Abstract
Background -
The CQC inspection of the Royal Lancaster Infirmary (RLI) in May 2021 rated the performance of the stroke department unsatisfactory, leading to a number of changes. A retrospective audit was performed to determine the impact of these changes for thrombolysed stroke patients.
Aim –
This retrospective audit assessed the performance of the stroke department at the RLI against the parameters set by the ‘Sentinel Stroke National Audit Program’ (SSNAP), comparing 6-month periods before and after the CQC inspection in May 2021. Method – Using electronic medical records and SSNAP data, we reviewed every thrombolysed stroke patient at the RLI between November 2020 until April 2021 and from May 2021 until November 2021, assessing 10 parameters and comparing the results with SSNAP targets. Since May 2021, changes to practice introduced included opening a new, larger stroke unit located directly opposite the Emergency Department, ring-fencing stroke beds, doubling the number of stroke specialists and stroke consultants reviewing all suspected stroke patients face-to-face within working hours.
Results -
46 patients were thrombolysed with 42 confirmed as having had ischaemic strokes on subsequent MRI imaging. All patients were discussed with a stroke consultant before thrombolysis. Mean time from arrival to CT improved from 51 to 34.5 minutes, admission to stroke unit from 7hr53 to 4hr36 and to thrombolysis from 2hr18 to 1hr22. The number of thrombolysis complications decreased from 5 to 2. Since the changes, the SSNAP grade for stroke unit admission improved from C to A and specialist assessments from E to B.
Conclusion:
The changes implemented following the May 2021 CQC inspection have had a positive impact on the care of thrombolysed stroke patients and overall SSNAP grades at RLI. Improvements are still required and the next steps include improving the efficiency of thrombolysis times and further improving SSNAP grades.
Comments
Thank you, excellent work.
Thanks.
In hours (08:00-17:00, Monday to Friday), the stroke specialist nurse/ACP attends with the stroke consultant. Out of hours, it is the ED team with the on-call Telestroke consultant (a video consultation service for 7 different hospitals in the region) and stroke nurse/ACP (until 20:00 weekdays and 08:00-20:00 weekends).
FAST positive patients currently go straight to CT before the NIHSS score is checked, but this is likely to change in coming months as we plan to administer the thrombolysis bolus in the CT scanner (meaning all assessments will need to take place pre scan).
No, our radiology team have agreed to proceed to CTA for patients presenting within the thrombectomy window within thrombectomy service operating hours without a creatinine being performed (as waiting for the blood results would delay emergency treatment).
Thank you for your response- very similar to how it runs in Plymouth- we found that the ED team pre-admitting the patient on their system and requesting the scan/liaising with radiology very much improved door to CT/thrombolysis times- although out of hours it is the medical SpR who attends thrombolysis calls.