stroke care in scotland 2009
Post on 09-Jan-2016
47 Views
Preview:
DESCRIPTION
TRANSCRIPT
Royal College of Physicians of Edinburgh
Scottish Stroke Collaboration Meeting
22nd September 2010
Queen Mother Conference Centre
Stroke Care in Scotland 2009
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)
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– 90% by the following day
Access to stroke unit care2005 to 2009
28 30 3235 37
615756
5449
81777776
71
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2005 2006 2007 2008 2009
Numberof
Patients(columns)
0
10
20
30
40
50
60
70
80
90
100
%against
standards(lines)
Stroke Patients % SU day 0 % SU <=1 day
% Admitted to a SU during stay NHS QIS 60% day 0 NHS QIS 90% <=1 day
Access to stroke unit care
0
10
20
30
40
50
60
70
80
90
100
AR
I
Dr
Gra
ys*
Nin
ewel
ls
PR
I*
RIE
SJH
WG
H
RI-
Gla
sgow
Sto
bhill
WI-
Gla
sgow
Sou
th G
lasg
ow IRH
RA
H
VoL Ayr
Cro
ssho
use
Hai
rmyr
es
Mon
klan
ds
Wis
haw
For
th V
alle
y
Bor
ders
DG
RI
Str
anra
er*
Rai
gmor
e
L&I
Bel
ford
*
Cai
thne
ss*
Ork
ney*
She
tland
*
Wes
tern
Isle
s
QM
H
VH
, Kirk
cald
y
Sco
tland
Per
cent
age 2 Days
1 Day
Same Day
NHSQIS 90%
NHSQIS 60%
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?
Early swallow screens
• NHS QIS standard– 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
Early swallow screen
47 4951
55
61
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2005 2006 2007 2008 2009
Numberof
Patients(columns)
0
10
20
30
40
50
60
70
80
90
100
%against
standards(lines)
Stroke Patients % Swallow Screen day 0 NHS QIS 100% day 0 (swallow screen)
Early swallow screens
0
10
20
30
40
50
60
70
80
90
100
AR
I
Dr
Gra
ys
Nin
ewel
ls PR
I
RIE
SJH
WG
H
RI-
Gla
sgow
Sto
bhill
WI-
Gla
sgow
Sou
th G
lasg
ow IRH
RA
H*
VoL
*
Ayr
Cro
ssho
use
Hai
rmyr
es
Mon
klan
ds
Wis
haw
For
th V
alle
y
Bor
ders
DG
RI
Str
anra
er
Rai
gmor
e
L&I
Bel
ford
Cai
thne
ss
Ork
ney
She
tland
Wes
tern
Isle
s
QM
H
VH
, Kirk
cald
y
Sco
tland
Per
cent
age
2 Days
1 Day
Same Day
NHSQIS
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
Early access to brain imaging
• NHS QIS standard– 80% on the day of admission
• Rationale– Early scanning is most cost-effective strategy
Early access to brain imaging
2732
3742
49
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2005 2006 2007 2008 2009
Numberof
Patients(columns)
0
10
20
30
40
50
60
70
80
90
100
%against
standards(lines)
Stroke Patients % Scanned day 0 NHS QIS 80% day 0 (scan)
Early access to brain imaging
0
10
20
30
40
50
60
70
80
90
100
Per
cent
age
2 Days
1 Day
Same Day
NHSQIS
Issues
• Staff to request scans early after admission
• Protocol driven requests
• Adequate capacity
• Partnership with radiology – make them aware of targets and performance
• Reporting
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
Early aspirin administration
41
51
59
67 68
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2005 2006 2007 2008 2009
Numberof
Patients(columns)
0
10
20
30
40
50
60
70
80
90
100
%against
standard(line)
Aspirin Denominator (excl CIs) % Aspirin <=1 day NHS QIS 100% <=1 day
Early aspirin administration
0
10
20
30
40
50
60
70
80
90
100
AR
I
Dr
Gra
ys
Nin
ewel
ls PR
I
RIE
SJH
WG
H
RI-
Gla
sgow
Sto
bhill
WI-
Gla
sgow
Sou
th G
lasg
ow IRH
RA
H
VoL Ayr
Cro
ssho
use
Hai
rmyr
es
Mon
klan
ds
Wis
haw
For
th V
alle
y
Bor
ders
DG
RI
Str
anra
er
Rai
gmor
e
L&I
Bel
ford
Cai
thne
ss
Ork
ney
She
tland
Wes
tern
Isle
s
QM
H
VH
, Kirk
cald
y
Sco
tland
Per
cent
age
2 Days
1 Day
Same Day
NHSQIS
Issues
• Early scanning and reporting
• Protocol driven prescribing
• Nurse prescribing – patient group prescribing
• Documentation of definite contraindications
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
Early assessment in NV clinic
30
4043
58
80
0
1000
2000
3000
4000
5000
6000
7000
2005 2006 2007 2008 2009
Numberof
Patients(columns)
0
10
20
30
40
50
60
70
80
90
100
%against
standard(line)
Outpatients % Outpatients <= 7 days NHS QIS 80% <=7 days
Early assessment in NV clinic
0
10
20
30
40
50
60
70
80
90
100
AR
I
PR
I
Str
acat
hro
SJH
WG
H
IRH
RA
H
Ayr
Cro
ssho
use
DG
RI
Rai
gmor
e
L&I
Bor
ders
For
th V
alle
y
Hai
rmyr
es
Mon
klan
ds
Wis
haw
QM
H
VH
, K
irkca
ldy
RI_
Gla
sgow
Sto
bhill
WI-
Gla
sgow
Sou
ther
n G
ener
al
Vic
toria
Inf
Sco
tland
Per
cent
age
2008
2009
NHSQIS
Early assessment in NV clinic
0
10
20
30
40
50
60
70
80
90
100
AR
I
PR
I
Str
acat
hro
SJH
WG
H
IRH
Ayr
Cro
ssho
use
Hai
rmyr
es
Mon
klan
ds
Wis
haw
For
th V
alle
y
Bor
ders
DG
RI
Rai
gmor
e
L&I
QM
H
VH
, Kirk
cald
y
Sco
tland
Per
cent
age
3 Days
2 Days
1 Day
Same Day
Issues
• Patient awareness
• GP awareness
• Streamlined referral processes
• Demand management
• Adequate clinic capacity
• Capacity spread through week
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
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
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
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
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
Questions?
Royal College of Physicians of Edinburgh
Scottish Stroke Collaboration Meeting
22nd September 2010
Queen Mother Conference Centre
top related