1. Royal College of Physicians of Edinburgh Scottish Stroke Collaboration Meeting nd September Queen Mother Conference Centre

2. Stroke Care in Scotland 2009

3. 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)

4. 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

5. Access to stroke unit care 2005 to 2009

6. Access to stroke unit care

7. 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?

8. 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

9. Early swallow screen

10. Early swallow screens

11. 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

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

13. Early access to brain imaging

14. Early access to brain imaging

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

16. 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

17. Early aspirin administration

18. Early aspirin administration

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

20. 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

21. Early assessment in NV clinic

22. Early assessment in NV clinic

23. Early assessment in NV clinic

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

25. 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

26. 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

27. 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

28. 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

29. 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

30. Questions?

31. Royal College of Physicians of Edinburgh Scottish Stroke Collaboration Meeting nd September Queen Mother Conference Centre