Joining Forces – Maintaining the Pace of Change Maintaining the pace of change: activities across...

Joining Forces – Maintaining the Pace of Change

Maintaining the pace of change: activities across the networks

Jacqueline BriggsSouth West Stroke Research Network Manager


Overview


Peninsula Heart & Stroke

Network

Avon, Gloucestershire, Wiltshire and Somerset Cardiac

& Stroke Network

Dorset Cardiac & Stroke Network

South West Stroke

Research Network


An extended group of people with similar interests or concerns who interact and remain in informal contact for mutual assistance or support.

A system of people or things: a large and widely distributed group of people or things such as stores, colleges, or churches that communicate with

one another and work together as a unit or system

Networks?

The Clinical Research Network. Supporting research to make patients, and the NHS, better

NIHR 2011

The treatment, care and rehabilitation of cardiac and stroke patients involves a diverse range of organisations. The role of the Network is

to bring these organisations together, with patients and carers to improve services.

AGWS C&S Network Website 2011


Stroke continues to be a regional priority with good progress in part of the care pathway particularly discharge and community care

Networks and the SHA are working together to try and improve performance related to Stroke vital signs particularly the sign that 80% of patients admitted with a stroke spend 90% of their hospital stay in designated stroke facilities – set out in the Operating Framework for the NHS 2011-12

Ongoing improvement in reporting systems / datasets remains the other key area of work

Individual Networks also have regional priorities…………………

With Thanks to:Richard Gleave - Director of Project Improvement

South West Strategic Health Authority


• Dorset Improving Psychological Support after Stroke Project (NHS improvement Pilot project)

– showing significant improvements in levels and quality of psychological screening and support in the community setting utilising better collaborative working within existing teams

• Direct to CT/Acute Stroke Unit pathways (RBCH)

• Know Your Pulse & TIA video Campaigns: the Life Channel

– The Network developed 2 campaigns to raise awareness of the importance checking your pulse and TIA signs and symptoms which ran in GP surgeries across the county

• Phantom Head (DCH)– The radiology department at Dorset

County Hospital trained all of their radiographers in CT head using a phantom head funded through the Network

With Thanks to:

Sara Leonard – Network Manager

Francis Avis – PPI Lead

DIPSS training - rehabilitation

Dorset Stroke Network


• Roll out of the assessment bed (PHT)– Following a successful pilot at Poole Hospital

NHS Foundation Trust, the stroke assessment bed has been rolled out across the whole county

• Training Accreditation (UKFST)- Network wide collaboration to develop three

stroke training programmes (care of the stroke survivor, psychological support after stroke and managing aphasia) for out of hospital care, submitted for UK Forum for Stroke Training (UKFST) accreditation.

• GRASP-AF– So far, the Network has recruited 36% of

practices to download the GRASP-AF toolkit. Since August, Dorset has seen a 5% increase in Warfarin prescribing.

• Patient and Public Involvement Model– Quoted as example of good practice by National

Audit Office – February 2010– Presented at National UK Stroke Forum in

Glasgow – December 2010• Care Quality Commission Life after Stroke Review

– The organisations within the Network were ranked as some of the best in the country for their stroke care in the recent CQC review

Francis Avis presenting at UKSF on PPI

Dorset Stroke Network (2)


PENINSULA HEART & STROKE NETWORK

• Continuing to provide Service

Improvement Managers in most key clinical / geographical areas to support local priorities and work programmes

• Clinical Education Facilitators in most main Peninsula sites facilitating the implementation of stroke competencies in acute and community organisations and nursing homes – over 2000 people have received training in a number of different formats

• Advising Commissioners on the local application of the NICE quality Standard

• Supporting the development of pilot

models for Early Supported Discharge e.g. North Devon for 12/12

With Thanks to:

Martin James – Network Lead

Michelle Roe – Network Manager

Peninsula Heart & Stroke Network


• Development of clinical guidelines e.g. Hemicraniectomy referral guidelines and providing advice on new technologies such as Direct Thrombin Inhibitors • Supporting the implementation of GRASP-AF tool in primary care• Developing information packs on AF for primary careManagement guidelines, Treatment Decision Tree, Patient

decision aid for Antithrombotic Therapy. • Continued development of the Peninsula Stroke data set and facilitation of data collection• Supporting organisations in National projects e.g. A project at the RD&E looking at increased access to TIA clinics

PENINSULA HEART & STROKE NETWORK

Peninsula Heart and Stroke Network(2)


With Thanks to:

Sunita Berry – Network Director

• Thrombolysis

- Working collaboratively across 9 acute hospital sites has enabled AGWS Cardiac & Stroke Network to deliver 24/7 Thrombolysis in 7/9 sites. - The Network Stroke Consultant rota supports all sites on a 24/7 basis, with Thrombolysis being delivered via all emergency departments. - Between April 2010 and March 2011, over 200 patients received the service, about 22% doing so via the Network Stroke Rota. • Using data to improve clinical care

- The network has been working with trusts to enable the use of data collection to support improvements in clinical care. - As part of the Accelerating Stroke Improvement Incentive

Scheme Trajectories programme (ASIIST), the network asked trusts to compete to demonstrate the most improved care.

1st place - Salisbury Foundation Trust2nd place - University Hospitals Bristol 3rd place - Great Western Hospital in Swindon

AGWS Cardiac & Stroke Network


• Atrial FibrillationA successful atrial fibrillation project has enabled the AGWS Network to claim the top spot in the National Improvement Programme for atrial fibrillation.

- 6/8 PCTs in the Network have participated with 17,569 patients have been registered with the GRASP-AF tool. - This is a contribution of over one-third of all patients registered on GRASP.-Early results show that between 3-5% of additional patients in the network are now receiving anticoagulation. - Further development of the project in 2011/12 will aim to concentrate on increasing the numbers receiving anticoagulants and recording and improving the time spent in therapeutic range for patients.

AGWS Cardiac & Stroke Network (2)

• Care Quality Commission Life after Stroke Review - PCTs in the AGWS network performed particularly well. - 6/8 PCTs were classed as being amongst the best of the 152 PCTs reviewed. - One PCT was judged as better and another, fair. - Swindon PCT which was ranked 15th in the national survey


Recruitment

3676 20199 394

82

422

133673

335

0

200

400

600

800

1000

1200nu

mb

er recruited

2006/7 2007/8 2008/9 2009/10 2010/11

Summary of recruitment across the south west

Extended area

Peninsula

From April to March 2010/11

83% into category 3 RCT’s

1008112 300 476 555

81.6% increase overall

- 59% in original area

- 152% in expanded area

Involved with expanded

areaB

A

S

E

L

I

N

E


Recruitment per year

0

20

40

60

80

100

120

140

160

180

Plymouth Derr/ MG

Yeovil Truro Torbay Taunton /Will Exeter Barnstaple

2006/7

2007/8

2008/9

2009/10

2010/11

Royal Devon and Exeter site team win the Pharma Times

Clinical Research Site of the Year award Jan

2011


Expanded region recruitment 2009/10 and 2010/11

0

20

40

60

80

100

120

140

B/Mou

th Dor

Poole

NBTUHB

WSM

Bath

Glou

c

Salisb

ury

Swindo

n

N Som

PCT

2009/10

2010/11

‘The contribution from SW sites (to the IRIS study) Bath, Torbay, Bournemouth has been fantastic with these three

sites accounting for 50% total UK randomisations’ Professor Gary Ford – SRN Director


1008 in total – April to March 2010/11

32% SoS 12% LotsCare 12% Clots3

per study recruitment April to March 2010/11

012 6 2

128

4

4938

22 24

80

724

41

100

42

24

09

326

1 0

44

180 7

0

50

100

150

200

250

300

350

ARUBA

CADISS

BUCS

CARS

CLO

TS 3

DIAS

DNA lacu

nar

ECHO P

IV

ECHO P

IV co

nt

ENOS

FABRY

IMRPOVE

IST3

IRIS

LOTs

LUNS

OTC

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Podca

st

REACHSO

S

Stash

Stroke

INF

TARDIS

TOMAS

VIST

White

hall

Stroke Oxygen Supplementation Study - A randomised controlled study of the benefits and risks of routine oxygen treatment after acute stroke

Clots 3 – A randomised Trial to establish the effectiveness of intermittent pneumatic compression to prevent post stroke DVT

LotsCare – Evaluating the clinical and cost effectiveness of a patient and carer centred system of Longer Term Stroke Care delivered by a single stroke care coordinator


Patient, Carer and Public Involvement

• PCPI Lead – Tim Ayers – Nurse Consultant and PCPI coordinator Gwenda Pay

•Integrated into network activities and structure

• Four lay members on both the management group and PCPI Working Group that oversees network PCPI activities

• Database of over 160 people commenting on our activities and research in the region

•Wider opportunities for lay members to work with e.g. Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC) and the Stroke Association to help promote stroke research

Members of PCPI working Group at a recent meeting


Examples of studies developed in the south west

IMPROVE-Stroke: IMproving the PRevention Of Vascular Events after Stroke or TIA – a randomised controlled

pilot trial of nurse independent prescriber-led care pathway-based risk factor management

Dr Martin James – RD&E ExeterFunded and currently recruiting

Reach to Grasp Project Dr Ailie Turton – University of the West of England

Funded and currently in set up

Does the use of Nintendo Wii gaming system in a home environment improve dominant arm function in patients after

stroke with upper limb weakness?

Dr Katja Adie – Royal Cornwall HospitalFunded and currently in set up through

Plymouth Clinical Trials Unit

Supported cognitive behavioural therapy self-help for post-strokedepression (SHiPS): A pilot randomised controlled trial

Dr Paul Farrand – Exeter University Awaiting a decision on funding

ECHO PIV: A pilot study to determine clinical utility in carotid artery diseaseDr Phil Gates – Peninsula Medical School

Funded and currently recruiting

Working with the Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC – part of

NIHR)

1. The ReTrain Study of effectiveness and cost effectiveness of Action for Rehabilitation from Neurological Injury (ARNI) for survivors six months on from stroke: exploratory and multi-centre pragmatic randomised clinical trial comparing ARNI individual, ARNI group and

usual care.

2. Stroke Thrombolysis project – constructing a model that predicts the population benefit from Thrombolysis and a similar

model to support improvements in hospital delivery of Thrombolysis


Summary of our development……


People to thank…..

• The SW SRN and Peninsula Heart and Stroke Network clinical lead, Dr Martin James for his continuing support, leadership, patience and encouragement

• The three lead practitioners for the SWSRN Leigh Barron, Liz Whelan and Anna Orpen, and good luck to Leigh later this month as she gets married!

• To the management group of the SWSRN and the SW Networks Clinical Lead and Managers group for help with organising this event

• To the session chairs• To everyone involved in supporting network activities,

both clinical and research across the area and to the stroke patients who take part in our activities and studies


We are all trying to maintain the pace of change….

Joining Forces – Maintaining the Pace of Change Maintaining the pace of change: activities across...

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