1. Supporting NHS Wales to Deliver World Class Healthcare AWSSIC Hywel Dda- Bronglais Learning Session Two 25 th March 2009

2. Slide 2 All Wales Stroke Services Improvement Collaborative About your Organisation Hywel Dda NHS Trust, Bronglais Hospital, Ceredigion, sparse population but large catchment area South Gwynedd, Powys, Ceredigion New Trust, vast changes – previously smallest Trust in Wales but now cover west and south west Wales and one of the largest Motivated and cohesive stroke MDT management (Ceredigion)

3. Slide 3 All Wales Stroke Services Improvement Collaborative Brief outline of problem To improve care for stroke patients locally To ensure all patients admitted to acute stroke area (or as soon as possible) Limited by bed pressures lack of data collection lack of involvement of external areas i.e. other wards, Emergency Admission Unit (EAU) territorial consultants

4. Slide 4 All Wales Stroke Services Improvement Collaborative Brief outline of problems and their resolution Acute stroke area (four beds) established approx one year ago – working well, but mixed sex and insufficient beds to enable 72 hours of cardiac monitoring for each patient, daily telephone checks for stroke patients admitted elsewhere to prioritise admissions Documentation for acute stroke insufficient – new standards set and charts being developed, to include all parameters Data Collection – database installed, individual with skills and motivation identified to lead on data collection and data entry, retrospective audit to provide baseline data

5. Slide 5 All Wales Stroke Services Improvement Collaborative Brief Outline of Problems and their Resolution Most data missing from notes in retrospective audit – audit tools changed to collect data prospectively, Allied Professionals looking at shared record keeping Multidisciplinary Stroke Project Team established – all with precise actions to develop their part of the service, incredibly motivated but limited for time to make changes A&E – not using established guidelines or ROSIER – new protocol devised to enable improved assessment and treatment plans

6. Slide 6 All Wales Stroke Services Improvement Collaborative Strategy for Change All changes implemented via the newly established Stroke Project Team members, HCSW and Ward Clerk also involved EAU consultant included ROSIER on clerking proforma Stroke protocol introduced into A&E via department sister and consultant, EAU/A&E paperwork brightly coloured for ease of finding Charts devised by stroke unit team to best meet their needs Planned monthly dissemination of audit results

7. Slide 7 All Wales Stroke Services Improvement Collaborative Measurement of Improvement Evolutionary and in it’s infancy! Baseline data demonstrates current service Prospective data collection and subsequent improvement actions will demonstrate progress ‘It takes persistence to reach a goal’ Max Stein 2009

8. Slide 8 All Wales Stroke Services Improvement Collaborative Lessons learnt and Message for Others Don’t be afraid! Big task, daunting at times Tackle the small, simple items first for maximum impact Be inclusive of all staff whoever they are Tackle the ‘big guys’ (Senior Managers) get the message across that stroke matters and outcomes for patients can be improved (and lead to savings in the long term!) Include other consultants who may not feel stroke is ‘sexy’ or outcomes are changeable for patients