Enhancing Stroke Care: Achieving HEAT Targets

1. Royal College of Physicians of EdinburghScottish Stroke Collaboration Meeting22nd September 2010Queen Mother Conference Centre

2. Stroke Care in Scotland 2009

3. Structure of inpatient stroke services in Scotland

4. Access to stroke unit care • NHSQIS standards • 60% on day of admission • 90% by the following day • Rationale • Stroke unit care reduces risk of death/disability • Some patients more appropriate for non SU bed • ? HEAT target coming • 90% by the following day

5. Access to stroke unit care2005 to 2009

6. Access to stroke unit care

7. Issues • Enough stroke beds locally? • Efficient processes to ensure early admission? • Medical cover to ensure patient safety • Protection of beds and working with bed manager • Efficient moving on policies • Daily discharge rounds • Joint working with social services • Early supported discharge • HEAT target?

8. Early swallow screens • NHS QIS standard • All patients admitted with stroke should have a swallow screen documented on the day of admission • Rationale • Swallowing problems affect about 50% of admitted stroke patients • Oral fluids and food may cause pneumonia

9. Early swallow screen

10. Early swallow screens

11. Issues • Robust recording of screening process • Paper proformas • Electronic records • Training of front door staff • Early access to stroke unit • Feedback of performance to staff

12. Early access to brain imaging • NHS QIS standard • 80% on the day of admission • Rationale • Early scanning is most cost-effective strategy

13. Early access to brain imaging

14. Early access to brain imaging

15. Issues • Staff to request scans early after admission • Protocol driven requests • Adequate capacity • Partnership with radiology – make them aware of targets and performance • Reporting

16. Early aspirin administration • NHSQIS standard • All patients with ischaemic stroke should receive aspirin on day of admission, or following day • Rationale • Aspirin within 48 hours of ischaemic stroke improves outcomes

17. Early aspirin administration

18. Early aspirin administration

19. Issues • Early scanning and reporting • Protocol driven prescribing • Nurse prescribing – patient group prescribing • Documentation of definite contraindications

20. Early assessment in NV clinic • NHSQIS standard • 80% of patients should be seen within 7 days of receipt of referral • Rationale • Diagnosis and secondary prevention are more effective soon after the TIA/stroke

21. Early assessment in NV clinic

22. Early assessment in NV clinic

23. Early assessment in NV clinic

24. Issues • Patient awareness • GP awareness • Streamlined referral processes • Demand management • Adequate clinic capacity • Capacity spread through week

25. Summary • Indicators of stroke service performance are improving • Particular improvement in access to TIA clinics • Still marked variation and room to improve further in most places

26. International Comparisons Acknowledgement to: Erin Lalor, Dawn Harris, Anthony Rudd, Sònia Abilleira, Martin Dennis, Frances Horgan, Mark Vivian, Hazel Dodds, Alex Hoffman, Monique Kilkenny, Dominique A Cadilhac

27. International Comparisons Acknowledgement to: Erin Lalor, Dawn Harris, Anthony Rudd, Sònia Abilleira, Martin Dennis, Frances Horgan, Mark Vivian, Hazel Dodds, Alex Hoffman, Monique Kilkenny, Dominique A Cadilhac

28. International comparisons Acknowledgement to: Erin Lalor, Dawn Harris, Anthony Rudd, Sònia Abilleira, Martin Dennis, Frances Horgan, Mark Vivian, Hazel Dodds, Alex Hoffman, Monique Kilkenny, Dominique A Cadilhac

29. International comparisons Acknowledgement to: Erin Lalor, Dawn Harris, Anthony Rudd, Sònia Abilleira, Martin Dennis, Frances Horgan, Mark Vivian, Hazel Dodds, Alex Hoffman, Monique Kilkenny, Dominique A Cadilhac

30. Questions?

31. Royal College of Physicians of EdinburghScottish Stroke Collaboration Meeting22nd September 2010Queen Mother Conference Centre