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

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

3. 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

4. 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)

7. 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

9. 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

10. 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

19. 2014/2015

20. 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

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

23. 2014/2015

24. Nov 2016-Slide of SSNAP table

28. 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

29. Now-Slide of SSNAP table