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Scottish Stroke Care Audit System

Scottish Stroke Care Audit System. NHS Fife 2012 data Dr Sue Pound, Stroke Consultant Hazel Fraser Stroke Co-ordinator Isla McBain, Stroke Audit assistant Nov 2013. National Scottish Stroke Care Audit System (SSCAS).

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Scottish Stroke Care Audit System

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  1. Scottish Stroke Care Audit System NHS Fife 2012 data Dr Sue Pound, Stroke Consultant Hazel Fraser Stroke Co-ordinator Isla McBain, Stroke Audit assistant Nov 2013

  2. National Scottish Stroke Care Audit System (SSCAS) Facilitates collection of data which reflects the quality of stroke services Acts as a stroke register Ensures routine outcomes adjusted for casemix Monitors health boards performance against national standards Monitors health board performance against HEAT target HEAT target ended March 2013 however remains a Scottish Stroke Standard Scottish Stroke Standards were updated for 2013

  3. Data PeriodJanuary 1st to December 31st 2012Patients discharged with a final diagnosis of stroke • Inpatient data based on stroke patients only • Victoria Hospital: 538 •  Out patients for analysis of waiting times for audit only those with a Definite cerebrovascular diagnosis are included • VHK 193 (417 seen at clinic) • QMH 218 (433 seen at clinic) • Through out the year data is reported on early diagnosis of stroke. Final figures are based on patients discharged in that time period with a final diagnosis of stroke so may vary slightly

  4. Actions to improve delivery of stroke care in relation to NHS QIS Care bundle proforma comprising ASU,CT,WSST and Aspirin initiation to be commenced in A & E Exception reporting and regular feedback weekly to A & E, AU1and ASU to continue Outreach service – includes senior nursing staff from the stroke unit Initiation of incident forms if appropriate Raise awareness and educate staff on stroke

  5. 2012 – day 0: 37%, day <=1 : 83%2011 data day 0: 31% day<=1: 65%

  6. Additional Actions to improve access • Direct Access to stroke unit where possible • Regular visits to A & E and AU • Encourage staff to phone outreach team • Care Bundle includes query stroke/TIA • Review rehab pathway & explore ESD • Implementation of a standard operating procedure for the acute stroke unit • Working with capacity team

  7. Additional Actions to improve times to scanning • Raise awareness of availability of scanning – up to 10pm OOH • A & E Dr’s to request CT scans early • Outreach team to encourage early scanning • Radiology training radiographers in CT • Pre alerting Xray

  8. Additional actions to improve % WSST • Train the trainers – champions of WSST • Care bundle completion • A & E and AU1 training and awareness • Weekly feedback on performance • Dysphagia subgroup of MCN • Outreach team to ensure WSST performed

  9. Additional actions to improve aspirin results • Outreach team encourage stat dose to be given • Care bundle completion • Ensure patients with same day discharge are given STAT dose • Prescribe alternative routes • CT scan results more timely • Developed Patient Group Directive for Aspirin

  10. ACTIONS Audit delays Education SAS and A & E Thrombolysis governance meetings A & E Alerted by SAS CT prewarned stroke admission STAT (stroke and TIA assessment training)

  11. Outpatient referral to seen at clinic standard 80% of new patients with a stroke or TIA are seen within 7 days of receipt of referral to the neurovascular clinic QMH 81%, VHK 82% 2011 data Fife wide 78%

  12. Actions to improve waiting times • Increased one stop TIA clinics to 4 a week • Additional clinic with no CT/Doppler access • TIA Hotline • Improve GP awareness through campaigns and PLTs • Developed and continued update of TIA clinic referral form and pick up points in A & E and AU which are accessed daily • Screening of all referrals • Introduction of RMS had led to delays though this is improving

  13. HEAT target To improve stroke care “90% of all patients admitted with a diagnosis of stroke will be admitted to a stroke unit on the day of admission, or the day following presentation” by March 2013 NHS Fife failed the target, performance had dropped in Nov and Dec 2012 Jan – March 2012 : 71% Jan – March 2013: 95% Apr – June 2012 : 85% Apr – June 2013: 95% Jul – Sep 2012 : 91% July – Sept 2013: 97% Oct – Dec 2012 : 79%

  14. New Challenges • To continue to improve performance against updated stroke care standards • HEAT target has been adapted as a national stroke standard • Continuation of outreach service • Downstream bed availability • Possible development of a HEAT target to reflect a bundle of care • Collection of additional information – pilot site for rehabilitation audit.

  15. Stroke Care Standards Update for 2013 90%of all patients are admitted to the stroke unit on the day of, or the day following presentation, and remain in specialist stroke care until in-hospital stroke related needs are met. *it is expected where possible and safe, all patients with a stroke be directly admitted to the stroke unit 90% of patients have CT/MRI imaging within 24 hours of admission *expectation is that all patients with suspected stroke will have imaging as soon as possible. This standard will be reviewed and may be changed to within 12 hours.

  16. Clinical Standards Update for 2013 cont’d 1 90% of patients are screened by a standardised assessment to identify and difficulty swallowing on day of admission Aspirin is given on the day of admission or the following day (for all patients in whom a haemorrhagic stroke, or other contraindication, as specified in national audit, has been excluded.) 80% of new patients with stroke or TIA are seen within 4 days of receipt of referral to the TIA clinic

  17. Clinical Standards Update for 2013 cont’d 2 MCN monitors delay between arrival and administration of thrombolysis. 80% of patients should receive bolus within one hour of arrival 80% of patients undergoing carotid endarterectomy have the operation within 14 days of the stroke event

  18. 2013 performance up to 30th September Access to stroke unit <= 1day target 90%

  19. Water Swallow screening test day 0

  20. Brain imaging <= 24 hours

  21. Aspirin given as per SSCAS <= 1day

  22. Seen TIA clinics <= 4days (from receipt of referral)

  23. Thrombolysed <= 60 mins 27.3% for last 12 months Since January thrombolysed 49 patients 3 were in patients 8 thrombolysed for a non index event (door/needle time does reflect actual time) 10 under 1 hour Further 15 under 1hr 30mins.

  24. Carotid Endarterectomy within 14 days Numbers small 33% for last 12 months 14 CEA since Jan 2013 data not complete yet

  25. Further information available at www.strokeaudit.scot.nhs.uk Any local queries please contact Hazel Fraser Stroke Co-ordinator Hazel.Fraser@nhs.net

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