Stroke Pathway Project

Description:Review and establish community stroke pathways based on best practice to improve seamless service and clinical outcomes. Implement integrated early supported discharge & 6 month stroke reviewsAlign community stroke pathway with acute & long-term service developments

PROJECT SUMMARY

KEY MILESTONES

Date of Update: 29th December 2014

RISKS AND ISSUES

ACHIEVEMENTS/COMMENTARYCommunity stroke developments are in the implementation and delivery phase, supporting the back-door for patient flows. The next stage for this project needs consideration to ensure it embedded within a whole integrated pathway approach. There are a number of stroke work-streams which either require project development or a coordinated approach to delivery including• NOACs• Stroke JSNA• Hyper Acute Stroke Units – PAH and Beds, Herts and Luton• Whole pathway specification and financial modelling• Electronic TIA referrals• Performance and Delivery across providersRecommendations/Request for ActionEstablishment of a multi-agency stroke stakeholder group to coordinate project and stroke/TIA work-streamsDecisions regarding recommended next steps in HASU/ASU provisionSupport to review the Midlands and East Specification for the whole pathway and develop a local specification and strategyDevelop and agree KPIs.

Current Objectives:• Provide Early Supported Discharge (ESD) to 40% of stroke survivors• Provide 6 month post stroke reviews to all stroke survivors• Reduce length of hospital stay and improve seamless flow to community• Reduce risk of death and dependency associated with stroke• Ensure high levels of patient and carer satisfaction with services• Establish integrated psychology pathway • Establish stroke pathway evaluation tools & performance measures • Establish a stroke leadership group to coordinate commissioning & provision• Establish the new TIA referral system for PAH in primary care• Redefine stroke project for Q4 2014-15 & 2015-16

Previous Current Forecast

RAG Risk/Issue Description / mitigation

Risk Decision re PAH HASU

West Essex CCG to present business case re PAH HASU to board Jan14.Awaiting presentation from ambulance service on impact . West Essex planning for divert from April 15 – felt to be unrealistic timescales. E&NHHT need time to mobilise

Risk Stroke Project Priorities for and redefinition needed to guide next steps of project

Issue PAH TIA Clinic electronic referral system

West Essex CCG & PAH changing to electronic referral pathway. Requested E&NH GPs adopt system for PAH. PAH will run fax and electronic system until GPs implement. Proposed 19/01/15

Issue Commissioning for Value: Elective spend

Paper suggests high elective spend, which required local interpretation. Working with David Hodson to review and understand data

Issue ESD ‘resolved patients’

Patient identified by ward as no needs subsequently identified with social care needs – proposed all patients discharged home from acute contacted by ESD

Risk ESD Coordinator at PAH

No full time coordinator at PAH could lead to lack of engagement. Meeting with PAH to establish trusted assessment

• Nov 2014: ESD East & North Herts Hospital Trust Month 1 data reporting• Dec 2014: Establish integrated psychology pathway (cognition & mood) • Jan 2015: Draft stroke JSNA to be published to stakeholders by Public Health• Jan 2015: ESD to commence at Princess Alexandra Hospital & other acute

providers. Commence 6 month reviews. Embed of Stroke Association.• Jan/Feb 2015: 2015/16 Stroke CQUIN agreed for E&NHHT, HCT & PAH• Jan 2015: New PAH TIA referral system operational• Jan/Feb 2015: Stroke Leadership Group Operational• April 2015: Stroke Caring with Confidence Course

ALIGNED WORKSTREAMS• HASU decisions – PAH & Beds, Herts & Luton• Performance, delivery & contract monitoring• NOAC/AF & Vascular pathways• Danesbury Beds• PH Self Management• HCC Contracts and LTC management Completed by: Jill Catchpole

East & North Herts CCG: Stroke Pathway Draft Highlight Report 29th December 2014

Pathway Stage Project AreaPlanned

Completion Date

Suggested Revised

Date

Actual Completion

DateStatus / Comments & Performance

Prevention

Anti-coagulation and NOACs (New Oral Anti-coagulants) Lead: Rachel Joyce/Amanda Flower Linked: HCC Public Health Self Management Future: Public campaign

Performance: Public Health England Cardiovascular Disease Profile: Stroke Published Aug2014 (2012/13 data) http://www.yhpho.org.uk/ncvincvd/pdfs/stroke/06K_Stroke.pdfNational prevalence 1.7 E&NH CCG 1.5%Secondary diagnosis of atrial fibrillation: National: 28.8% of stroke admissions in England. E&NHCCG, 28.0%. Increase from 23.9% in 2010/11

Pre-Hospital Phase (Ambulance Conveyance)

No Specific Current Project Area Linked: EEAST Optima modelling of impact of PAH not providing thrombolysis and HASU services on stroke. Awaiting presentation date Future: Business as usual negotiations over QE2 divert & HASU financial modelling

n/a

Although green performance in Q2 down on Q1

Hyper-Acute Stroke Services

Delivery of Hyper-Acute Stroke Units -Beds/Herts/Luton CCG Agreed Configuration West Essex CCG – Future of PAH as potential Hyper-Acute Unit Lead: Beverley Flowers/Rachel Joyce/Jill Catchpole Project to address performance and outcomes associated with early specialist treatments

tba

See next slide

Acute Stroke Unit & In-patient Stroke Rehabilitation

Performance Monitoring: Lead Quality Team Danesbury Beds: Lead Chris Badger CQUIN 7 day working & Joint Care Plans: Jill Catchpole/Rachel Joyce Future: ASU provision within context of HASU reconfiguration & tariff agreement

31/1/15

See next slide

Early Supported DischargeImplementation of Stroke Early Supported Discharge for mild to moderate disability Lead: Andrew Godfrey/Jill Catchpole

30/9/15Month 1 data: Lister: 20%; CCG 18.2%Mobilisation plan amended based on better than predicted recruitment Patient letter of support of service in Welwyn and Hatfield Times

Community RehabilitationCommunity KPI: Lead Jill Catchpole Psychology Pathway 31/03/15

HCT now submitting but requires validation prior to sharing – projected Jan/Feb highlight49 staff trained on psychology pathway & rolling programme. Self management end of Q3 90 attendees

6 Month Reviews 6 month reviews for all stroke survivors Lead: Andrew Godfrey/Jill Catchpole 30/9/15

Model and pathway being piloted. To be delivered by ESD team & stroke association. Full roll out from January 2015.

TIA

Performance & Contract Monitoring: Lead Quality team

PAH TIA electronic Future: Public Awareness

See next slide

30/1/15

Other -SSNAP Awaiting publication Q2 data

Areas of under performance –September/October (*QP)Metric Target CCG Level ENHT PAH

Stroke 4 hours direct to a stroke unit 90% 50% 51.9% 46.8% 48.7% 54.5% 59%

Stroke 90% of time on stroke unit 80% 75% 70.4% 67.3% 66.7%

Stroke Thrombolysed within 3 hours 12% 4.1% 12.8% 2.4%/ 15.2% 5.7% 2.8%

Stroke TIA within 7 days of onset 65% 49.2% 56.4% 46.7% 63.9%

Stroke high risk treated within 24 hours 60% 79.3% 57.9% 42.9% 25%