South West Stroke Research Network: Achievements and Innovations in Stroke Care

1. So what have the Networks been up to this year? Dr Martin James – Stroke Physician, Royal Devon & Exeter Hospital

2. The South West Stroke Research Network Population 5.05M 17 acute sites 8 community sites

3. South West SRN Recruitment 1497 1008 Expansion to Western CLRN area 555 476 300 Baseline 112 Year on year recruitment from original and extended areas

4. South West SRN Recruitment 1497 Expansion to Western CLRN area 1008 555 476 300 Baseline 112 Year on year recruitment by CLRN area

5. 34 studies open during 2011/12 61% RCT

6. SWSRN Recruitment by site

8. SWSRN Highlights from 2011/12 • SWSRN sites have recruited over 40% of the total to CROMIS-2 and have been asked to present at the CROMIS investigators meeting • SWSRN sites have recruited 40% of IRIS patients in the UK - Bournemouth, Bath and Torbay are the top 3 recruiting sites • SWSRN sites have recruited 40% of AVERT UK recruitment in 2012 • SWSRN sites have recruited 37% of the INTERACT2 recruitment in the UK - from 4 of the 20 UK sites – Bath (top UK recruiter), Exeter, Bournemouth and Taunton • Truro the first to recruit to PODCAST outside the investigator’s site • CLOTS-3 heroes this month – Salisbury and Gloucester (others in the past) • INTERSTROKE set up in collaboration between the Exeter SRN team and the NIHR Clinical Research Facility • PCPI – over 300 people now on the database; April newsletter on the new look website http://www.southweststroke.nihr.ac.uk

9. SWSRN Performance 4th recruitment overall (6th in population size) 3rd in recruitment to RCT’s2nd in recruitment per population 34 studies open during 2011/12 61% RCT

10. SWSRN Performance 4th recruitment overall (6th in population size) 3rd in recruitment to RCT’s2nd in recruitment per population 34 studies open during 2011/12 61% RCT

11. SWSRN Performance 4th recruitment overall (6th in population size) 3rd in recruitment to RCT’s2nd in recruitment per population 34 studies open during 2011/12 61% RCT

12. TWIST – all 7 Peninsula centres now open IMPROVE-Stroke – all but completed, study team now working on HTA funding bid for full study LAST – just opened in Exeter ECHO-PIV – highest recruiting study in Exeter Reach-to-Grasp – two centres now open in Western CLRN area (Bristol and North Somerset) PenCLAHRC thrombolysis modelling Platform and poster at European Stroke Conference, Lisbon ReTrain – IGO study now open South West Studies

13. Avon, Gloucestershire, Wiltshire and Somerset Cardiac & Stroke Network Peninsula Heart & Stroke Network Dorset Cardiac & Stroke Network PENINSULA HEART & STROKE NETWORK

14. Accelerating Stroke Improvement Domains Implementing Best Practice in Acute Care Joining Up Prevention Improving Post Hospital and Long Term Care Key Areas of Focus • AF Detection and Treatment • Timely and effective management of TIA • Direct Admission to a Stroke Unit • Timely Brain Scan • Early Supported Discharge • Joint Care Plans using Single Assessment Process • Review at 6/52, 6/12 and yearly • Carers’ Assessment • Psychological Support

15. How can the NHS respond to the new challenges?

16. Network update - supporting QIPP in 2011-12 Network update - supporting QIPP in 2011/12 • Quality • Supporting centres to improve their ‘90% stay’ performance measure – from 50% in 2009 to 79% for 2012 • Psychological support – developing and supporting the implementation of a Peninsula wide, 4-tier model of psychological and emotional support • Nursing home education framework/training and assessment • Supporting quality data monitoring with Peninsula Stroke database/SINAP → SSNAP • Transparency – publicly available performance information on ‘OurHealth’ website PENINSULA HEART & STROKE NETWORK

17. Network update - supporting QIPP in 2011-12 • Innovation Simulation Modelling with PenCHORD/ PenCLAHRC to inform commissioning & change clinical practice • Thrombolysis – increasing access to alteplase • TIA – reviewing service models and delivery • Demand and capacity planning along the whole pathway • Scenario modelling to predict the impact of change e.g. Early Supported Discharge (ESD) PENINSULA HEART & STROKE NETWORK

18. Network update - supporting QIPP in 2011/12 • Productivity • Standard service specifications (TIA, Acute, Community Rehabilitation and ESD) • Early Supported Discharge – support pilots and evaluation of various models with local Service Improvement Managers (SIMs) • Specialist ‘generic’ cardiac nurses supporting the implementation of Stroke Strategy Quality Marker 1 (raising awareness, manual pulse checks and risk stratification etc.) • Working with SWAST to increase direct access to TIA clinics PENINSULA HEART & STROKE NETWORK

19. Network update - supporting QIPP in 2011/12 • Prevention – Atrial Fibrillation • Development and dissemination of GP information packages • Network Anticoagulation Guidance • Promoting the GRASP-AF tool (medicines management) and opportunistic pulse checking (local GP incentives) • Introducing pilot of INRstar software linkage from an acute trust to Primary Care PENINSULA HEART & STROKE NETWORK

20. Quality ASSIST2 Programme – 8 participating trusts: • Reducing 7-day inpatient mortality by 25% • Increasing the proportion of patients who receive all of the 9 Sentinel key indicators by 80% • A doubling in patients receiving Early Supported Discharge • 85% increase in the proportion of ischaemic stroke patients who receive thrombolysis

21. 24/7 Stroke Thrombolysis rota • Collaboration between 9 acute trusts (one outside the network) – 14 clinicians. This year in AGWS, over 1000 patients assessed, 256 thrombolysed, 25% with support from the Network rota Innovation – Personal Health Budgets for Stroke • Pilot has recruited 115 stroke patients - 50% receiving personal health budgets, 50% controls. Some amazing recovery stories, enabling patients and families to regain control of their lives

22. Prevention ‘Strike at Stroke – Anticoagulate’ – the largest AF programme in the country – 33,565 AF patients (19,457 High Risk) • Over 200 GP practices participated • 2.6% increase in anticoagulation • Maximum increase achieved +16% • Highest practice level of prescribing – 79% on anticoagulation • 601 additional patients anticoagulated • 24 strokes potentially avoided

23. Dorset Stroke Network 2011-12 • AF Strategy • Continued enrolment of GP practices to GRASP-AF • Review of anticoagulation pathways • Continued public awareness campaigns for ‘Know Your Pulse’ • AF-INCH (Atrial Fibrillation in Nursing and Care Homes) project underway • Patient and Public Involvement Model • Now covering CVD as a whole to support CVD Clinical Commissioning Programme: Stroke, Cardiac, Diabetes – vascular services coming online this year • Development of Hyperacute Service at Dorset County Hosp • Hyperacute stroke services launched at DCH in November 2011 • Delivery of 7/7 TIA Services at Dorset County Hospital • 7/7 TIA services launched in March 2012

24. Dorset Stroke Network 2011-12 • Improving Psychological Support after Stroke • showing significant improvements in psychological screening and support in the community, with better collaborative working within existing teams • Now rolling out to be county wide • Expanding project to psychological support for all long-term conditions • Early Supported Discharge Pilots • Poole and Royal Bournemouth pilots completed and evaluated • NHS Dorset pilot due to complete in June • High levels of patient and carer satisfaction • Excellent outcomes, significant bed day savings • Integrating the Network into CVD Clinical Commissioning Programme • Network supporting Commissioning through transition to CCGs • Work programme prioritised in line with regional and national objectives

25. Joining Forces 2012some final commentsThe South West Stroke Research Networkand The South of England SHA and Heart & Stroke NetworksJoint Annual Event