Stroke: Targets missed for 40% of patients on hospital discharge
Published: 01 Dec 2015
The Sentinel Stroke National Audit Programme (SSNAP) for the first time today, launches an audit report on the organisation of care for stroke survivors once they leave hospital.
The audit highlights the number and location of post-acute stroke services across the UK and outlines what a patient might expect in accessing these services. For example, what a patient might receive in waiting times for treatment, intensity and duration of treatment.
New standards around waiting time have been outlined for both Early Supported Discharge (ESD) teams and all other services. The recommended waiting times for ESD teams should not exceed 24 hours from leaving hospital and 40.1% are currently falling outside of this. All other services should be aiming to carry out patient reviews within 14 days and begin treatment within 90 days of referral.
This is one of two stroke reports published today (see also the SSNAP hospital care report).
The audit also reveals the need for all stroke patients to have access to comprehensive multi-disciplinary teams as there is a variation in the way services are organised. It also raises concerns about the number of nurses within post-acute inpatient services who are not trained in swallow screening, a key competency when treating stroke patients. Of the nurses on duty at 10am, the audit shows a median of 0 per 10 stroke beds were trained to screen the safety of swallowing – this is a key aspect of stroke nurse training.
It also covers resources needed to provide services, including team numbers and expertise and where reviews to assess a patient’s progress and on-going needs at 6 months post stroke, as recommended by the National Stroke Strategy, are taking place.
The stroke pathway is complex, and very little is known nationally about the organisation and structure of services available once the patient has left hospital. For the first time, the report is pushing to change this.
The audit covers data collection on 604 post-acute stroke services in England, Wales and Northern Ireland, and includes care in community hospitals, outpatient clinics and a patient’s own home. It also reports on the provision of 6 month assessment reviews.
Dr Geoffrey Cloud FRCP, associate director for stroke (CEEu), said:
“Together with the findings of the first post-acute organisational audit and the on-going SSNAP clinical audit, this report gives new and important information about the standard of stroke care outside hospitals nationally. In doing so, it provides valuable recommendations to improve standards for all those involved in providing and commissioning community stroke care. As with hospital care, services outside hospitals are under increased pressure for further availability of services and improvement. We hope that this report can be used in a practical way to help influence positive change.”
As with the post-acute stroke service commissioning report (June 2015), key recommendations around 6 month assessment reviews focused on the need for commissioning organisations (Local Health Boards in Wales) to ensure they are commissioning 6 month assessment reviews for all stroke patients and to ensure all data is submitted to SSNAP.
Participation in the first post-acute stroke service audit has been excellent, with 80% (604) post-acute services identified providing data. This is encouraging and shows the commitment of services to be involved in improving the overall stroke care pathway. The results reflect post-acute stroke services on 1 April 2015. The results are available on-line via the SSNAP Results Portal (<LINK>).
Key recommendations for post-acute stroke services and commissioners include:
1) All services treating stroke patients that are not currently entering data to the clinical component of SSNAP should do so.
2) Swallow screening is a key aspect of stroke nurse training. All nurses based within post-acute inpatient services treating stroke patients should been trained in this. This issue should be reviewed locally as a matter of priority.
3) All healthcare based services, should provide their patients with access to a comprehensive multi-disciplinary team – including doctors, nurses and a named social worker.
4) People’s access to psychological support should be as important as their access to physical support services.
5) All services which regularly treat stroke patients should ensure their staff receive specialist stroke training to ensure they can provide effective and compassionate stroke care.
6) All Early supported discharge (ESD) teams should assess patients and start treating them within 24 hours of hospital discharge.
7) With the national agenda around 7 day services in the NHS, Early supported discharge (ESD) teams should plan to provide services every day of the week in order to provide care equivalent to inpatient care.
8) All services should have a clear re-referral pathway in order for patients to return to a service if needed.
9) Patient information that is relevant and accessible needs to be freely available in all post-acute care settings.
10) All stroke patients should have a 6 month review. In England, this is in accordance with the National Stroke Strategy and all commissioners (Local Health Boards in Wales), not only those in England, should be funding them.
11) We would encourage Clinical Commissioning Groups (CCGs) in England, Local Commissioning Groups (LCGs) in Northern Ireland and Local Health Boards (LHBs) in Wales to ensure that all stroke patients are receiving a 6 month review and this is entered onto SSNAP.
12) All stroke patients should have access to vocational rehabilitation where appropriate