centralising to a seven day acute stroke service in greater … · 2019. 4. 15. · bury ccg d c c...

Greater Manchester Stroke

Operational Delivery Network

Centralising to a seven day acute stroke service in Greater Manchester

– lessons learnt

Sarah Rickard (Manager) & Dr Jane Molloy (Clinical Lead)

@GMStrokeODN


Operational Delivery Network Our providers

3 Hyper Acute Stroke Units

6 District Stroke

Centres

16 community rehabilitation

teams



Our pathway



CCG total score

2014 2015 2016

Apr-Jun 2014

Jul-Sep 2014

Oct-Dec 2014

Jan-Mar 2015

Apr-Jun 2015

Jul-Sep 2015

Oct-Dec 2015

Jan-Mar 2016

Apr-Jul 2016

Aug-Nov 2016

Eastern Cheshire CCG D D D D C C B B B A

Bolton CCG D D X D B B B B A A

Bury CCG D C C B A A A A A A

Central Manchester CCG D D D C B B B B A A

Heywood, Middleton and Rochdale CCG

C C C B A A A A A A

North Manchester CCG D C C B A A A A A A

Oldham CCG C C C B A A A A A A

Salford CCG C B C B B A A B A A

South Manchester CCG D D D D C B B B B A

Stockport CCG D C C D C B B A B A

Tameside and Glossop CCG D D D D C C B B B A

Trafford CCG D D C D B B B B A A

Wigan Borough CCG D D C C B B B B A A



GM stroke units total score

8

5

4

2 2

2

2

3 3

2

2

2

2

3

2

3

5

1

2 2

3

4 4

0

2

4

6

8

10

Jan-Mar 2015 Apr-Jun 2015 Jul-Sep 2015 Oct-Dec 2015 Jan-Mar 2016 Apr-Jul 2016 Aug-Nov 2016

A

B

C

D

E



GM vs London vs England

40

45

50

55

60

65

70

75

80

NationalAverage (Allteams)

GM all unitstrend

London allunits trend



Patient flow 2 years on

• Pathway patient flow broadly stable • 13% increase in pathway strokes Y1; returned to pre centralisation

levels in Y2 • 93% stroke admissions via HASU; 94% admitted to stroke ward • Residual activity at District Stroke Centres but not pathway breaches

- FAST –ves, inpatient strokes, onset >48 hours • Increase in directly admitted stroke patients at DSCs treated on non-

stroke wards in Y2 – due to bed pressures • Reduced mimics assessed at HASUs in Y2; fewer admitted to HASU

wards in Y2 – suggests better recognition and subsequent management of patients by stroke services

• 85% strokes conveyed by ambulance (few breaches); 10% self/GP referral

• Increase in proportion of strokes <4hours time of onset at HASUs in Y2 – suggests better detection and conveyance to hospital



Key lessons – patient flow

• High burden of false positives at HASUs – improve recognition of stroke and improve hand off

• Direct admissions still happen at ASUs - can the units still provide appropriate care?

• Consider referral pathways – carotid artery, pregnancy, renal, TIA etc

• Consider exclusions to pathway – children, late onset, pregnancy, FAST negatives etc



Key lessons - operational

• Get the launch right! Engage and communicate

• Agree a suite of SOPs to support key processes

• Agree at CEO level robust process (with £ levers) to ensure timely repatriation

• Ensure sufficient support to manage increased patient flow at HASUs

• Consider transfer to and impact on community teams

• Measure impacts – agree metrics



Critical success factors

• Decision to centralise based on robust evidence – hearts and minds finally won!

• Collaborative approach built relationships and trust over time

• Effective use of data to demonstrate impacts of change

• Establishment of an Operational Delivery Network



Networks add value

Focal point for stroke in GM and increasing our national profile

Governance structures through which organisations can hold each to

account, with mechanisms to identify and address issues and risks

A voice for patients and carers, and involving the voluntary sector

Involving a wide range of stakeholders and providing

opportunities for networking and peer support, and sharing of best

practice

Strategic approach to improving local stroke services across the whole care pathway and providing a clear vision

for the future

Forums for discussion, agreement, implementation and resolution of operational issues and facilitating

service improvements


Operational Delivery Network Get in touch

[email protected]

[email protected]

www.gmsodn.org.uk

@GMStrokeODN

centralising to a seven day acute stroke service in greater … · 2019. 4. 15. · bury ccg d c c...

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