• 10.00am Welcome and introduction– Cerilan Rogers
• 10.05am Feedback from expert panel process– Paul Tromans
• 10.20am Update on project workstreams– Anne Freeman
• 10.40am Stroke audits in Wales – Sarah Jones
• 11.00am Coffee• 11.20am Developing an integrated stroke service
– Chris Burton• 11.30am Developing a stroke unit
– Pradeep Khanna• 11.50am Issues in proving imaging services to stroke patients
– Shawn Halpin• 12.10pm Questions and discussion
– Chris Burton• 12.35pm Appraisal of stroke care maps
– Chris Burton
• 1.45pm Feedback of maps– Chris Burton
• 2.15pm Regional issues - thrombolysis in South East Wales– Tom Hughes
• 2.30pm Regional stroke forum development update– Sam Crane
• 2.40pm Coffee• 3.00pm Discussion on regional network
development– Chris Burton
• 3.30pm Evaluation and Close– Chris Burton
Last, current and next
• Results of the RCP Organisational Audit
• Profession Specific Audit process
• AOF audit
• RCP interim audit
RCP Organisational Audit 2008
• “There is reason for optimism”
• Stroke now high on the political agenda
• Effective acute stroke units providing ‘basic’ stroke care
• Do not rush into providing thrombolysis before other components of the service are functioning well
RCP Organisational Audit 2008 (ii)
• “Stroke care in Wales is now high on the list of political priorities and it can be expected that major improvements will be seen over the next two years”
• Need to live up to this expectation
Key findings• Hyper acute care
– Need to have good quality basic care– Provision of thrombolysis in Wales remains very low– Paramedic services integral to acute stroke services
• Imaging– Access outside normal working hours and at
weekends is a problem– Need to meet new imaging standards for the
management of TIA– No problems highlighted in Wales
Key findings (ii)
• Stroke units– The single most beneficial intervention– Small increase in provision in Wales since
2006– All stroke patients should be managed on a
stroke unit
Key findings (iii)
• Staffing– Nursing improving– Psychology, orthotics, podiatry, dietetics poor– Likely lack of physiotherapy, OT, SALT– Social Worker, specialist training
• Community care– ESD saves resources and improves outcomes– Only 10% of services in Wales have ESD
Key findings (iv)
• Discharge planning– Patients need more information, including
their primary care discharge summary
• Training– Need to meet training needs for all staff
• Research– Not well developed in Wales– Research should be an integral part of all
stroke services
Key findings (v) – Wales specific
• Specialist community team– at 14 sites, previously 1
• Early supported discharge– at 2 sites, previously 4
• Thrombolysis– provided at 2 sites
Key findings (vi) – Wales specific• CT scanning (weekdays)
– At 16 sites within 24 hours, previously 9
• CT scanning (weekends) – At 6 sites within 24 hours, previously 4
• Neurovascular / TIA clinic – At 14 sites, previously 9– Seen within 7 days at 8 sites, previously 3– High risk cases seen within 24 hours at 6 sites,
previously 0– Low risk cases seen within 7 days at 6 sites,
previously 0
Key findings (vii) – Wales specific• Patient / carer views sought at 19 sites,
previously 16• Report of patient views produced at 7
sites, previously 3• Organisational scores
– 12 sites improved scores, 5 stayed within 2 points of previous score, 3 sites had lower scores
– 1 unit now in the upper quartile, previously 0– 6 in middle quartile, previously 5
Conclusions
• This is the marker by which progress in Wales will be measured
• Efforts need to continue
Profession specific audits• 2nd Pilot• Aim to incorporate the profession specific audits
into the main RCP audit in the future• RCP / professional colleges involved in the
development of Nursing, Physiotherapy, Nutrition and Dietetics, Speech and Language Therapy, Occupational Therapy
• SSIP Programme of work – Clinical psychology, social work, podiatry
• Focus on in-patient care
Profession specific audits (ii)
• Pilot – Contribute to understanding of stroke services
in Wales– Test the web based approach
• Protocols – Developed by WAG– On the website at
• News and Events• Audits
Location, location, location
• All of the audits sit on the Stroke in Wales website
• nww.stroke.wales.nhs.uk
• Looks like this…
Profession specific audits (iii)
• Audits were available on-line from 14th October
• Pass key needed to access the audits section of the website
• Due to be completed by 30 November 2008
Annual Operating Framework
• Target outlined in WHC (2007) 058
• Implementation of National Standards for Stroke Services in Wales
• Action plan process was intended to focus on stroke unit development to achieve the target
Annual Operating Framework (ii)
• “By March 2009, all patients suspected of having a stroke are assessed and treated in specialist stroke units which comply with the following 5 characteristics identified by the Royal College of Physicians:– Access to continuous physiological monitoring– Access to scanning within 3 hours of admission– Access to brain imaging within 24 hours of admission– Policy in place and adhered to for direct admission
from A and E– Access to specialist ward rounds at least 5 times a
week
Annual Operating Framework (iii)
• An audit tool is being developed
• Nevill Hall Hospital
• Likely to be more consultation
• Audit to be carried out in April
• Via the stroke website
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