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Stroke Services at HWPH NHS Foundation Trust

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Presentation on theme: "Stroke Services at HWPH NHS Foundation Trust"— Presentation transcript:

1 Stroke Services at HWPH NHS Foundation Trust
“Getting It Right” Dr Derek Hilton Consultant Stroke Physician Annual Members Meeting 18th September 2013

2 What is a stroke?


4 TIA / “Mini-strokes”

5 ¼ all stroke – working age
Rule of ⅓ 6% NHS expenditure £2.8 bn Does not include social care Average LOS 28 days ¼ all stroke – working age

6 A Comprehensive Stroke Service

7 TIA: “Medical Emergency” High Risk patients
Seen within 24 hours Surgery within 7 days Low Risk patients Seen within 7 days Surgery within 14 days from onset

8 “Thrombolysis” within 3 hours
Extended to 4.5 hours


10 Rehabilitation at home works Creation of Community ESD Teams
For a specific cohort of patients Creation of Community ESD Teams Well-defined service specification


12 A Comprehensive Stroke Service

13 Low Risk ‘One Stop’ TIA Clinic
Heatherwood Hospital Mon, Weds, Fri Clinics Summer 2012 Morning: Doppler, ECHO, Bloods Afternoon: Consultant review

14 Hyperacute Services & High Risk TIA Clinics



17 Acute Stroke Unit

18 Acute Stroke Unit Later-presentation stroke patients Receive Bucks repatriated patients < 72 hours 17-bedded Unit Stabilisation Therapy Assessment for rehab potential Significant proportion of patients go home or to NH from ASU

19 Rehabilitation – Ward 8 HW
12 rehab beds 6 weeks therapy ESD Early Supported Discharge Community-based therapy 6 weeks Home Sooner Better outcomes


21 Performance – Bed capacity

22 Performance – Bed capacity

23 Length Of Stay

24 Performance – Diagnostics

25 Performance – Therapies & Nursing

26 Performance – Therapies & Nursing

27 Performance – Therapies & Nursing

28 Why missing inpatient targets?
Problem Mitigating actions/plans Diagnosis Receiving 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&E Stroke lead consultant identified on A&E Training for A&E nursing and medical staff on Stroke pathway and diagnosis – Slot on A&E induction & sporadic teaching sessions Consultant and ANP walkabout – junior doctors 24/7 Stroke coordinator Targeting individual doctors Diagnostics Doppler'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 diagnosis Gold 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. Capacity Bed 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 opens Increase awareness Trust wide Development 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. Staffing Stroke coordinator post was vacant from May to Sept – vital role in executing the stroke pathway SaLT post vacant – difficult to get a SaLT therapist to do communication assessment within allotted timeframe Stroke coordinators in post since September Stroke 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 Control Target NOV OCT SEPT AUG JULY JUNE MAY APRIL Trend Hand Hygiene (%) 100.0 100% VIP (%) Environment (%) MRSA protocol (%) Patient Experience Compliments 15 20 23 18 12 10 Name bands Consistently 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."

32 The Future…..

33 Thank you

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