Aims and objectives
The main purpose of the stroke day programme is to give stroke service users and carers the opportunity to share their experiences with others in similar situations and with NHS and other professionals who manage and provide the service.
The specific objectives are as follows:
More than fifty user and carers attended the day, held at the Ransdale Hotel in Bridlington, and there was also a good representation of therapy and nursing staff working at the Bridlington hospital and in East Riding Intermediate Care, and the Stroke Family Support team. Information stalls were provided by the East Riding Carers’ Support Service and Strokewatch.
The purpose of the workshop, to get feedback from users and carers who have experienced the stroke service, was introduced by Strokewatch. This was followed by a presentation by the Nurse Consultant for Stroke about the Hull & East Riding Stroke Service and what has been achieved within that service so far.
The morning part of the session was also attended by Dr Nasar who takes the lead for the medical care of stroke patients at the Bridlington Hospital. One of the main issues in this area is its location on the edge of two Hospital Trusts. No representative from Scarborough and North East Yorkshire Hospitals Trust was able to attend, which was unfortunate as the people of Bridlington need more information and explanation about the development of a stroke service in their area.
Following the presentation, a very interactive discussion ensued, led mainly by users and carers of the service. There was recognition and concern that some parts of the acute management of stroke care is not readily available at the Bridlington Hospital, and patients have to travel to Scarborough Hospital for investigations such as CT scanning and Carotid Duplex Scanning. Delays in scanning were reported by patients to be as long as ten days after admission. This was disturbing, as the national recommendations are that CT scanning should take place within 48 hours and sooner if the patient is not neurologically stable.
The workshop then moved on to getting written feedback from users and carers about their experiences. Their comments were wide ranging but highlighted the following areas that we need to take into account in the further development of the service:
1. Bridlington people, in the main, go to either Scarborough or Bridlington Hospital following a stroke. The Bridlington Hospital does not have the facilities to provide acute care of stroke patients and the experiences of users and carers at the workshop supports this concern.
2. Patients’ experience in relation to the amount of therapy they might receive was quite varied, but it would be useful to have that discussion with therapists based at the Bridlington hospital in relation to the resources required for the rehabilitation of stroke patients and their current work pressures.
3. Experiences of care at Scarborough Hospital were also varied, but some points were worrying.
ACTION: this needs to be brought to the attention of the Scarborough Nurse Managers to see what can be done to improve the service and provide better co-ordination of care for stroke patients who are either sent in the first instance to Scarborough hospital or transferred there for a period of time.
4. Information about treatment and rehabilitation plans was less than satisfactory for many users and carers.
ACTION: The Nurse Consultant will discuss with the Nurse Manager and teams at Bridlington Hospital how we can implement the personal information and health record for stroke patients, to achieve better information for patients and carers.
5. Almost all user and carers experienced great difficulty with regard to accessing information about benefits that they might be entitled to.
ACTION: Strokewatch and the Nurse Consultant for Stroke are currently seeking to resolve this problem by introducing a short but informative leaflet that can be distributed to patients and carers in acute and rehabilitation units and wards, along with the new patient-held health information and record booklet.
Final Points
We know from experience at Hull Royal Infirmary that very few stroke patients from the Bridlington area are transferred to Hull’s Acute Stroke Unit. We are also aware that during the year 2002, as many as 50% of stroke patients received to the Driffield Hospital for rehabilitation did not access an Acute Stroke Unit either at Hull or Scarborough hospitals, but transferred directly from Bridlington.
If patients are to be admitted directly to the Bridlington hospital, there needs to be a much more responsive infrastructure to provide CT scanning within 48 hours (and more urgently if necessary). The Acute management and co-ordination of care for patients transferring from Scarborough Hospital to Bridlington Hospital might also be much better supported by a Specialist Nurse who can co-ordinate and support the care of stroke patients throughout their journey, linking into the Hull & East Riding Stroke Services and support mechanisms as needed.
Since this workshop the Nurse Consultant has met with Bonnie Atkinson who has been commissioned by the Scarborough and North East Yorkshire Trust to review their current stroke service and make recommendations to the Trust. This is very encouraging and the Nurse Consultant offered to support the teams in Bridlington if required, once recommendations are made and a plan agreed.
Dinah Fuller
Nurse Consultant for Stroke
Dilys Page
Strokewatch.