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Date submitted 31.08.16
Site RIEContact Details Mark Smith ([email protected]) Title of case study “Fast Track” Stroke Rehabilitation Pathway in the Integrated Stroke
Unit (ISU), RIE6EA (choose one, see AED)
EA2: Hospital Capacity and patient Flow Realignment
Please describe the project in 250 WordsBackground NHS Lothian needs to meet Scottish Stroke Care Audit (SSCA) standards contained within the
Acute Stroke Bundle. These include accessing a stroke unit bed on the day of admission to hospital. This target was not being consistently met at RIE.
Through accelerated discharge planning, referral and rehabilitation processes in selected groups of patients, Allied Healthcare Professionals (AHPs) as part of the multidisciplinary team could potentially improve the pathway for those patients and, as a result, increase access to ISU beds.
At the outset, the median time from date of Edinburgh Intermediate Care Service (ICS) referral to actual hospital discharge was 11.5 days.
Aim/ Anticipated Benefit [Description of anticipated benefit] To reduce median length of stay in ISU by three days for those patients requiring rehabilitation
who were not delayed by processing complex packages of care or placements by end October 2016 resulting in more patients receiving rehabilitation in the community setting sooner.
Implementation & Approach [Improvement & Engagement approaches used] As part of the NHS Lothian QI Academy a multi key stakeholder steering group was convened. Identified and prioritised causative factors and gathered baseline data. Performed a series of PDSA cycles and looked at cumulative effects on tally charts. Prioritised clinical AHP intervention according to case-mix/presenting features/prognosis. Early alerts (email, telephone) to Edinburgh Intermediate Care Service to prepare the pathway. Project began March 2016 and is still current, involving all three ISUs in Lothian.
Outcome [Outcomes and evidence of impact of improvement on 6EAs, overall 4 hour performance or specific flow group(s)] Early indications from the “fast track” project suggest that the median time from Edinburgh ICS
referral to hospital discharge from RIE for patients meeting the agreed criteria has been reduced from 11.5 (6-18) days to 2 (0-5) days for 12 patients.
The project is still current and the pathway has been sustained for patients who meet the appropriate clinical criteria with ongoing data collection.
Key Lessons Learned Reduction in concerns which may lead to risk aversion in hospital discharge planning for stroke. Anecdotal approval through structured questionnaire by service users of earlier discharge home. Intelligence gathering which may result in greater service responsiveness to potential changes
through the Health & Social Care Integration processes involving stroke pan Lothian. Having the right key stakeholders engaged was a critical aspect of the success and sustainability. Taking an organisation wide approach to QI with stroke as an early indentified pathway was of
value in embedding the work within the clinical pathway.
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