Integrated Stroke Project

Problem Statement

The Integrated Stroke Project was completed in early 2019. The project involved wards 23 and 31, and the Community Stroke Rehabilitation service within the Adult Rehabilitation and Health of Older People department.

What are we trying to achieve?

The project:

• identified opportunities for integration of ward 23 (General rehab) and the new ward 31 (acute stroke), in order to improve patient experience and outcome for stroke patients across their acute, rehab and community care
• improved integration of the acute stroke ward, general rehabilitation ward, and community stroke rehabilitation unit
• developed a new model of care, which involved short-term rehabilitation of between 7 and 10 days on the acute stroke ward.

What have we done?

• Started the short-term rehabilitation in September 2018.
• Started the phase 2 hyper-acute stroke pathway (out of hours diversion) on 3 September 2018, with a repatriation pathway established.
• Made a number of Allied Health plan-do-study-act (PDSA) improvements to increase face-to-face rehabilitation moments for patients while they are undergoing rehabilitation (groups, timetabling, enriched environments, self-practice etc).
• Used PDSA to improve coding and patient record flow from acute to general rehabilitation.
• Used PDSA for stroke folders, which include patient information that follows patients across their whole stroke pathway.

What did we find?

Acute length of stay for patients reduced from 6.4 days to 6 days from November 2017 to November 2018. (Note: Rehabilitation length of stay increased form 26.1 days to 27.2 days from November 2017 to November 2018).

Analysis of the Diagnosis Related Group codes of stroke patients being admitted to rehabilitation revealed a higher proportion of patients with more complex codes from 2016 to 2018.

How did we make a difference?

From November 2017 to November 2018, the percentage of:

• eligible patients who were thrombolysed increased from 11% to 16% (12 month average). Thrombolysis is a treatment to dissolve dangerous clots in blood vessels and improve blood flow.
• acute patients admitted to organised stroke unit increased from 81% to 83%  (12 month average)
• acute patients transferred to inpatient rehabilitation increased from 55% to 61% (12 month average).

Where to from here?

The increasing length stay of patients on the rehabilitation ward matched with the increased complexity (combined with the fact that the general rehabilitation facility is no longer fit for purpose). The model of care needs to be reviewed in line with planning for a specialised rehabilitation centre.

We will continue to track Ministry of Health indicators using the service scorecard and make improvements as business as usual.

The acute stroke service will review its service provision and follow-up of high risk patients, regarding secondary stroke prevention strategies.