supporting nhs wales to deliver world class healthcare gwent healthcare nhs trust royal gwent...

Supporting NHS Wales to Deliver World Class Healthcare

Gwent Healthcare NHS TrustGwent Healthcare NHS TrustRoyal Gwent HospitalRoyal Gwent Hospital

Royal Gwent Hospital Task GroupRoyal Gwent Hospital Task Group

44thth February 2009 February 2009

All Wales Stroke Services Improvement CollaborativeAll Wales Stroke Services Improvement Collaborative

Royal Gwent HospitalRoyal Gwent Hospital• Acute general hospital in Newport covering 5 boroughs• 45 – 50 Stroke admits/month• Patients admitted via A and E and MAU - - source of referrals• Cross cover by Stroke Specialist Nurse• Accepts/reviews referrals from all wards to assess if meets

criteria for acute stroke unit• Integrated stroke pathway• 32 Bedded Ward (Acute Stroke Unit)• No ring-fenced beds• Multidisciplinary cover, including, Consultant with special

interest in Stroke, medical team, physiotherapy, occupational therapy, speech therapy, pharmacy and dietetics


The Task

• To data collect on the parameters of care for stroke patients

• To identify from the data our specific areas for improvement

• Difficult to establish/quantify its effect on patient care – rationale for data collection


The ContextThe Context

• Coordinated by the task group based on the ASU

• Collated data from all areas involved in stroke care throughout the patient’s journey

• All referred acute stroke patients to the RGH


Task assessment and analysisTask assessment and analysis

• Anecdotal evidence of gaps in knowledge, service and practice in stroke care

• CNS on review of patient or retrospectively, commenced data pro forma

• Physiotherapy, Occupational therapy, Speech and Language therapy attached to ASU completed data as required

• Adapted CNS pro forma to incorporate NLIAH criteria


Strategy for ChangeStrategy for Change

• Formal and informal meetings• Multidisciplinary meetings• Pro forma on paper kept in centrally

located file easily accessible to all • Dissemination of information and feedback

of NLIAH meetings by project lead• All data input by members of task group• Two months, commenced mid-December


Measurement of EffectivenessMeasurement of Effectiveness

• Daily review of data sheets by CNS• Identified uncompleted data and liaised

with appropriate member of MDT• Approached ASU nursing staff to support in

data collection• Twice weekly review of file in MDT

meetings


Effects of ChangesEffects of Changes

• Provided hard evidence of where gaps in service lie• Now an on-going tool for assessment - - established

a baseline• Identifies differing patient pathways• Has not resolved problem but has given areas to

focus on• More aware of time scales and enables us to prompt

certain assessments • Getting people on board and completing the pro

forma


Effects of Changes- Negatives Effects of Changes- Negatives • Lack of awareness of NLIAH project so task group required

to encourage enthusiasm and motivation of additional staff • Getting people on board and completing the pro forma• Difficulty getting others to take ownership of NLIAH project• Lack of consistent commitment from original team

members• Difficulty in getting the team together • Difficulty in attaining full attendance for meetings• Data set not detailed enough to give variables i.e. aspirin,

thrombolysis• Reliant on CNS input i.e. no data collection during CNS-

leave• Task group not fully representative of patient pathway i.e.

no representation from A and E/MAU


Lessons learntLessons learnt

• Look towards what you have to use for data collection before reinventing the wheel

• Initial introduction to NLIAH for all relevant trust members

• Get committed team with representation from all relevant areas


Message for OthersMessage for Others

• Data collection can be easily incorporated into daily roles with commitment from a team and quickly starts to provide a basis for change

supporting nhs wales to deliver world class healthcare gwent healthcare nhs trust royal gwent...

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