Jump to: Page Content, Site Navigation, Site Search,

Exeter Primary Care Trust Headache Clinic

Description A stroke service covering acute and community care across health and social care organisations
Setting Acute stroke unit, primary care stroke unit and community services.
Populationting All patients with a diagnosis of stroke.
Intervention summary Design of care pathway advising primary care services to send patients with suspected diagnosis of stroke to Torbay Hospital for diagnosis and assessment. Once medically stabilised, patients are transferred to the community stroke unit at Newton Abbot.
Outcome Summary Over 90% of patients with stroke now admitted to the stroke units; patients seen quickly; reduced length of hospital stay
Startup Cost Nil. The remodelling of the community services were part of Primary Care Trust community hospital changes and skill mix.
Running Cost Absorbed into pre-existing services – the community stroke unit took over one of the wards of a community hospital.
Funding The stroke service is subject to PbR and agreements between local commissioners.
Started 2003
Ended 2005, but ongoing continuous improvement
Location South Devon, England
Contact
  • Name: Fiona Jenkins
  • Address: South Devon Healthcare NHS Foundation Trust, Torbay Hospital, Lawes Bridge, Torquay, TQ2 7AA
  • Telephone: 01626 357301
  • Email: fc.jenkins@nhs.net

    • Background

    A stroke service covering the Acute Stroke Unit in Torbay Hospital, and primary care services based in three Primary Care Trusts (PCTs) and two social services providers.

    What is the problem you are trying to solve?

    We are aiming to improve stroke care by meeting national guidance and local requirements of patients and providers for an effective stroke care pathway.

    What local organisations are involved?

    South Devon Healthcare NHS Foundation Trust, Teignbridge PCT, and South Hams and West Devon PCT (now Devon PCT), Torbay PCT (now Torbay Care Trust), Devon Social Services and Torbay Social Services (now Torbay Care Trust)

    How many people are running this project and who are they?

    One head of physiotherapy services for South Devon.

    What local population are you targeting?

    Any adult with a diagnosis of stroke in the South Devon area

    How many people are you targeting?

    765 new patients per annum

    Interventions

    What interventions are you using to address the problem?

    A care pathway has been developed which includes advice to primary care services to send all patients with a suspected diagnosis of stroke to Torbay Hospital for diagnosis and assessment. Those with minor symptoms have quick access to the Transient Ischaemic Attack (TIA) Clinic. For those with confirmed stroke, a thrombolysis service has been set up, requiring prompt conveyance of patients to hospital, rapid access to computed tomography scanning and availability of a thrombolysis service for suitable patients.

    The Acute Stroke Unit now admits 90% of patients with a stroke through its unit (prior to the review this figure was 46%) Once patients are medically stabilised they are transferred to the community stroke unit at Newton Abbot which is led by a physiotherapy consultant. As well as prompt specialist care for suspected strokes, the service offers extended support for patients during their recovery with improved access to community rehabilitation and social care support.

    Is the project design based on evidence? If so, please state reference.

    Yes, there is wide-ranging evidence 1 - 24 .

    Since the project was completed the National Service Framework (NSF) for long-term conditions has been published 11 ; the redesigned stroke service meets these requirements.

    Outcome

    What outcomes or planned outcomes are you measuring?

    • The percentage of patients admitted with a stroke having care provided on the stroke unit;
    • Access to TIA clinic;
    • Availability of thrombolysis service;
    • Access to therapists post hospital discharge;
    • Sentinel stroke audit performance; and
    • Length of stay in hospital.

    Do you have any outcomes or results yet? If so, what are they?

    • Over 90% of patients with stroke are now admitted to the stroke units;
    • People with TIA can generally be seen on the next working day;
    • A thrombolysis service has been developed and is available every day;
    • People can access therapy from staff with particular expertise in stroke after discharge from hospital;
    • Patients in the community can self refer when further therapy is required; and
    • The whole service has performed well in the Sentinel Audit for Stroke.

    The results of the first part of the National Sentinel Audit for Stroke 2006 where published in July 2006. The first part of the audit looks at the organisation of care, which includes looking at the use of specialist protocols for stroke care, the availability of services such as thrombolysis and access to specialist staff.

    For this audit the health community entered data for the stroke service provided by the acute ward at Torbay Hospital and the rehabilitation ward at Newton Abbot Hospital jointly. This reflects the joint working of the two units. The audit involved 238 sites and 207 Trusts.

    Overall the service in South Devon achieved a total score of 88. This is the second highest score given nationally, and reflects the significant work that has gone into developing the stroke service. Full audit results for the second part are awaited.

    The South Devon Area Stroke Service was delighted to win the Health and Social Care Award 2006 for improving access.

    Is your project relevant to a government target or guideline?

    The NSF for older people 7 and the NSF for long term conditions. 11

    Feedback

    What obstacles did you have to overcome to set up this project?

    Engaging all organisations was difficult. However, this was facilitated through an older people strategic review group which was functioning at the time.

    What have you learned about the project so far?

    Having a care pathway that is endorsed by patients, staff and the organisations makes change effective.

    What would you do differently?

    Financial modelling at various stages, as the introduction of Payment by Results (PbR) has implications for services that cross organisational boundaries and has the potential to put tension into a service that meets patients need – but is not based on traditional models of delivery.

    References:

    1. BASP. Benchmarking Survey of Stroke Services. Newcastle: British Association of Stroke Physicians. 2003.
    2. Borril, C, West M, Rees A, Dawson J, Shapiro D, Richards A, Carletta J and Garrard G. The effectiveness of teams in the National Health Service. Final Report for the Department of Health. 2001.
    3. CHI. The National Service Framework for Older People: A review of progress with implementation. London: Commission for Health Improvement. 2003.
    4. Dam M, Tonin P Casson S, Ermani M, Pizzolato G, Iaia V and Battistin L. The effects of long-term rehabilitation therapy on post-stroke hemiplegic patients. Stroke. 1993; 24: 1186-81.
    5. Department of Health. The national plan for the new NHS: The new NHS the need for change. Leeds: NHS Executive. 2000.
    6. Department of Health. The NHS Plan: a plan for investment, a plan for reform. 2000. www.dh.gov.uk (search for 010481829, accessed 26 April 2007).
    7. Department of Health. The National Service Framework (NSF) for Older People. 2001. www.dh.gov.uk (search for 23633, accessed 26 April 2007).
    8. Department of Health. The single assessment process: assessment tools and scales. London: Department of Health. 2001.
    9. Department of Health. Guidance on free nursing care in nursing homes. HSC 2001/017: LAC. 26. London: Department of Health. 2001.
    10. Department of Health. Community Care Act. London: The Stationery Office. 2003.
    11. Depatrment of Health. National Service Framework (NSF) for long term conditions. London: The Stationery Office. 2005.
    12. Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients. Oxford: Cochrane Library Issue 4, Update Software. 2001.
    13. Forster A, Young J. The clinical and cost effectiveness of physiotherapy in the management of elderly people following a stroke. Evidence Briefing. London: Chartered Society of Physiotherapy. 2002.
    14. Heart Outcome Prevention Evaluation Study Investigators (HOPE). Effects of an angiotensin- converting enzyme inhibitor, Ramipril, on cardiovascular events in high-risk patients. New England Journal of Medicine 2000; 342: 145-153.
    15. Intercollegiate Working Party. The National Clinical Guidelines on Stroke. London: Royal College of Physicians. 2000 (updated 2002). www.rcplondon.ac.uk/pubs/books/stroke (accessed 26 April 2007).
    16. Johnson J, Pearson V. The effects of a structured education course on stroke survivors living in the community. Rehabilitation Nursing 2000; 25: 59-65.
    17. Kwan J, Sandercock P. In-hospital care pathways for stroke (Cochrane Review Issue 3), Oxford: Cochrane Library Issue 4, Update Softwear. 2003.
    18. Mant J. Overview of the evidence for the Stroke Family Care Workers in Proceedings of the Royal College of Physicians of Edinburgh Consensus Conference on Stroke Treatment and Service Delivery, Editor Dennis M. Royal College of Physicians of Edinburgh. 2001; 31 (8).
    19. Pushpangadan M, Wright J, Young J. Evidence-based guidelines of the early stroke management. Hospital Medicine 1999; 60: 105-114.
    20. Rodgers H. Rehabilitation – Hospital or home? – an overview. In Dennis M (Ed) Proceedings of the Royal College of Physicians of Edinburgh Consensus Conference on Stroke Treatment and Service Delivery. Royal College of Physicians of Edinburgh. 2000; 31 (8).
    21. Rudd AG, Irwin P, Rutledge Z, Lowe D, Wade D, Morris R, Pearson MG. The national sentinel audit for stroke: a tool for raising standards of care. Journal of the Royal College of Physicians of London 1999; 33: 460-464.
    22. Stroke Unit Trialists’ Collaboration. Collaborative systematic review of the ramdomised trials of organised inpatient (stroke unit) care after stroke. BMJ 1997; 314: 1151-1159.
    23. Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Oxford: Cochrane Library Issue 4, Update Softwear. 2001.
    24. The Stroke Association. Stroke Good Practice in Social Care and Health Care. London: www.stroke.org.uk 2002.