1. Profession Specific Audit for Stroke Care Initiated by Intercollegiate Stroke Working Party (ICSWP) National Sentinel Audit (1998….2006) RCP National Clinical Guidelines for Stroke Professions specific audit versions (2002) Multidisciplinary project: SLT, PT, OT, Nursing & Dietetics Aims: to test documentation and benchmark services against national standards. To direct resources and change patterns of care

2. Methodology 30 Trusts contacted 25 SLT services participated Organisational audit: 1 per site Clinical care audit: 5 per site Participants encouraged to complete audit as a team Consecutive admissions from February 2006 Format: Excell vs Word file

3. SLT Organisational Audit (n = 25) Stroke Specialist SLTs67% Stroke Consultant SLTs 4% Participation in research63% Swallow screening tool88% Communication screening tool 8% Access to videofluroscopy 88% Access to FEES42%

4. SLT Clinical Care Audit (n = 130) Summary of assessment results94% Discussed with client/carers71% Discussed with MDT88% Screening for swallow by non-SLT41% Intervention plan81% Goals included68% Intervention discussed with client50% Discharge report to client27% Discharge report to professional41%

5. Evaluation by participants Time consuming Audit not a priority Need a central audit coordinator Difficulty accessing patient notes Reduce number of questions Incentive to improve documentation

6. The way forward Profession specific audit can identify target areas for effort and resources An essential component in raising clinical care standards To seek funding to further develop the MDT component: organisational audit To make revised tools available on professional websites

7. Connecting for Health (NPfIT) Do Once and Share Programme Courtesy of the- Stroke Care Action Team

8. DOAS Stroke Care Action Team Core: Tony Rudd Helen Newton Alex Hoffman Deborah Oliver Project Manager (tba) Extended: Intercollegiate Stroke Working Party User and carer group Professional networks (e.g. BASP, SRN, UK Stroke Forum, National Stroke Nursing Forum, Stroke Association Different Strokes and..)

9. Connecting for Health Do Once and Share (DOAS) Programme Develop a common approach to common conditions/topics, recognising differences in care processes. Reduce unknowing duplication Create national consistency Reduce waste of professional and patient time Ensure a common input to the technical office

10. Stroke Care Action Team Objectives Build on existing work - Model Care Pathway – “quality and consistency of patient care” Promote approach to care management which facilitates good communication and sharing of information.. Information pathway Data – nature, collection points Reduce duplication, create consistency while allowing for local variation

11. Stroke Care Action Team All adult stroke patients after triage, confirmation of clinical diagnosis, resuscitation & acute treatment (TIA and acute treatment by separate DOAS team – Prof Alastair Buchan) Until hospital discharge or 56 days, whichever sooner Transfers of care included

12. Out of scope Road-testing or pilots Primary prevention Triage and immediate treatment Care of stroke patient in primary care Long term & those in private sector Service organisation/staffing levels, skill mix etc Comprehensive knowledge data base Detailed technical output

13. Timeframe Project started 30 th November 2005 Interim report March 2006 Ended 31 st May 2006 Final report June 2006

14. The raw material (NICE) National Clinical Guidelines & National Service Framework/SIGN/Cochrane etc > 40 “Stroke Care Pathways” & other local work National Stroke Dataset Scottish Stroke Datasets National Sentinel Audit of Stroke Southern Cluster Stroke “Pathway”

15. Input to project ICSWP – SLT – Physio – OT – Dietetics – Pharmacy – GP – User/carer – Physician – Nurse Individuals User and carer groups (e.g. RCP Patient-Carer Network) Stroke Northumbria BASP Stroke Nurses Forum Southern Cluster National Spine

18. “Guidance issues” Should prompt/dictate actions and be dynamic single record, as well as record data Use in multiple settings (e.g. A&E,) by many people Provide all outputs e.g. audit, transfer of care summaries, referrals, information leaflets etc Ease of use, internal referencing, navigation Accessible to patient and carer Must evolve Must allow local variation/development MUST ENCOURAGE LOCAL DEVELOPMENT Training

19. Your feedback The SLT version of the patient pathway will be posted on the RCSLT stroke yahoo e-group for comments by end of September 2007. Comments can be made on the structure of the time-line as well as the assessment tools recommended. Remember the pathway is designed as “best practice” rather than based on limited, rationed resources.

20. strokepathway@rcplondon.ac.uk