Royal College of Physicians of Edinburgh Scottish Stroke Collaboration Meeting 22nd September 2010 Queen Mother Conference Centre

Stroke Care in Scotland 2009

Structure of inpatient stroke services in Scotland Hospitals admitting acute stroke 32 Stroke admissions ~8000 No. per hospital 16 to 601 No. (%) admitted to hospital without SU 227 (2.8%) SU bed days available 285,000 SU bed days required for 100% access 214,000 Mean length of stay in hospital (range) 27 (13-42)

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

Access to stroke unit care 2005 to 2009

Access to stroke unit care

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?

Early swallow screens NHS QIS standard Rationale 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

Early swallow screen

Early swallow screens

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

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

Early access to brain imaging

Early access to brain imaging

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

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

Early aspirin administration

Early aspirin administration

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

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

Early assessment in NV clinic

Early assessment in NV clinic

Early assessment in NV clinic

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

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

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

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

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

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

Questions?

Royal College of Physicians of Edinburgh Scottish Stroke Collaboration Meeting 22nd September 2010 Queen Mother Conference Centre