Hull & East Riding Stroke Service 
ANNUAL REPORT
April 2005/6
ANNUAL REPORT
April 2005/6
TABLE OF CONTENTS
INPATIENT ACTIVITY AND ACUTE CARE MANAGEMENT
3&4
TIA SERVICE REPORT (JANUARY DECEMB ER 2005)
.. 4,5,6,7
DEVELOPING A THROMBOLYSIS SERVICE
7
DEVELOPMENTS IN THE COMMUNITY STROKE SERVICE
.. 7,8,9
- Community
Stroke Team
- Central
point of contact
COMMUNITY OCCUPATIONAL THERAPY REPORT
9&10
NUTRITION AND DIETETICS SERVICE REPORT
..10,11,12
TRAINING AND EDUCATION
.....12,13,14,15,16
AUDIT/RESEARCH
.. 17
USER/CARER INVOLVEMENT
17
STRATEGIC OBJECTIVES FOR 2006/07
18
ACUTE STROKE CARE PATHWAY (APPENDIX 1)
19
COMMUNITY STROKE CARE PATHWAY (APPENDIX 2)
20
IN PATIENT ACTIVITY AND ACUTE CARE MANAGMENT
The number of patients admitted through the Stroke Care Pathway in the Acute hospital equates to 708 (up to and including the end of March 2006) which again provides a very similar picture year on year to previous years in terms of activity. The Service now has well established co-ordination of stroke patients in the Acute hospital supported by the Stroke Co-ordinator, TIA Nurse Specialist, Nurse Consultant in Stroke and Stroke Physician. The Service has developed strong working relationships with the staff in the Assessment Unit and Bed Bureau together with Bed Managers and Nursing and Medical staff across outlying Medical Wards at the Hull Royal Infirmary.
This year, the Stroke Team enabled 76% of stroke patients admitted to the Hull Royal Infirmary to access the Acute Stroke Unit on Ward 110 (National average number of patients getting to an Acute Stroke Unit is currently 50%), the remaining 24% of stroke patients were supported on outlying wards by the Stroke Team in conjunction with Consultant Physicians and Geriatricians and Nursing Teams. A significant number of these patients were supported through the Stroke Pathway into Community based Rehabilitation facilities and all of them referred on for follow up support following discharge home.
PLEASE REFER TO ACUTE STROKE PATHWAY DOCUMENT
ATTACHED (Appendix 1)
Breakdown of Activity
|
Patients from |
166 (25%) |
|
Patients from |
223 (33%) |
|
Patients from |
182(27%) |
|
Patients from |
86 (13%) |
|
Patients from other PCT area |
21 (2%) |
56% of the total stroke population were aged 75 and over, 25% between 66-74 years of age and 19% under the age of 65. There is a national recognition that approximately 10% of stroke sufferers will be of working age. It is quite concerning, therefore that locally 19% of our stroke population is under the age of 65. This requires a real focus locally both in terms of ensuring we develop adequate provision for younger stroke survivors as well as identifying the key risk factors for this population group and strategies for more robust prevention.
Risk Factor Management
The
Stroke Team have worked hard to capture each stroke patients individual risk
factors and whether these risk factors have been previously identified. 60% of stroke patients had Hypertension as a
risk factor with 86% of them already on antihypertensive medication before the
stroke. This may support the suggestion
that blood pressure controls need to be more vigorously approached to prevent
stroke.
Likewise
in terms of Cholesterol, 44% of the stroke population were identified as having
Hypercholesteraemia as a risk factor with 49% of
those already on treatment and treatment actioned by the stroke team was 51% of
cases.
It is
nationally recognised that approximately 25% of Ischaemic Stroke is of
Cardioembolic origin (such as Atrial Fibrillation). Locally 14% of stroke patients were
identified as having Atrial Fibrillation as a cause of their stroke. This may reflect the routine requirement for
further investigations for irregular heartbeat (via 24 hour ECG monitoring)
needing to be done as an outpatient which would not be reflected in this
data. 31% of patients who were
identified as having Atrial Fibrillation during their hospital admission were
previously not receiving anticoagulant treatment for this condition.
20% of
the patients were admitted with a risk factor of smoking.
Likewise
when assessing the percentage of stroke patients having carotid artery stenosis this is difficult to get an accurate picture as
a high percentage of these patients will go on to have Carotid Doppler
investigation post discharge from hospital; the Stroke Team needs to do further
work next year to collate more accurate information.
15% of
patients were identified as having Diabetes.
All but 7% of stroke patients with diabetes were previously diagnosed
with this condition which again may highlight the potential need for better
secondary prevention in this area.
19.6%
of this years stroke patients had a history of
previous stroke with 22.5% of that population group having suffered a stroke
less than 6 months previously and 73% more than a year. This may also indicate
a requirement for much more emphasis of management of individuals stroke risk
factors long term in the Community.
In
total the Service recorded 19% of the stroke population died during their
admission to hospital (16% of the total deaths died within the first 30
days). This compares favourably with the
National Average of approximately 22% in the first 30 days. The percentage of stroke patients who died
once getting to the stroke unit was 12.7%.
This again supports the evidence that Stroke Units significantly reduce
mortality.
TIA SERVICE REPORT JANUARY DECEMBER 2005
The number of logged referrals was 624 which were slightly up on 2004s logged referrals of 622.
The waiting times to see the Nurse Specialist hovered around the 7-10 day mark for most of the year but alas the waiting times did increase during periods of annual leave and bank holidays as have done in previous years.
The waiting times for investigations after seeing the Nurse Specialist remained pretty much the same as the year before with an average wait of 2-3 weeks for a Carotid Doppler and 3-4 weeks for a routine CT scan but with the continued support of the Vascular laboratory and the radiology department the walk in service for urgent patients continued. Their continued support is highly valued by the service.
The appointment of a locum Consultant meant that the number of Consultant clinics could be increased from June 2005 and this has had a very positive effect on the waiting times and also accessibility for those patients that need an urgent appointment and may not necessarily need to see the Nurse Specialist.
As in previous years because of the increase in the number of referrals, the number of allocated investigation slots does not meet the demands of the service and in periods of annual leave the Nurse Clinics do not run. In previous years the service has been supported by the senior staff on the Stroke unit but this year due to their own staffing issues this had not been possible.
Activity Chart
|
MONTH BY MONTH YEAR: 2005 |
PATIENTS SEEN BY TIA NURSE |
PATIENTS SEEN BY DR.ABDUL-HAMID |
PATIENTS SEEN BY DR. ZUROMSKIS |
PATIENTS WHO HAD CT |
PATIENTS WHO HAD CAROTID DOPPLER |
|
JAN |
51 |
29 |
0 |
25 |
31 |
|
FEB |
56 |
47 |
0 |
26 |
36 |
|
MAR |
60 |
64 |
0 |
25 |
27 |
|
APR |
48 |
47 |
0 |
23 |
43 |
|
MAY |
62 |
45 |
0 |
18 |
43 |
|
JUN |
50 |
34 |
17 |
24 |
36 |
|
JUL |
55 |
20 |
11 |
24 |
24 |
|
AUG |
54 |
40 |
34 |
24 |
51 |
|
SEP |
25 |
44 |
5 |
24 |
45 |
|
OCT |
61 |
42 |
24 |
30 |
39 |
|
NOV |
63 |
55 |
47 |
24 |
36 |
|
DEC |
39 |
31 |
18 |
18 |
37 |
TOTAL |
624 |
498 |
156 |
285 |
448 |
Waiting times for consultation and investigations
|
Month by Month Year: 2005 |
Nurse clinic |
Consultant clinic |
CT Scan |
Doppler scan |
|
January |
14 days |
Dr Abdul Hamid: 8 weeks |
2 weeks |
1 week |
|
February |
10days |
Dr Abdul Hamid 8 weeks |
2 weeks |
2 weeks |
|
March |
9 days |
Dr Abdul Hamid 8 weeks |
3 weeks |
3 weeks |
|
April |
7 days |
Dr Abdul Hamid 8 weeks |
3 weeks |
3 weeks |
|
May |
5 days |
Dr Abdul Hamid 8 weeks. Dr Zuromskis 4 weeks |
4 weeks |
4 weeks |
|
June |
7 days |
Dr Abdul Hamid 7 weeks. Dr Zuromskis 3 weeks |
3 weeks |
5 weeks |
|
July |
7 days |
Dr Abdul Hamid 6 weeks. Dr Zuromskis 3 weeks |
3 weeks |
6 weeks |
|
August |
7 days |
Dr Abdul Hamid 6 weeks. Dr Zuromskis 3 weeks |
3 weeks |
3 weeks |
|
September |
7 days |
Dr Abdul Hamid 5 weeks. Dr Zuromskis 3 weeks |
4 weeks |
2 weeks |
|
October |
17days |
Dr Abdul Hamid 5 weeks. Dr Zuromskis 4 weeks |
4 weeks |
3 week |
|
November |
10 days |
Dr Abdul Hamid 5 weeks. Dr Zuromskis 6 weeks |
5 weeks |
3 weeks |
|
December |
7 days |
Dr Abdul Hamid 3 weeks. Dr Zuromskis 7 weeks |
6 weeks |
4 weeks |
Dyson Stubbins, TIA Nurse Specialist
The number of patients with a history of TIA who went on to have a stroke between April 2005 and March 2006 equated 11% (75 out of 678) of the total stroke population with 37% 28 out of 75) of that number having suffered a TIA less than 6 months previously, 10% (8 out of 75) between 6 months and 1 year and 52% (39 out of 75) more than a year previously.. The risk of developing a stroke after hemispheric TIA can be as high as 20% in the first month with the greatest risk within the first 72 hours.
National recommendations now require patients to be able to access a Neurology Clinic within 7 days of suspected TIA. Locally, this standard has been met approximately 50% of the time. Patients who are in the higher risk category of going on to have a stroke within 1-2 weeks of suffering as Transient Ishcaemic Attack are not able to benefit from a service responsive enough to prevent this. Considerable additional resource would be required to ensure investigative procedures are accessible much sooner than current waiting times which is averaging to 3-4 weeks for Carotid Doppler in particular.
The Stroke Team also intend to disseminate clearer guidance over the next year, particularly in the Accident & Emergency and Acute Assessment Unit at Hull Royal Infirmary to support the required management for patients admitted with Transient Ischaemic Attack. Investigations should include CT brain and Carotid Doppler scanning where appropriate before patients are discharged home to be reviewed urgently in the Minor Stroke/TIA Outpatient Clinic.
DEVELOPING A THROMBOLYSIS SERVICE
Over the past year training has taken place to ensure that all nursing and care staff on the Acute Stroke Unit have been trained with regards to the background assessment and clinical management of patients who may be considered and go on to receive Thrombolysis. In addition to this, Nursing Guidelines and Protocols have been approved through the Nursing & Midwifery Practice and Policy Committee. Dr Abdul-Hamid, lead Stroke Physician has registered the Hull Royal Infirmary site with the International Stroke Trial for Thrombolysis. The Stroke Service is awaiting approval via the Clinical Practice Committee for the Acute Trust. In addition to this, significant barriers remain, particularly in relation to adequate resource both in terms of providing the service 24 hours a day, 7 days a week and adequate resources to provide close monitoring to patients post Thrombolysis infusion. These service requirements have been raised through the LDP process for the Acute Trust.
DEVELOPMENTS IN THE COMMUNTY STROKE SERVICE
This year 234 patients benefited from continued rehabilitation in an inpatient community setting across Hull & East Riding with an average length of stay of 6 weeks. Community Hospitals at Beverley and Withernsea in particular have provided additional stroke rehabilitation facilities enabling more patients to benefit from rehabilitation nearer to their own home.
APRIL 2005
|
Destination |
Number of Patients |
Transfer to own home |
Transfer to Nurse/Res
Home |
Return to Acute |
RIP |
Length of stay |
||
|
|
|
|
|
|
|
|
Average number of days |
Average Number of weeks |
|
Alderson |
60 |
9 still in |
47(92%) |
1(2%) |
3(3%) |
0 |
50 |
7 |
|
St Marys |
63 |
7still in |
34(61%) |
16(28.5%) |
4(7%) |
2(3.5%) |
36 |
5 |
|
Rossmore |
50 |
6 still in |
34(77%) |
9(20%) |
1(2%) |
0 |
48 |
7 |
|
Beverley |
32 |
7 still in |
22(88%) |
3(12%) |
0 |
0 |
32 |
7 |
|
Alfred Bean |
9 |
2 still in |
7(77%) |
2(23%) |
0 |
0 |
44 |
6 |
|
Hornsea |
4 |
2 still in |
1(50%) |
0 |
0 |
1(50%) |
57 |
8 |
|
Withernsea |
16 |
2 still in |
10(71%) |
4(29%) |
0 |
0 |
36 |
5 |
|
|
|
|
|
|
|
|
|
|
|
Total |
234 |
35(15%) |
155(78%) |
33(17%) |
8(4%) |
3(1%) |
43.2 |
6 |
The Service continues to be well
supported by
The Hull Acute Therapy Service (HAHTS team) receive referrals as patients are discharged from the hospital, and in the case of stroke patients, when discharged from the stroke beds at Alderson, Rossmore, St Marys and Beverley Westwood.
The team is based in a portacabin at Hull Royal Infirmary and is staffed as follows:
Team leader/Physiotherapist Linda McFadden
Senior I Occupational Therapist Val Masterman
Senior II Physiotherapist ` Rotational
Senior II Occupational Therapist Rotational
Generic Technical Instructors Linda Clark
Diane Hughes
Chris Taylor
All of the above are WTE
Departmental Secretary Gloria Wells (0.77WTE)
From
Ward 110 40
Stroke Beds 41
Ward 2, CHH 21
GM wards 16
PRH wards 3
Neurosurgery 1
AAU 1
Ward 12 2
Dinah Fuller 1
Linda McFadden, Team Leader/Physiotherapist
Community Stroke Team
The most significant development within the Stroke Service this year has been the establishment of a Community Stroke Team working directly within the Service. The team is lead by the Nurse Consultant in Stroke and comprises of 2 Stroke Nurse Specialists and 3 Support Workers. This team provide ongoing support for patients and their carers post discharge from Acute Hospitals, support the Nurse Consultant in Stroke with continued medical and clinical management of stroke patients in community based rehabilitation settings and will develop a remit for ongoing specialist advice and support to Community Health and Social Care Professions to support stroke patients in all community settings as required.
Central Point of Contact
The Nurse Consultants Secretary and Stroke Service Facilitator now supports a central point of contact number which can be accessed by Health & Social Care Professionals, patients and carers alike. This is already proving to be extremely valuable for prompt support and response in relation to stroke enquiries in the area.
PLEASE REFER TO THE COMMUNITY STROKE CARE
PATHWAY DOCUMENT ATTACHED (Appendix 2)
COMMUNITY OCCUPATIONAL THERAPY REPORT
East Riding of
Since the set up of the Stroke Service no further funding for Stroke Rehabilitation has been made available for the East Riding. Staffing remains as follows:
1.33 Senior Occupational Therapist
1.00 Occupational Therapy Assistant
Stroke Rehabilitation continues to be provided as an integral part of the Community Rehabilitation Service for both In-patients and Services provided in the community.
In-patient Beds
Patients continue to be seen by the Occupational Therapists
working in the Community Hospitals in Hornsea, Withernsea, Driffield and
Beverley. All patients are seen within the standard of three working days
following receipt of referral to Occupational Therapy.
Gaps
Shortfalls in providing the service continue due to limited
funding made available for Stroke Rehabilitation, the rural nature of the East
Riding, and the limited staffing levels in particular in the Holderness area.
The increase in stroke beds at
City of
Step-down Stroke
Rehabilitation Beds
In
Community Rehabilitation Service
Gaps
In the City of
Monitoring of this shortfall is in place with a waiting list being
maintained and updated on a monthly basis for those patients who are referred
to be seen in the community. An average of 30 people remain
on the waiting list at the end of each month.
Clinical
Governance
The Clinical Specialist Occupational Therapist contributes to the
clinical governance of the service by carrying out clinical supervision for all
Occupational Therapists involved in stroke rehabilitation on a case by case
basis. The Clinical Specialist Occupational Therapist is also involved in the
Stroke Foundation Course and delivery of in service training to Occupational
Therapists. In 2005/2006 time was also given to the development and audit of
the Therapy Six Month Review service for patients in the City of
Alison Forrester, Head Occupational Therapist Clinical Specialist
Stroke,
Community Rehabilitation,
NUTRITION AND
DIETETICS SERVICE
Service provision
- Acute
The
service is provided by 0.5WTE senior I dietitian, who
works across ward 110 HRI and ward 2 CHH.
It is a three-day service i.e. Monday, Wednesday and Thursday. Outside of these hours there is a very
limited service, provided by the general dietetic department.
Number of new stroke patients/follow up contacts seen within the acute trust (HRI and CHH)
|
April 05-March 06 |
New patients |
Follow up |
total |
|
|
160 |
800 |
960 |
- Community
Provides a service in Primary Care and Stroke Rehabilitation Units across 4 PCTs and attending MDT/Care review meetings in Stroke Rehabilitation Units as required.
Patients are seen in mainstream dietetic clinics, Residential/Nursing Home care and in their own homes (if indicated)
Referral guidelines are available to enable appropriate dietetic care and optimise nutritional outcomes for these patients.
Nutritional support
- Acute
It is estimated that 40 50% of stroke patients will initially have swallowing problems. The dietitian assesses nutritional status, estimates nutritional requirements and recommends a nutritional treatment plan to enable requirements to be met within the limitations established by SALT (NBM or texture modification). There is a high usage of Naso-Gastric and PEG feeding tubes. The stroke service has established protocols for the usage and care of these tubes. Nutritional support is the main area of work for the acute service dietitian.
- Community
Reviews of nutritional status are undertaken with changes to enteral tube feeding regimens as required as oral intake improves or weight loss occurs.
Secondary
prevention/risk reduction
- Acute
The
dietitian gives advice to newly diagnosed and known
diabetic patients to help improve diabetic control and thereby reduce the risk
of further strokes. Advice is also
provided to patients who are overweight or have a raised cholesterol level. If caseload pressures prevents this happening
while an inpatient (often the case), a referral is made to the community
dietetic service to provide this advice as an outpatient.
- Community
Dietetic support to the Nurse led TIA Clinic is provided twice a month
Local community clinic support for patients referred with hyperlipidaemia or for weight management (or as
Education
- Stroke Foundation Course delivered quarterly
- Evidence based Stroke Care (Level3)
- Texture Modification Training in Stroke Rehabilitation Units
- Enteral Tube Feeding in Nursing Homes updates undertaken
Acute/community
therapy services partnership liaison
There
is close liaison between the acute and community dietetic services to
facilitate the transfer of patients from a hospital to a community setting. It
is essential that patients with PEG feeding tubes, being discharged into their
own home or a nursing home, have a seamless service. The acute service dietitan
organises the training
of patient, relatives or carers - as required.
A Homeward feeding pump and drip stand is provided and discharge feed
supplies organised. There is an agreed
discharge information sheet sent to the community dietitan
to enable future supplies of feed etc to be established and follow up
arrangements to be organised. These
patients usually rely on their feeding tube for 100% of their nutrition and
hydration, so it causes a great deal of difficulty for community based staff
and distress for patients if the discharge process goes wrong. Every effort is being made to raise awareness
of this process.
Developments
completed
- Enteral Tube Feeding Policy updated locally
- Implementation and training for Malnutrition Universal Screening Tool (MUST) in Primary Care/ Stroke Rehabilitation Units with Nutrition resource folders updated.
- Nutritional
screening tool (acute) has been implemented across
- Nutrition Support manuals updated and replaced on all acute trust wards including ward 110 HRI and ward 2 CHH
Developments in
progress
- A collaborative acute/community Audit of enteral tube feeding patient discharge has commenced.
- Data collection is ongoing to identify shortfalls.
Planned
developments/concerns/shortfalls
·
Although the dietitian (Acute Hospitals
Trust) works closely with all members of the MDT, there is insufficient time
available to enable attendance at the weekly MDT meetings held on ward 110 and
ward 2. The 0.5WTE spread over 3 days
and two sites make the high nutritional support caseload difficult to meet.
- There are limited dietetic resources available in the Holderness
Area to support stroke rehabilitation.
- A budget overspend is predicted for enteral
tube feeding equipment approaching £40,000 in this year.
BRITISH ARTIFICIAL
NUTRITION SURVEY (BANS) 2000-2003
Local data is provided to this national survey and the last national published figures were for 2000-2003.
This reports that there has been a steady growth of adult patients on Home Enteral Tube Feeding (HETF), showing an 11% growth in point
prevalence *, with new registrations being relatively constant year on year.
Also the main reason for requiring HETF was a swallowing disorder (70% of patients) and CVA was the single most common diagnosis (32% of patients)
|
|
2004 |
2006 |
|
Current patient
registrations (total) |
254 |
389 |
|
New patient
registrations (for six months) |
51 |
58 |
|
Mean feeding time
(days) |
277 |
372 |
Local data (
This trend seems set to continue and results in an increased dietetic caseload and resultant overspending of the enteral tube feeding budget
*point prevalence is the number of patients registered with BANS who were on Artificial Nutrition Support at the specified census point in time
SPEECH AND LANGUAGE
THERAPY
Overview
The East Yorkshire Speech and Language Therapy (SLT) Service (part of the Therapy Services Partnership) provides input to the stroke service on the rehabilitation ward (ward 2) at Castle Hill Hospital, outpatient services to East Yorkshire Community (excluding Hull and Holderness) and to the Hull Stroke Rehabilitation Units (at St Marys, Rossmore and Alderson).
During the past year, the Speech and Language Therapy service to all of these areas has been severely compromised due to maternity leave, sick leave and staff moving out of the area. Staffing has gradually improved towards the end of the financial year, as outlined under the different service areas below.
Ward 2 (Stroke
Rehabilitation)
The SLT service to ward 2 has continued to provide a service to patients with swallowing difficulties over the past year but low staffing levels often prevented an adequate service being delivered to patients with communication difficulties.
At the end of the year, staffing has gradually improved to 2 sessions (1session =1/2 day) provided by a specialist therapist and 3 sessions provided by a junior therapist, along with some carryover activities being carried out by the generic therapy assistant. This level of staffing is insufficient to allow the SLT to work fully as part of the multi-disciplinary team, such as joint working with other therapists and attending case conferences and goal setting meetings, or to provide intensive levels of therapy.
Community Outpatient
Service (
Towards the middle of the financial year (August 2005) the
outpatient service to all clients with communication difficulties was closed
due to the severity of the staffing crisis in our team. This allowed us to focus our limited staffing
on aiming to provide a timely assessment and review service to inpatients with
swallowing and communication difficulties at Castle Hill and
Towards the end of the year, staffing gradually increased to a level which currently allows us to provide a service to clients with swallowing difficulties which is approaching our standards for waiting times. The outpatient service for clients with communication difficulties has also now re-opened but there is still a significant waiting time for appointments and the level of therapy input we are able to provide is restricted.
Stroke Rehabilitation
Units
The specialist stroke SLT who was providing 8 sessions to the units in 2004, went on maternity leave in February 2005. Between February and December 2005 a basic level of service was maintained at St Marys, Alderson and Rossmore units through junior SLTs providing weekly communication sessions and Dinah Fuller providing a service to clients with swallowing difficulties. The post holder has since returned, however she is currently only providing 5 sessions alongside 2 sessions from a junior therapist. This is due to the main post holder now working part time and still being needed to help within other areas of the wider SLT service due to continued reduced staffing. These sessions are to be increased as staffing allows.
Despite our reduced staffing levels, we have been able to pursue some new developments. Thanks to the charitable donations from the Society of Mice and from the units own fundraising events we have been able to purchase computer therapy software packages including REACT, Aphasia Tutor and Speech sounds on cue. We have been able to use these within the units with the assistance of care staff, with the aim of being able to provide more intensive input despite our staffing difficulties. We are still lacking adequate computer hardware in the units and have been reliant on one laptop which has so far limited this facility. Since March 2006 SLT has been involved with developing group therapy at Alderson stroke unit and currently runs a weekly joint session with the OT for clients with cognitive and communication difficulties. We hope to continue to further develop and expand both these areas over the coming year.
Kathryn Connolly and Anna Ray
Specialist Speech and Language Therapists
TRAINING &
EDUCATION
Stroke Foundation
Course
Two Foundation Courses were organised this year, one in October 2005 and one in March 2006 with approximately 50 attendants across the acute and community settings from Health & Social Care and Private Residential and Nursing Homes.
Training in Psychology
The local Stroke Service valued greatly support from Ros Pratt, Clinical Psychologist in the provision of 2 Specialist Training Days for stroke team members in aspects of Clinical Psychology relating to stroke.
The Stroke Service is still unable to access much needed Clinical Psychology in put which is proving to be detrimental to individuals health and well being in a significant number of cases.
Stroke Degree Module
This year the Hull & East
Riding Stroke Service in conjunction with
Number of Students: 21
Student Participation
- This
post-graduate module was run in association with the
- The module was inter-professional with 7 physiotherapists, 7 occupational therapists and 7 nurses attending, all with a varied amount of experience in stroke rehabilitation.
- Student
attendance was over 6 days on alternate Wednesdays from
- Students worked in profession specific groups to produce a presentation on evidence based practice and outcome measures.
Module Evaluation
16 students completed the module evaluation.
How useful has the module been?
Very useful = 14 Useful = 2 Of little use = 0 Of no use = 0
To what extent has the module met your expectations?
Exceeded = 11 Satisfactory = 5 Not met = 0
How did you rate the organisation?
Excellent = 9 Good = 5 Satisfactory = 2 Poor = 0
Do you have any suggestions about how the module could be improved?
- More room for whole group discussions
and frequently asked questions.
- More time to share knowledge and common
experiences of working in stroke rehab with other participants
- Sessions on role of speech and language
therapists and rehabilitation nurses.
- The last day would have benefited from
being a full day rather than a half day of independent study.
- Full days each time rather than two
half days of independent study would have benefited those travelling to
- Probably would be better to have done
critical appraisal and evidence based practice at the beginning of the
module.
- The session on patient perspectives
would have been better at the beginning of the module.
Have you any other comments you would like to make?
- The room/venue was not appropriate
- Room sometimes too hot, sometimes cold
- Venue quite poor
refreshments left a
bit to be desired
- Session on What is Rehabilitation lacked
in-depth knowledge
would like more emphasis on rehabilitation approaches.
- Good to have it in
- Enjoyable course
ensure handouts
available prior to course.
- Unavailability of some complex notes
frustrating and disappointing
- Really enjoyed hearing about other
disciplines
- Group presentations a valuable insight
into multi-disciplinary approach
- Pan-disciplinary format a fundamental
strength
- Difficult to look at all professions
and feel that therapies were the main issue with nursing a little pushed
into the background.
- Very enjoyable course
- Really enjoyed course, very interesting
- Overall content was good, enjoyed the
module.
Module Leaders
Comments
Overall the module ran quite smoothly with good attendance
levels. The students were enthusiastic
and engaged well with the module, contributing throughout in discussions and
questions and answers. They also
networked with each other during the days at
The main problems were those related to running a module away from college. The room allocated in The Institute of Rehabilitation was quite cramped for 21 students plus teaching staff and as a consequence was often stuffy and hot. Refreshments, provided by the catering department of Hull Royal Infirmary, were erratic at times.
Visiting lecturers from the
WebCT proved to be a useful tool in disseminating information and encouraging communication between students. Initial written information and instructions were needed, supplied by Gerry Kregor, and some support and advice in the first few weeks, but all students were able to access it throughout the module.
The structure of each of the six days worked well. Some students commented in the evaluation that they would have preferred not to have had the two half days of independent study as it would have reduced the amount of travelling. However I made myself available at The Institute of Rehabilitation during those times for tutorials and many of the students used the opportunity to discuss their assignments with me.
19 out of the 21 students submitted assignments, although 5 required extensions to the hand-in date due to either work or personal issues.
Module Results
19 students completed the assignment
1 A, 6 Bs, 7 Cs, 3 Ds, 2 Fs
Range: 35 75
The Stroke Service will look to further discussion with
Training for Practice
and District Nurses
Three full day training sessions have been offered to Practice and District Nurses and Community Matrons from April 2005 to March 2006 with more planned for this year. This has been very well received with a total of 39 nurses attending. The programme offers comprehensive information / training about stroke (i.e Anatomy and functions of the brain, Acute Management of Stroke patients, Dysphagia management, TIA) and also offers the opportunity to inform Practice & District Nurses about the development of the Hull & East Riding Stroke Service.
AUDIT/RESEARCH
The Stroke Service is no further forward in securing the necessary infrastructure to participate in national and international stroke research and there is no capacity within existing resources to support this. This is still a source of great disappointment to the Stroke Team.
Data for the National Sentinel Audit for Stroke Care has recently been submitted by Dr Abdul-Hamid, lead Stroke Physician.
The most significant achievement in relation to audit has been the stroke register data which is providing ongoing clinical outcome measures. A more detailed report will be disseminated to the PCTs regarding clinical data relating to their areas.
USER/CARER
INVOLVEMENT
The local Stroke Service continues to be well supported by User and Carer representation. Since the demise of Strokewatch, a local User and Carer Forum has emerged with four main supporters:
Marianne Boyd plays a key role in working closely with professionals and users and carers to signpost individuals to local stroke support clubs and forums.
Mr Keith Henman supports the development and availability of information which is set out in lay terms and easily understandable by local stroke survivors. He also plays a key role in organising annual events enabling stroke survivors and carers to meet up and be updated by the local Stroke Service Team.
Mr Brian Archibald and Mr Alan Bowmaster take a lead in working closely with stroke rehabilitation units and team members to support stroke survivors on a one to one basis and in group settings.
This support is proving to be invaluable both to stroke survivors and the local stroke teams.
STRATEGIC OBJECTIVES FOR 2006/07
- Develop
Rapid Response Service to support pathway and clinical treatment in the
Community with minor stroke, TIA symptoms.
- Develop
close working/networks with Chronic Disease Management Teams, community
based to support ongoing risk factor management and care of stroke survivors long term.
- Introduce a
limited Thrombolysis service as resources allow.
- Establish
the Community Stroke Co-ordination Pathway across the Hull & East Riding patch.
- Focus on
service developments/support networks for young stroke survivors in the
area.
- Establish
clear guidance for management of patients with minor stroke/TIA who are at
high risk of further stroke within 7 days.
ACUTE STROKE CARE PATHWAY
All outlying stroke patients continue to be
supported by the Specialist Stroke Team and transferred to the Acute Stroke
Unit as soon as a bed is available where appropriate.
COMMUNITY STROKE CARE PATHWAY
The Hull & East Riding Stroke Service has a Specialist Stroke Team who are based in the Community.
Their remit is as follows:
