Improvements in WHHT Stroke Service Dr T Adesina Consultant Geriatrician and Stroke Physician Clinical lead for stroke, WHHT

Profile Geriatrician and General Physician Consultant appointment June 2009 Consultant Stroke physician at University College Hospital, London and North Middlesex University Hospital up 2010-2014. WHHT since June 2014

Stroke- the past Hospital admission for Stroke patients- Nightingale wards, Patients admitted under care of any of a number of general physicians, Very little happened quickly, Brain scans difficult to obtain and hence rarely done, Referred to geriatricians for rehabilitation-long wait, No stroke specialist service either in hospital or community

not so long ago……… “Stroke is a non-acute condition” “Hospitalisation for nursing, therapy or social needs” (1988) “CT scan for more than 10% of patients needed justification(1994)” “Little acute care can do, emphasis on rehabilitation” (1997) “Move away from hospitals and towards community care for Stroke” (2000)

Stroke at WHHT Consultant Stroke Physicians Dr Tolu Adesina Dr Mohit Bhandari Dr David Collas Clinical Nurse Specialists – Bleep 1044 via Switch   Karyn Butchard Ruth Harvey Jayshree Bhana Dana Vainoriute Louise Timoney Ian Bagaoisan Research Nurse Saul Sundayi

SSNAP- sentinel stroke national audit programme Collects a minimum data set on every Stroke patient including acute care, rehabilitation, 6 month follow up and outcome measures in England, Wales and Northern Ireland To benchmark services regionally and nationally To monitor progress To support clinicians in identifying where improvements are needed To empower patients to ask questions

Sentinel stroke national audit SSNAP score calculated from key indicator scores which are grouped into 10 domains. Scanning Stroke unit Thrombolysis Specialist assessments Occupational therapy Physiotherapy Speech and language therapy Multidisciplinary team working Standards by discharge Discharge processes

2014/2015

Close scrutiny of patients journey Increased Consultant presence Stroke Early supportive discharge service Change in culture “turn NO to why not or what if?” Sharing of SSNAP results with MDT Learning from other units

True MDT involvement 7 day working Inclusive environment Education about Stroke, SSNAP Strong nursing leadership Stroke nurse specialists Data Administrators 7 day working

2014/2015

Nov 2016-Slide of SSNAP table

now and the future…… Increased Consultant workforce Hyper-acute Stroke unit at Watford site-October 2017 WHHT to be accountable lead provider for Stroke pathway in West Hertfordshire Links with Imperial healthcare Hospitals for endovascular pathway

Now-Slide of SSNAP table