Maintaining the pace of change:
activities across the networks
Jacqueline Briggs
South West Stroke Research Network Manager
Joining Forces – Maintaining the Pace of Change
Overview
Joining Forces – Maintaining the Pace of Change
Avon, Gloucestershire, Wiltshire
and Somerset Cardiac & Stroke
Network
Peninsula Heart
& Stroke
Network
Dorset Cardiac &
Stroke Network
South West
Stroke
Research
Network
Joining Forces – Maintaining the Pace of Change
Networks?
An extended group of people with similar interests or concerns who interact
and remain in informal contact for mutual assistance or support.
A system of people or things: a large and widely distributed group
of people or things such as stores, colleges, or churches that communicate with
one another and work together as a unit or system
The treatment, care and rehabilitation of cardiac and stroke patients
involves a diverse range of organisations. The role of the Network is
to bring these organisations together, with patients and carers to
improve services.
AGWS C&S Network Website 2011
The Clinical Research Network. Supporting research
to make patients, and the NHS, better
NIHR 2011
Joining Forces – Maintaining the Pace of Change
South West Strategic Health
Authority
Stroke continues to be a regional priority with good progress in part of the
care pathway particularly discharge and community care
Networks and the SHA are working together to try and improve
performance related to Stroke vital signs particularly the sign that 80% of
patients admitted with a stroke spend 90% of their hospital stay in
designated stroke facilities – set out in the Operating Framework for the
NHS 2011-12
Ongoing improvement in reporting systems / datasets remains the other
key area of work
Individual Networks also have regional priorities…………………
With Thanks to:
Richard Gleave - Director of Project Improvement
Joining Forces – Maintaining the Pace of Change
Dorset Stroke Network
•
Dorset Improving Psychological Support
after Stroke Project (NHS improvement Pilot
project)
– showing significant improvements in levels
and quality of psychological screening and
support in the community setting utilising
better collaborative working within existing
teams
•
Direct to CT/Acute Stroke Unit pathways
(RBCH)
•
Know Your Pulse & TIA video Campaigns:
the Life Channel
– The Network developed 2 campaigns to
raise awareness of the importance
checking your pulse and TIA signs and
symptoms which ran in GP surgeries
across the county
•
DIPSS training - rehabilitation
Phantom Head (DCH)
– The radiology department at Dorset
County Hospital trained all of their
radiographers in CT head using a phantom
head funded through the Network
With Thanks to:
Sara Leonard – Network Manager
Francis Avis – PPI Lead
Joining Forces – Maintaining the Pace of Change
Dorset Stroke Network (2)
•
•
•
•
•
Roll out of the assessment bed (PHT)
– Following a successful pilot at Poole Hospital
NHS Foundation Trust, the stroke assessment
bed has been rolled out across the whole county
Training Accreditation (UKFST)
- Network wide collaboration to develop three
stroke training programmes (care of the stroke
survivor, psychological support after stroke and
managing aphasia) for out of hospital care,
submitted for UK Forum for Stroke Training
(UKFST) accreditation.
GRASP-AF
– So far, the Network has recruited 36% of
practices to download the GRASP-AF toolkit.
Since August, Dorset has seen a 5% increase in
Warfarin prescribing.
Patient and Public Involvement Model
– Quoted as example of good practice by National
Audit Office – February 2010
– Presented at National UK Stroke Forum in
Glasgow – December 2010
Care Quality Commission Life after Stroke Review
– The organisations within the Network were
ranked as some of the best in the country for
their stroke care in the recent CQC review
Francis Avis presenting at UKSF on PPI
Joining Forces – Maintaining the Pace of Change
PENINSULA HEART &
STROKE NETWORK
Peninsula Heart & Stroke
Network
• Continuing to provide Service
Improvement Managers in most key clinical /
geographical areas to support local priorities and
work programmes
• Clinical Education Facilitators in most
main Peninsula sites facilitating the
implementation of stroke competencies in acute
and community organisations and nursing
homes – over 2000 people have received
training in a number of different formats
• Advising Commissioners on the local
application of the NICE quality Standard
• Supporting the development of pilot
models for Early Supported Discharge e.g.
North Devon for 12/12
With Thanks to:
Martin James – Network Lead
Michelle Roe – Network Manager
Joining Forces – Maintaining the Pace of Change
Peninsula Heart and Stroke
Network(2)
• Development of clinical guidelines e.g. Hemicraniectomy
referral guidelines and providing advice on new technologies such
as Direct Thrombin Inhibitors
• Supporting the implementation of GRASP-AF tool in
primary care
• Developing information packs on AF for primary care
Management guidelines, Treatment Decision Tree, Patient decision
aid for Antithrombotic Therapy.
• Continued development of the Peninsula Stroke data set
and facilitation of data collection
• Supporting organisations in National projects e.g. A project
at the RD&E looking at increased access to TIA clinics
Joining Forces – Maintaining the Pace of Change
PENINSULA HEART &
STROKE NETWORK
AGWS Cardiac & Stroke
Network
•
Thrombolysis
- Working collaboratively across 9 acute hospital sites has enabled
AGWS Cardiac & Stroke Network to deliver 24/7 Thrombolysis in
7/9 sites.
- The Network Stroke Consultant rota supports all sites on a 24/7
basis, with Thrombolysis being delivered via all emergency
departments.
- Between April 2010 and March 2011, over 200 patients received
the service, about 22% doing so via the Network Stroke Rota.
•
Using data to improve clinical care
- The network has been working with trusts to enable the use of
data collection to support improvements in clinical care.
- As part of the Accelerating Stroke Improvement Incentive Scheme
Trajectories programme (ASIIST), the network asked trusts to
compete to demonstrate the most improved care.
1st place - Salisbury Foundation Trust
2nd place - University Hospitals Bristol
3rd place - Great Western Hospital in Swindon
Joining Forces – Maintaining the Pace of Change
With Thanks to:
Sunita Berry – Network Director
AGWS Cardiac & Stroke
Network (2)
• Atrial Fibrillation
A successful atrial fibrillation project has enabled the
AGWS Network to claim the top spot in the National
Improvement Programme for atrial fibrillation.
- 6/8 PCTs in the Network have participated with
17,569 patients have been registered with the
GRASP-AF tool.
- This is a contribution of over one-third of all patients
registered on GRASP.
-Early results show that between 3-5% of additional
patients in the network are now receiving
anticoagulation.
- Further development of the project in 2011/12 will
aim to concentrate on increasing the numbers
receiving anticoagulants and recording and improving
the time spent in therapeutic range for patients.
• Care Quality Commission Life after Stroke Review
- PCTs in the AGWS network performed particularly well.
- 6/8 PCTs were classed as being amongst the best of the 152 PCTs reviewed.
- One PCT was judged as better and another, fair.
- Swindon PCT which was ranked 15th in the national survey
Joining Forces – Maintaining the Pace of Change
Recruitment
From April to March 2010/11
83% into category 3 RCT’s
B
Summary of recruitment across the south west
Involved with
expanded area
A
S
number recruited
1200
E
1000
L
800
600
N
0
82
133
99
201
394
422
2007/8
2008/9
E
400
200
335
I
76
36
2006/7
112
300
476
Extended area
673
2009/10
555
2010/11
1008
81.6% increase overall
- 59% in original area
- 152% in expanded area
Joining Forces – Maintaining the Pace of Change
Peninsula
Royal Devon and
Exeter site team win
the Pharma Times
Clinical Research Site
of the Year award Jan
2011
Recruitment per year
180
160
140
120
2006/7
100
2007/8
2008/9
80
2009/10
2010/11
60
40
20
0
Plymouth Derr
/ MG
Yeovil
Truro
Torbay
Taunton /Will
Exeter
Joining Forces – Maintaining the Pace of Change
Barnstaple
Expanded region recruitment 2009/10 and 2010/11
140
120
‘The contribution from SW sites (to the IRIS study) Bath,
Torbay, Bournemouth has been fantastic with these three
100
sites accounting for 50% total UK randomisations’
Professor Gary Ford – SRN Director
80
2009/10
2010/11
60
40
20
y
Sw
in
do
N
n
So
m
PC
T
bu
r
lo
uc
G
Ba
th
SM
W
B
UH
NB
T
Do
r
Po
ol
e
Sa
lis
B/
M
ou
th
0
Joining Forces – Maintaining the Pace of Change
1008 in total – April to March 2010/11
32% SoS 12% LotsCare 12% Clots3
per study recruitment April to March 2010/11
350
326
300
250
200
150
128
100
100
80
6
24
7
4
2
24
0
18
9
1
7
0
0
VI
S
T
W
hi
te
ha
ll
22
12
0
24
44
42
41
38
St
as
h
St
ro
ke
IN
F
TA
R
D
IS
TO
M
AS
49
50
D
N
S
SO
O
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N
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Ts
LO
IR
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FA
BR
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P
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D
TS
LO
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AR
S
S
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IS
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S
0
Stroke Oxygen Supplementation Study - A randomised controlled study of the benefits and risks of routine oxygen
treatment after acute stroke
Clots 3 – A randomised Trial to establish the effectiveness of intermittent pneumatic compression to prevent post stroke
DVT
LotsCare – Evaluating the clinical and cost effectiveness of a patient and carer centred system of Longer Term Stroke
Care delivered by a single stroke care coordinator
Joining Forces – Maintaining the Pace of Change
Patient, Carer and Public
Involvement
• PCPI Lead – Tim Ayers – Nurse
Consultant and PCPI coordinator
Gwenda Pay
•Integrated into network activities and
structure
• Four lay members on both the
management group and PCPI Working
Group that oversees network PCPI
activities
• Database of over 160 people
commenting on our activities and
research in the region
Members of PCPI working Group at a
recent meeting
•Wider opportunities for lay members to
work with e.g. Peninsula Collaboration
for Leadership in Applied Health
Research and Care (PenCLAHRC) and
the Stroke Association to help promote
stroke research
Joining Forces – Maintaining the Pace of Change
Examples of studies developed
in the south west
Working with the Peninsula Collaboration for Leadership in Applied
Health Research and Care (PenCLAHRC – part of NIHR)
Does the use of Nintendo Wii gaming system in a home
IMPROVE-Stroke:
IMproving
the
PRevention
Of Vascular
environment improve
dominant
arm
function in patients
after
Supported
cognitive
behavioural
therapy
self-help
for
post-stroke
1. The
ReTrain
Study
of effectiveness
and
cost
effectivenesscontrolled
of Action for
Reach
toupper
Grasp
Project
Events
after
Stroke
or
TIA
–
a
randomised
stroke
with
limb
weakness?
depression
(SHiPS): A Injury
pilot randomised
controlled
trialmonths on
Rehabilitation
from
Neurological
(ARNI)
for
survivors
six
ECHO
PIV:
A pilot
study
to
determine
clinical
utility
in carotid
artery disease
Dr
Ailie
Turton
–
University
of
the
West
of
England
pilot
trial
of
nurse
independent
prescriber-led
caretrial
from stroke: exploratory
and
multi-centre
pragmatic
randomised
clinical
Dr
Phil
Gates
–
Peninsula
Medical
School
Dr
Paul
Farrand
–
Exeter
University
Funded
and
currently
in setHospital
up
Dr
Katja
Adie
–
Royal
Cornwall
pathway-based
risk
factor
management
comparing
ARNI individual,
ARNI
group
and usual care.
Funded
currently
recruiting
Awaiting
a decision
funding
Funded
and and
currently
inonset
up through
Dr Martin
James
– RD&E
Exeter
2. Stroke Thrombolysis
project
– constructing
model that predicts the
Plymouth
Clinical
Trials aUnit
population benefit
from and
Thrombolysis
and arecruiting
similar model to support
Funded
currently
improvements in hospital delivery of Thrombolysis
Joining Forces – Maintaining the Pace of Change
Summary of our development……
Joining Forces – Maintaining the Pace of Change
People to thank…..
• The SW SRN and Peninsula Heart and Stroke Network
clinical lead, Dr Martin James for his continuing support,
leadership, patience and encouragement
• The three lead practitioners for the SWSRN Leigh
Barron, Liz Whelan and Anna Orpen, and good luck to
Leigh later this month as she gets married!
• To the management group of the SWSRN and the SW
Networks Clinical Lead and Managers group for help
with organising this event
• To the session chairs
• To everyone involved in supporting network activities,
both clinical and research across the area and to the
stroke patients who take part in our activities and studies
Joining Forces – Maintaining the Pace of Change
We are all trying to maintain the pace of change….
Joining Forces – Maintaining the Pace of Change