Breaking through the usual 'reasons why not' to deliver gold standard Stroke Care in Aintree
A multidisciplinary LiA Team at Aintree University Hospital NHS Foundation Trust have broken through 'the usual reasons why not' to make significant improvements to the quality and safety of care for stroke patients.
The 'gold standard' for patients who have had a stroke is to receive thrombolysis within 60 minutes. This has a major impact on the recovery of the patient and their quality of life following a stroke. Stroke Physicians Dr Claire Cullen and Dr Nik Sharma worked out that the average time at their hospital for patients to receive thrombolysis was 72 minutes, with only 22% happening within the recommended 60 minutes.
Claire and Nik decided to use the LiA approach to connect people around their mission to improve outcomes for stroke patients.
The team worked together to identify the key people involved in managing stroke patients in the early stages of the pathway and the LiA team was formed. They held a well-attended LiA Staff Conversation which included paramedics, emergency staff, junior doctors, stroke physicians, clinical nurse specialists and radiology.
As a result of 'getting the right team around the table' there have been some important changes, which they have made happen between them. These include:
- A closer liaison with the Ambulance Service and the development of a Stroke Training Programme
- Better deployment of medical and nursing stroke leads in the Emergency Department
- Closer working and direct access to Radiology Department
- Consultants leading changes to on–call working practice to ensure a senior clinician is always present
- A dedicated stroke bleep for consultants to improve access.
The impact on the pathway has been dramatic and is heading towards the achievement of the gold standard of care for all stroke care patients:
- The average 'door to needle' time has already been reduced to 53 minutes and is down to an average 38 minutes at peak times
- The total proportion of patients thrombolysed within 60 minutes has risen to 64% - 86% at peak times
- The fastest thrombolysis time achieved so far is 22 minutes.
Dr Claire Cullen said “Since we introduced the new bleep system we have been able to see patients much quicker. It’s still early days, but we have seen five patients each of whom have been thrombolysed within 35 minutes, the quickest being 22 minutes. This is great news and means that we should see a better, fuller recovery for our stroke patients”.