Outline The HEAT target for stroke unit care Early swallow screen Early access to brain scanning More later from Andrew Farrall Early use of aspirin Bundles of care Early access to TIA clinics
HEAT target What is a HEAT target? Performance across Hospitals and Boards Calculation explained Alternatives data to be produced next yr
HEAT Ministerial targets for NHS Health Improvement improving health and life expectancy; Efficiency and Governance Improvements continuously improving the effectiveness and efficiency of the NHS in Scotland; Access to services recognising patients need for quicker and easier use of NHS services; and Treatment appropriate to individuals ensuring patients receive high quality services that meet their needs.
A stroke unit Definition A defined bed area where stroke patients are preferentially admitted; Medical, nursing and allied health professionals in that area have undertaken specific training in stroke; and Patients are discussed at a multi disciplinary meeting at least weekly. This definition has allowed some small isolated hospitals to be included in HEAT targets
The calculation Numerator number of stroke patients who stay in hospital more than two nights who are in a stroke unit bed on Day or 1 Denominator number of stroke patients who stay in hospital more than two nights excluding those transferred in from other inpatient units or who have a stroke whilst in hospital
Access to stroke unit care Over 8 stroke admissions in 21 799 stroke unit beds in Scotland (still increasing) 82% of patients access a stroke unit bed during admission (up from 71% in 25) Mean LOS down to 25 days. Most patients remain in a stroke unit until discharge
Performance against the HEAT target in 21 ARI Dr Grays QMH Ninewells PRI RIE SJH WGH RI-Glasgow Stobhill WI-Glasgow South Glasgow IRH RAH VoL Ayr Crosshouse Hairmyres Monklands Wishaw Forth Valley Borders DGRI Stranraer Raigmore L&I Belford* Caithness* Orkney* Shetland* Western Isles VH, Kirkcaldy Scotland 1 9 8 7 6 Percentage 5 4 3 2 1 Within 1 Day HEAT 8% NHSQIS 9%
1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % Stroke unit care by NHS Board Ayrshire & Arran Borders Dumfries & Galloway Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles Scotland % pre-su % in SU % post-su % Stayed in SU
Delays to stroke unit admission VH, Kirkcaldy ARI Dr Grays Ninewells PRI RIE SJH WGH RI-Glasgow Stobhill WI-Glasgow South Glasgow IRH RAH VoL Ayr Crosshouse Hairmyres Monklands Wishaw Forth Valley Borders DGRI Stranraer Raigmore L&I Belford* Caithness* Orkney* Shetland* Western Isles QMH Scotland 1 Same Day 1 Day 2 Days NHSQIS 6% NHSQIS 9% 9 8 7 6 Percentage 5 4 3 2 1
Trends in access to stroke unit care Stroke Patients % SU day % SU <=1 day % Admitted to a SU during stay NHS QIS 6% day NHS QIS 9% <=1 day 9 1 8 9 Number of Patients (columns) 7 6 5 4 3 2 8 7 6 5 4 3 2 % agains standar (lines) 1 1 25 26 27 28 29* 21
Issues with calculation Performance helped by excluding in hospital strokes and transfers in. Does not penalise those keeping patient in medical admissions over first night Does not give credit for direct admissions to stroke unit for a short overnight admission Data are available to allow local teams to explain their performance
Discussion
Swallow screen on the day of admission
Delays to documented Swallow screen 1 9 8 7 6 Percentage 5 4 3 2 1 Same Day 1 Day 2 Days NHSQIS ARI Dr Grays Ninewells PRI RIE SJH WGH RI-Glasgow Stobhill WI-Glasgow South Glasgow IRH RAH VoL Ayr Crosshouse Hairmyres Monklands Wishaw Forth Valley Borders DGRI Stranraer Raigmore L&I Belford Caithness Orkney Shetland Western Isles QMH VH, Kirkcaldy Scotland
Trend in swallow screen 9 8 Stroke Patients % Swallow Screen day NHS QIS 1% day (swallow screen) 1 9 7 8 Number of Patients (columns) 6 5 4 3 7 6 5 4 3 % against standards (lines) 2 2 1 1 25 26 27 28 29* 21
Discussion
Brain scanning on day of admission
NHSQIS 2 Brain scan on day of admission % Performance in 21 Trend over 5 years More from Andrew Farrell later
Delays to Brain scanning Shetland Western Isles QMH VH, Kirkcaldy Scotland ARI Dr Grays Ninewells PRI RIE SJH WGH RI-Glasgow Stobhill WI-Glasgow South Glasgow IRH RAH VoL Ayr Crosshouse Hairmyres Monklands Wishaw Forth Valley Borders DGRI Stranraer Raigmore L&I Belford Caithness Orkney* 1 9 8 7 6 Percentage 5 4 3 2 1 Same Day 1 Day 2 Days NHSQIS
1 9 8 7 6 5 4 3 2 1 Delays to Brain scan in hours Within 12 Hours Within 24 Hours Within 48 Hours Same Day NHSQIS Percentage ARI Dr Grays Ninewells PRI RIE SJH WGH RI-Glasgow Stobhill WI-Glasgow South Glasgow IRH RAH VoL Ayr Crosshouse Hairmyres Monklands Wishaw Forth Valley Borders DGRI Stranraer Raigmore L&I Belford Caithness Orkney* Shetland Western Isles QMH VH, Kirkcaldy Scotland
Trends in delays to brain scanning 9 8 Stroke Patients % Scanned day NHS QIS 8% day (scan) 1 9 7 8 Number of Patients (columns) 6 5 4 3 7 6 5 4 3 % against standards (lines) 2 2 1 1 25 26 27 28 29* 21
Early administration of aspirin for ischaemic stroke
Delays to first aspirin administration 1 9 8 7 6 Percentage 5 4 3 2 1 ARI Dr Grays Ninewells PRI RIE SJH WGH RI-Glasgow Stobhill WI-Glasgow South Glasgow IRH RAH VoL Ayr Crosshouse Hairmyres Monklands Wishaw Forth Valley Borders DGRI Stranraer Raigmore L&I Belford Caithness Orkney Shetland Western Isles QMH VH, Kirkcaldy Scotland
Trends in delays to aspirin 9 8 Aspirin Denominator (excl CIs) % Aspirin <=1 day NHS QIS 1% <=1 day 1 9 7 8 Number of Patients (columns) 6 5 4 3 7 6 5 4 3 % against standard (line) 2 2 1 1 25 26 27 28 29* 21
Issues raised Should any antiplatelet drugs count? Based on NHSQIS standard which refers to aspirin NHSQIS standard based on SIGN guideline 18 No trials of clopidogrel in acute phase of established stroke unclear about balance of risk and benefit Certainly increasingly used in longterm secondary prevention SSCA collects, and will report use of any antiplatelet drug
Discussion
Bundles Patients who meet the HEAT target more often meet all other NHSQIS standards as well.
% meeting other NHSQIS standards depending on whether meet HEAT target ARI Dr Grays Ninewells PRI RIE SJH WGH RI-Glasgow Stobhill WI-Glasgow South Glasgow IRH RAH VoL Ayr Crosshouse Hairmyres Monklands Wishaw Forth Valley Borders DGRI Stranraer Raigmore L&I Belford* Caithness* Orkney* Shetland* Western Isles QMH VH, Kirkcaldy Scotland 1 9 8 7 Percentage 6 5 4 3 2 1 SU <=1 day SU >1 day or Not SU
Discussion
Delays in being seen in a TIA clinic
Delays to TIA clinic assessment Same Day 1 Day 2-3 Days 4-7 Days NHSQIS 1 9 8 7 Percentage 6 5 4 3 2 1
Trends in early assessment in TIA clinics Outpatients % Outpatients <= 7 days NHS QIS 8% <=7 days 7 1 6 9 8 Number of Patients (columns) 5 4 3 7 6 5 4 % against standard (line) 2 3 1 2 1 25 26 27 28 29* 21
Discussion.