This paper demonstrates how a multi-disciplinary team came ...



Changing for the Better – a patient centred approach

This paper demonstrates how a multi-disciplinary team came together and developed a patient centred approach with a new care pathway, resulting in improved patient care and outcomes.

Transient Ischaemic Attacks (TIAs) affect 35 people per 100,000 of the UK population each year. Described as mini strokes, TIAs may be the only warning sign a major stroke is imminent.

The incidence of stroke after TIA is very high. A study showed in 2007 that if patients receive early treatment this figure can be reduced.

A multi-disciplinary team came together and created a care pathway revolutionising the care provided to patients after a TIA. Results show consistent improvements in patient care and outcomes.

1. Background information

This service is a partnership between Morriston and Singleton Hospitals and General Practitioners (GP's) in the Swansea locality area, involving a multi-disciplinary team of staff from across primary and secondary care sectors.

The Client group targeted was any patient who had suffered a suspected Transient Ischaemic Attack (TIA).

These patients came from a variety of sources, including self-referral into A&E departments, referral from GPs and on-call medical teams in the Medical Admission Units (MAU) of both hospitals.

2. Brief outline of problem

Stroke is devastating and affects people of all ages; the physical and psychological problems resulting from stroke affect patients and their relatives for the rest of their lives. In addition there is a huge economic

burden of stroke. In 2006/2007 stroke cost the Welsh health and social care economy £1, 853, 550 (£62 per capita).

The incidence of stroke after TIA is very high especially within the first 7-30 days. A 2007 study showed that in patients receiving early, aggressive treatment for TIA this figure was reduced by 80%.

3. What was the cause of the problem?

In 2006 / 2007, audits and a TIA pilot scheme revealed patients in Swansea were not receiving an optimal level of TIA service.

The problem was attributed to the inefficient way the out-patient clinic based referral system worked. Referral from GP’s and subsequent consultation with a specialist stroke physician was taking a number of weeks. This delay alone prevented early medical treatment and subsequent referral.

A multi-professional group of clinicians realised this system needed to be radically changed so all parties were interacting and communicating with each other in a ‘real time’ service, with the patient at the centre of the process.

4. What did you decide to do to correct the problem?

The core stakeholder group met on numerous occasions and following the recommendations of the pilot study, and professionals from all disciplines, a care pathway was developed where no previous pathway had existed. The aim being, to achieve rapid recognition, assessment and treatment of TIAs in line with NICE guidelines. This would:

• Offer a rapid open access service to all patients

• Reduce the amount of people admitted to hospital

• Ensure appropriate and effective use of resources

• Reduce the number of subsequent strokes and improve outcomes for patients

• Reduce the economic burden to the Welsh health and social care economy

• Provide advice on lifestyle modifications

5. How did you measure the improvements?

Since 2006, SENTINEL audit organisational scores for TIA provision have shown consistent improvements.

Availability of audit data allowed the team to consistently measure numerous points along the pathway, enabling them to see what was working and where further improvements were needed.

6. What effects have the changes had?

The changes made to the TIA pathway since 2007 have revolutionalised the service.

7. What have you learnt?

The availability of audit data allows ongoing analysis of the problems and provides the ability to make robust plans to improve the service over time (1 Year). The relatively long lead in period of preparation provided a solid foundation on which to build.

Success was ensured with the excellent communication within the stakeholder group and their individual teams and the willingness of all involved to work hard.

8. What would your message be to others?

At the heart of this innovative ‘real time’ patient centred service is the enthusiasm, drive and energy of all staff groups involved. Sustained change has been achieved with a combination of good leadership, vision and willingness to engage in this collaboration resulting in vastly improved patients’ healthcare and outcomes.

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