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

2. Use of SSCA data to improve performance
Linda Campbell
NHS Highland

3. SSCA Data Collection Belford Hospital Caithness General Hospital
Lorn and District Hospital
Raigmore Hospital
Part Time SSCA Auditor – Susan Gallagher with support of Stroke Coordinators. Stroke Administrator helps to do data input. Raimore and Lorn and try to collect prospectively and CGH and Belford retrospectively- going there every 2-3 months
Land Mass of 33,028 km sq
41% of Scotland

4. Challenges Getting people into the Stroke Unit Swallow Screening
Timely CT and aspirin
NVC appointments
Waiting time to Carotid Surgery
Like everyone we strive to meet the QIS standards and have done a lot of work since the inception of the stroke unit in And personally I think we have come a long way. Biggest challenge is getting people into the unit and you can see from the figures published in June that we were worse in 2009 than in Why- lots of reasons
CT scanning – 3 broken scanners at various points through-out the year- out with the control of the stroke team. The SSCA data is presented by the Stroke Team at their annual audit day to the rest of the hospital. These days are always very well attended and we end up with an upsurge in referrals in questions and referrals after this. So we use the data is this way but we are also trying to use it to improve practical day to day working. So there has been some work to try and improve the admission rates and this has involved the team searching out there patients going up each day, on a Monday going round all the wing wards- what is interesting is other staffs perception that those with milder stroke don’t need to be in a stroke unit- but I certainly don’t find that that is the case. The big step forward has been the intorduction in 2010 of the Whiteboard

5. Improving Admission Rates
Ward 6A Consultant on call- Paul Findlay 22/09/10 Select Day- Today
Name
Dob
Admit
Reason
From
SEWS
Comment 1
Jane Smith
22/09/37
?Stroke
Town
Onset divert A&E for CT ? Thrombolysis 2
John Smith
21/09/48
R facial weakness
Nairn
Bells Palsy 3
Tam Jones
20/09/24
Collapse
Golspie 6
Found on floor by carer at 10. Known AF ?L weakness
Our 1 day admission fell in 2009 by 4%- not a huge drop but when you consider that we are getting less than 50% of pts to the Unit within a day this needs to improve. Previously we had to go to 6A and relied on the staff telling us who came in, now the team have access to the ‘whiteboard’ and we are much more pro-active in finding out what has happened to everyone who came in with stroke ? Stroke. ? Tia, weakness is another key word and we tend to check the collapses but I have to say that most of these turn out to be cardiac. The aim of this is to recognise our patients early and get them transferred early-

6. Again this has improved (the Lorn figure hasn’t but this was a recording issue!) but Raigmore especially has some way to go. The stroke unit manager, Janet MacRae, developed a audit capture form in the middle of last year when we started trying to capture data prospectively- it lists the name, dob, admission to hospital and admission to stroke unit as well as swallow screen. We have also been highlighting on risk forms when screens have not been done. Part of the role of the team reviewer is to check swallow and record it so hopefully this will see further improvement.

7. CT Scanning and Aspirin
New pathways currently being explored with radiology
Challenge every time there is a change of medical staff
Presentations at the ‘Friday’ meetings have highlighted delays
Triage nurses to order CT on notification being considered

8. NVC Stroke Unit Clinic Room
It was fairly obvious that we were never going to met the NVC 80% within 7 days without re-evaluating our service. The plan was to have a daily clinic but with a 2 man medical team this was a major challenge, so with the support of CHSS and the Highland Cross- we got funding to set this up- Cost Neutral to the health board, very important. This meant that NVC pts could be seen without having to leave the ward area .The impact of this 25% more patients seen in % within 7 days a huge improvement on the previous year

9. Any Questions?

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