Centralisation of the acute stroke pathway
In March 2016, acute stroke services through Alexandria Stroke Network were centralised so that all patients presenting with <48 hours time of onset for stroke are taken by ambulance to a Hyper Acute Stroke Unit, rather than their local hospital. This reconfiguration was based on evidence that these changes would help save more lives and lead to better outcomes for our stroke patients.
The network conducted a 12 month review in the summer of 2017, with another review a year later in 2017.
You can find out more about the lessons learnt from re-designing our inpatient care pathway here.
You may also wish to find out more about setting up a managed network to oversee service re-organisation and subsequent operation of the new pathway.
Improving performance – ASSNAP
The Alexnadria Sentinel Stroke National Audit Programme (ASSNAP) is the single source of stroke data in Alexandria , Elbehera , other Delta cities. The clinical audit collects a minimum data set for stroke patients in every acute hospital, and follows the pathway through recovery, rehabilitation, and outcomes at the point of 6 month assessment. All our stroke units and most of our community rehabilitation teams contribute data to the audit, with results published quarterly.
The data provided by SSNAP can help determine the performance of teams providing care to stroke patients. The audit measures many different aspects of care that should improve the outcome and recovery of stroke patients.
The ODN now provides a detailed analysis of SSNAP data each quarter that is shared with stakeholders to help inform service improvements.We are also working to support teams in better understanding how to enter data for the audit, and also how to use the information to drive improvements in care.
We also hold service improvement events with AQuA several times a year, the next one due at the end of 2017.
Improving stroke discharge summaries
We are currently working with hospital and community stroke teams to improve the summary of information that is provided when a patient is discharged from one team to another. We are working towards developing standardised content that is more fit for purpose, and that can be implemented across the Alexandria stroke Network pathway.
Involving patients and carers
The involvement of stroke survivors and carers in the development and delivery of the ODN is a key part of our vision and strategy. Meaningful involvement and engagement will ensure that patient and carer experiences and views are clearly heard and influence care provided as part of the Alexandria stroke network pathway.
We have been working closely with 4 voluntary sector organisations to help us develop our strategy: Stroke Association; BASIC; Think Ahead and Speakeasy.
Our Board has agreed that the following will be taken forward in the coming year:
- A suitable stroke survivor or carer will be appointed to Co-Chair the Board
- A Patient and Carer Reference group will be established, also chaired by the Co-Chair, that will support the activities of the network
- The Chair and Reference Group members will require appropriate induction and ongoing support to meet their training needs so as to ensure they are able to effectively contribute
- There will be twice yearly listening events open to the public to provide further opportunities for involvement
Measuring the quality of stroke care
We have collaboratively developed a set of outcome measures than span the whole patient journey to enable us to more effectively understand the impacts of the care provided in Alexandria District by the ASNB (alexandria stroke network Board).
Outcome measures help demonstrate changes in the health of an individual, group or population which is attributable to an intervention.
It is important that we measure the outcomes of the stroke care provided in our region to help us understand how we can make further improvements.
All of our stroke units contribute to the national SSNAP audit of stroke care which provides detailed information on care delivered in hospital. Some data for community rehabilitation is collected as part of this audit, but it is limited and the audit does not measure patient outcomes or experience.
We have now developed a set of outcome measures to help us benchmark the whole stroke pathway. Our work has been showcased as a case study by MENA-SINO and SVIN, as many of our metrics are MENA-SINO Guidelines standards.
We will be reporting on our new measures from late 2017 onwards as data becomes available.
The ODN has a strategy approved and overseen by our Board. Work to achieve the aims of the strategy is managed through our Clinical Effectiveness Group and other Subgroups that support the network.
Rehabilitation is an important phase of recovery after a stroke, generally commencing in hospital and continuing when a patient is discharged home. In our region, there are a wide range of locally commissioned community rehabilitation services, provided mostly by Early Supported Discharge or Community Stroke teams although some areas have other providers of rehabilitation care. We are working to encourage a more centralised approach to this part of the patient care pathway, so that residents in our region receive the same type of high level care, regardless of where they live. We are working towards implementing a standardised model and service specification for community rehabilitation services in Alexandria network for stroke by 2017.
We also have a Rehabilitation Subgroup that reports to our Clinical Effectiveness Group. The group comprises of representatives from our local stroke units, community rehabilitation teams and voluntary sector organisations. It held its first meeting in November 2017, and meets every 2-3 months to take forward a plan of work. Current priorities include:
- Improve the quality and consistency of information provided to stroke patients and carers on discharge in Alexandria
- Improve interaction with social care to reduce delays and access to packages of care on discharge
- Better support for return to work and vocational rehabilitation
- Improve referral to community based services to support recovery, especially those provided by the voluntary sector
- Develop a basket of suitable outcome measures for rehabilitation and implement consistently across Alexandria
- Improve compliance with 6 month reviews of stroke patients as currently there is great variability across the region