Stroke
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Transcript of Stroke
Redesigning stroke services - specialising care and improving rehabilitationChris Streather - Clinical Director HfL Stroke Project
The case for change
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Target
Below Target
Above Target
London Stroke Providers against Sentinel Audit 12 key indicators 2006
Change in London Stroke Providers against Sentinel Audit 12 key indicators
2006 vs 2004 scores
London stroke units sentinel audit comparison 2004 and 2006
Current situationAspirations –
raising standards
Door to needle time < 30mins
CT scan within 24 hours of admission – 95%
Physio assessment within 72 hours of admission – 100%
Patients admitted to Stroke Unit on day of admission - 90%
Units will need to demonstrate how and when they will meet the required standard
Project objective - raise standards and improve outcomes
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90%
90%
90%
CT within 24 hours
Physio assessment within 72 hours
Patients treated in a stroke unit
Sentinel audit
Scope – end-to-end pathway
PreventionPrevention Acute Acute Rehab Rehab
PreventionPrevention Awareness Awareness Initial Assessment
Initial Assessment
On-going Assessment
On-going Assessment
Transfer of Care Transfer of Care
On-going Care
On-going Care
Scoping education along the stroke pathway
• Successful bid for funding from NHS London for a Project Team to:
– Undertake a needs assessment for the skills and knowledge required along the Stroke Pathway for all healthcare professionals
– Devise a leadership programme to develop leadership skills across the stroke community
– Development of a core syllabus to deliver the skills and knowledge required to bridge the theory-practice gap.
– Identify and commission potential providers to undertake provision of training for the syllabus
– Develop a standardised competency framework for all professional groups working with stroke patients
Educated workforce and public able to recognise the symptoms and risk factors
for stroke/TIAs
More patients presenting toacute care within 2 hours
of symptom onset
Public/patients make lifestyle choices to reduce
their stroke risk
All health and social careorganisations take prevention seriously
Prevention - what are we trying to achieve?
Stroke awareness
Rehabilitation and community care
For rehabilitation and community care, we are not commissioning a new service model but would like to improve the current models of care:
• Focus on a set of performance standards that all care settings can refer to
• High level understanding of need and service costs
Patient pathways into community therapy - currently
Stroke unit
No therapy
End of life care
Inpatientspecialist
rehab
Voluntary services
GP and community nursing
Community therapy
Early supported discharge
Community stroke team
Intermediate care
Generic team
Neuro team
Social care Vocational rehab
Psychology
Hyper-acutestroke unit
(HASU)
therapy long term Outside project scope Service gaps
Long-term Care
Vol
unta
ry a
nd
Inde
pend
ent s
ecto
rs
GP and Community Nursing
Social Care
Delivered by; Community stroke team,Pan Pathway stroke team
Or enhanced *Intermediate care
*Generic team*Neuro team
COMMUNITY CARE
Stroke Specialist SkilledCommunity therapy &
rehabilitation service
Including early supported
Discharge, Vocationalrehab, psychology
Patient pathways into community therapy – new model
Stroke unit
No therapy
End of life care
Inpatientspecialist
rehab
Hyper-acutestroke unit
(HASU)
In-reach or Out-reach
Access to lifelong care
Stroke patient and carers views
What made things worse after your stroke?
• No continuous support e.g. a key-worker• People felt “passed around”• Services did not share information• Not giving people time• Time – not given enough
Suggestions for improvement: key themes identified in the responses
Experience of care
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ospit
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skills
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taff
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equipm
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Finance
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fits in
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elp
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unicat
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sour
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Info
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troke
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Long Term Care
• Separate piece of work will be carried out
• Area identified by stroke patients, carers and variety of others as vital to improving service
• Links with social services need to be explored
• Need to understand process of regular review – who does it?
Long term care strategy
Stroke unit
No therapy
End of life care
Inpatientspecialist
rehab
Voluntary services
GP and community nursing
Community therapy
Early supported discharge
Community stroke team
Intermediate care
Generic team
Neuro team
Social care Vocational rehab
Psychology
Hyper-acutestroke unit
(HASU)
therapy long term Outside project scope Service gaps
Long-term Care
Long term care – patient and carers views
For patients :
“it takes years – we need emotional and mental support”
“having my own wheelchair has helped me and my carer”
“a month ago I could only use my lawnmower for ½ hour. Yesterday I used it for 1 ½ hours”
Long term care – patient and carers views
For carers:
“the sense of complete loneliness –fear”
“no adequate provision for respite care”
“It was like having a bereavement”
Role of the stroke networks
Network Board
Innovation Audit
Clinical Leadership
Education and Training
Quality
R & DResearch NetworksService Redesign
Technology
Stroke registry Opportunities across network
Evaluation of Performance
Patient and Carer Involvement
CommissionersService
Providers
Network Connections
“They have helped me get back to my old self again”
(Stroke Survivor)
