National Improvement Programmes – Does the improvement continue? - Stroke Poole Hospital NHS Foundation Trust Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013 More information about this event can be found at http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx

1. National Improvement Programmes
Does the improvement continue?
L Gleave, V Horn, J Leggett, S Ragab, T Villar
Stroke Service Poole Hospital Foundation Trust
Introduction
Poole stroke services admit approximately
530 patients with acute stroke each year. The
integrated unit has
8 acute and 19
rehabilitation stroke beds.
The original project aimed to:
1. Establish 24/7 thrombolysis service.
2. Offer a hyper-acute service for all stroke
admissions.
3. Increase direct admissions to the Stroke
Unit.
4. Increase % of stroke patients spending
>90% of hospital stay on the Unit.
Patients and carers were key partners in this
project, with patient representation on the
project steering group and information
gathered
from
discovery
interviews,
discussion forums and feedback forms
influencing developments.
This project relates to QM 4, 7, 8 & 9 of the
National Stroke Strategy.
Improved Hyper-acute Care
Poole Hospital has been thrombolysing
stroke patients since 2005, predominantly
during working hours. A 24/7 thrombolysis
service was launched in November 2009.
This initiative was facilitated by the Stroke
Improvement Project which enabled us to
focus on establishing a robust acute stroke
pathway supported by telemedicine and
teleradiology. Thrombolysis rates improved
to 4.5% by 2010, and has risen considerably
since then.
Participating in the Stroke National
Improvement Programme provided the
infrastructure
to
continue
further
developments. The success we saw
while participating in the project
demonstrated that we were able to make
changes that improve processes and
thus enhance patient pathways and
experience.
Team working, and a
willingness to try new ideas has ensured
the
help
the
National
Stroke
Improvement
team
offered,
has
continued to bear fruit.
Patients who are not eligible for thrombolysis but
have probably had an acute stroke can be assessed
on the stroke assessment trolley. This was one of
the initiatives introduced as part of the improvement
programme looking to improve direct admission
rates and the 90% stay target.
Patients are
admitted directly to the trolley from GPs or bypass
ED to receive stroke assessment from a senior
clinician within 1 hour of arrival. The trolley is situated on the acute stroke unit, ensuring
all stroke specific measures such as swallow screen, appropriate positioning and stroke
specific assessments are completed in a timely manner. This is now embedded practice
at Poole Hospital.
Results
% Thrombolysis Rates
Vital Signs Metrics
2010
2013
65%
83%
70%
91%
12.5
1.4
24/7 thrombolysis
Reflection
2.4
90% of stay
on stroke unit
CT scan
within 24 hrs
4.5
Key Learning
Quality Markers
2009
2010
2013
Swallow screening within
4 hours
20%
30%
53%
Aspirin within 24 hours
of admission
21%
63%
75%
.
 Many improvements in patient care
are possible within existing resources.
 Success is highly dependant on good
partnership working with colleagues
across the acute stroke pathway.
 Supporting the up-skilling of staff is
key to sustainability of changes
achieved.
 Value
of
Patient
and
Public
Involvement in improvement plans.
 Importance of senior management
commitment
challenges.
to
overcome