust members Get committed team with representation from all relevant areas

11. Slide 11 All Wales Stroke Services Improvement Collaborative Message for Others Data collection can be easily incorporated into daily roles with commitment from a team and quickly starts to provide a basis for change