18 Acute Stroke UnitLater-presentation stroke patientsReceive Bucks repatriated patients < 72 hours17-bedded UnitStabilisationTherapy Assessment for rehab potentialSignificant proportion of patients go home or to NH from ASU
28 Why missing inpatient targets? ProblemMitigating actions/plansDiagnosisReceiving late referrals from A&E & wards [process]Levels of skill to diagnose in A&E & wards [education]Default position should be to query stroke [education]Knowledge of stroke pathway [education]Sharing data with A&EStroke lead consultant identified on A&ETraining for A&E nursing and medical staff on Stroke pathway and diagnosis – Slot on A&E induction & sporadic teaching sessionsConsultant and ANP walkabout – junior doctors24/7 Stroke coordinatorTargeting individual doctorsDiagnosticsDoppler's - Patients wait (from 2 days to 2 weeks) whilst on ASU due to capacity on sonographer’s list.CTs – generally done on time. Breaches occur due to late referrals/late diagnosisGold standard is for patients to receive Doppler's and CT scans whilst on a Stroke ward within 24 hours of request.Division B are aware of the need for extra capacity for Doppler's.CapacityBed modelling suggests we have enough beds to support the number of patients admitted.ASU admit a range of between 0-5 patients per day. However, using the 80/20 rule, ASU must be able to accept 4 patients per day.In times of capacity pressures in the Trust, medical patients are admitted to ASU.Not consistently repatriating patients within 72 hours from HASU at Wycombe – risk of financial penalties if consistently fail.2 ring-fenced beds on the assessment unit once modular ward opensIncrease awareness Trust wideDevelopment of ESD service for Berkshire East will ensure some patients go home much earlier (target of 41%) – will help flow through ASU and decrease LOS. Due to start Autumn Better rehab outcomes for patients. ESD service will support ASU in maintaining 4 discharges daily.Increased communication between stroke coordinators in ASU and HASU. HASU will give us 24hrs warning of a patient becoming medically fit and in return we will endeavour to repatriate that patient to ASU within 24 hours.StaffingStroke coordinator post was vacant from May to Sept – vital role in executing the stroke pathwaySaLT post vacant – difficult to get a SaLT therapist to do communication assessment within allotted timeframeStroke coordinators in post since SeptemberStroke coordinators on weekdays are therapists and therefore cannot be pulled.New locum SaLT therapist starts this month who will focus on communication assessments.
29 Good news…….Infection ControlTargetNOVOCTSEPTAUGJULYJUNEMAYAPRILTrendHand Hygiene (%)100.0100%►VIP (%)Environment (%)MRSA protocol (%)Patient ExperienceCompliments152023181210▲Name bandsConsistently performing in infection control and patient experience
30 ASU “Friends & Family” Questionnaire Jan – August 2013
31 CQC Report:In contrast, on the acute stroke unit, patients and their relatives felt very well informed about their treatment plans and told us they were involved in making decisions about their care. One patient told us, "we have been given great family support."
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