ESD Stroke Pilot

Pilot Based on retrospective audit and budget of £75,000. Clinical Leads OT and Physio from RCH Acute Stroke Unit developing and leading pilot. Therapy based ESD Pilot commenced 07/11/11, for 6 months. Pilot area determined by area of greatest demand and where there is a fully established Stroke Unit. New Stroke Unit opened in the east of the county.

ESD PILOT Pilot Area Carrick, Kerrier and Penwith Central base of ESD team at Royal Cornwall Hospital Woodfield Stroke Unit Lanyon Stroke Unit Large rural geography with 1376 square miles.

Referral criteria for pilot Patients over the age of 18. New clinical diagnosis of Stroke via Consultant or CT. Stroke specialist intensive therapy more than twice weekly to achieve identified goals. Able to transfer independently or with assistance of one Patient and carer consent to ESD Home environment has been risk assessed Patients has risks minimised between carer visits Patient able to make basic needs known. Patients who have established dietary routine

Pilot Staff recruited – 1.0 wte Band 6 OT and 1.0 wte Band 6 Physio;1.8 wte Band 4 and 0.5 wte ESD Administrator. Demand for SLT and dietetics audited through the pilot and spot purchased as required. 5 day service delivered through one team based at the Acute Hospital. ESD service to respond to referral within 24 hours on a working day. Direct referrals for rehabilitation care packages with stroke specific trained carers.

Progress to date… 61 patients recruited to pilot in 5 months. 33 referred from Acute Stroke Unit and 27 from Community Stroke Unit. 204 bed days saved 3 patients referred from virtual clinic run by Nurse Specialists in ED. Median bed days saved per patient = 3. 8 patients readmitted, all with medical issues. 12 patients identified as requiring SLT input. No patients have required dietetic input currently.

Progress Rehabilitation care packages (STEPS) organised and delivered within 24 hours. ESD have responded to all referrals within 24 hours Contributed to increased direct admission to Acute Stroke Unit (improvement of 20 % since pilot). Community Stroke Unit LOS has reduced from 26 to 19 days. Rolling programme of Stroke education for Adult social Care carers.

ESD – Occupational Therapy & Physiotherapy activity (November 2011 – March 2012)

Stroke 90% target Change in pathway implemented

Benefits Cont… All patients improved in outcome measures. Seamless transfer of care along stroke pathway Median MRS Improvement: 2 pts Median Barthel Improvement: 15 pts Reduction in Community therapy referrals Close working relationships with Stroke Care co-ordinators. Reduction in long term POC

Patient and carer experience questionnaires All provided positive response to the service “It gave me confidence to try and return back to my daily life" (patient) "Mum's recovery has been so much better than expected and has improved on every visit" (carer) " I am able to tackle tasks that were previously unsurmountable" (patient) Direct quotes from questionnaires

Next steps Successful Business case for county wide service with following staffing; –Band 7 Clinical Lead for ESD (either OT or Physio) –North and East, and Central and West each containing 1 WTE Band 6 OT, PT and 2x WTE band 4 rehabilitation technicians. –1x WTE Band 6 SLT across county. –1X WTE Band 2 ESD Administrator Location of teams linked to Community stroke rehabilitation Units Continuation of collaborative working with STEPS. Use of assistive technologies to aid communication between team members being purchased. Continued discussion with Plymouth regarding their ESD service.

Any Questions? Contact Elizabeth Tremayne- Clinical Lead Occupational Therapist bleep 2731 Mandy Gibbs – ESD Specialist Physiotherapist