1. Example: designing new care pathways
How safe is our proposed Care?
Intraarterial thrombectomy pathway SRFT/CSC GM
Ilse Burger Stroke team SRFT
Haelo

2. Overwhelming evidence for IAT - NNT is very low and overall the
A framework for safety measurement and monitoring IAT service the CSC for GM .
Overwhelming evidence for IAT - NNT is very low and overall the
treatment is seen as being cost effective
A framework for safety measurement and monitoring.
Charles Vincent et al. BMJ Qual Saf doi: /bmjqs
Copyright © BMJ Publishing Group Ltd and the Health Foundation. All rights reserved.

4. ! Patient IAT pathway 999/ED/DSC/GP/GM wards/WALKIN HOME/REPAT MEDICS
Safe
Transfer
criteria
NWAS
SRFT
NWAS
PSC 1
INPATIENT BLOCK SRFT
Humphrey Booth
ASU/HASU
ED entrance PSC
Rapid AX CT/CTA – IVT
Refer IAT Stroke SRFT
2222 pre alert 2
Other diagnostics SRFT
MRI/XRAY & Other
Safe
Transfer
criteria
NWAS PSC 3
CRITICAL CARE SRFT HOPE - NHDU
SRFT ED entrance 4
SRFT ED DEPARTMENT – STROKE TEAM
RAPID ASSESSMENT AND TRIAGE
SRFT ANGIOSUITE
IMAGING xray
CT/CTP/CTA
IAT
INR/Anaesthetist/
Stroke Consultant
RESUS
IVT
MAJORS !
MINORS
PANDA 5
EAU/AAA

5. PAST HARM Failure to provide treatment – nationally as well GM wide
Current collection of measures:
Stroke specific: SSNAP audit, SSNAP mortality statistics, Mortality& Morbidity (RCP guidance) , SI, concise SI, Datix, staff questionnaire,
“walk about”
Nonspecific: Dr Foster, HSMI…..

6. RELIABILTY

7. Sensitivity of operations
Select an appropriate mix of formal and informal safety monitoring mechanisms & Use this information to take timely action to avert safety issues- process ongoing
current structures and committees:
Monthly stroke service team reviews – exec level
Weekly Stroke OPs group & fortnightly SSNAP group
Clinical governance structure
QI project leads and meetings

8. Anticipation and preparedness – ongoing in development
Don’t wait for things to go wrong before trying to improve safety
Explore new opportunities to develop ways to anticipate future risks
Use a variety of tools and techniques to build an understanding of the factors that give rise to safety issues

9. Integration and Learning ongoing in development
Use the analysis of incidents as a starting point to reveal the wider issues in the system
No current incidents but pathway tested for high risk patient - pregnancy
Place more emphasis on learning, feedback and action than simply on data collection
Integrate and tailor information to make it meaningful from the ward to the board- ongoing format but need to integrate live data once available

10. Current QI Project Door to needle Time (ongoing)
Door to cannulation time (started)
Stroke mimics – Healthier together - AJP project lead
Patient Flow ( at various levels of the pathway)
Digital solution ( GDE project stroke - just started )
Stroke team live Tracking boards & Dashboards
Identifying safety indicators in key areas:
procedure/ treatment related
Patient flow
Stroke Mimics
Identify meaningful patient centred outcome measure – mRS only collected
Review the qualitative aspect of data collection: feedback patient/ carer /staff reporting ? – aim to report qualitative and quantitative data from the “Shopfloor to the Board”