1. Supporting NHS Wales to Deliver World Class Healthcare All Wales Stroke Services Improvement Collaborative Learning Session One 21 st October 2009

2. Slide 2 Why are we here? Alan Willson Director of Research and Development NLIAH

3. Slide 3 Improve the reliability of care in Wales Raise the standards of care in Wales What are we actually trying to do?

4. Slide 4 An example from another setting Acute MI Care in US Aspirin at discharge ACEI for LVSD Beta-blocker at arrival Beta-blocker at discharge Door to lytic Door to PCI Smoking cessation advice Composite and all-or-none scores Survival rate/index Aspirin at arrival

5. Slide 5

6. Slide 6

7. Slide 7 Model for Improvement

8. Slide 8 Acute Phase Driver Diagram

9. Slide 9 All Wales Data

10. Slide 10 Examples from One Trust

11. Slide 11

12. Slide 12

13. Slide 13

14. Slide 14 All Wales - Compliance with First Hours Bundle Within 3 hours Screening tool Confirmation of diagnosis by experienced clinician Stat aspirin

15. Slide 15 All Wales - Compliance with First Day Bundle Within 24 Hours CT Scan Admission to stroke bed Swallow screen Regular aspirin

16. Slide 16 All Wales – CT Scan within 24 hours

17. Slide 17 All Wales – Swallow Screen in 24 hours

18. Slide 18 All Wales – Mobilisation within 72 hours

19. Slide 19 All Wales – Time to stroke ward admission

20. Slide 20 Findings Method makes sense Measurement and reliability are new concepts Team work is encouraged across pathway Connections with management need work We are seeing change and so are patients!

21. Slide 21 Why isn’t this audit? IMPROVEMENT Measure and use data now Include all patients and measure continuously Rapid cycle change Keep it simple Don’t aim for comparability Use charts of change over time Think of Obs Charts AUDIT Retrospective, report later Use snapshot audit giving one point in time No link to change process Often very detailed Aim is comparison No time run charts because too little data Think Post Mortems