Stroke rehabilitation quality improvement plan

Purpose

Oxford Health NHS Foundation Trust (OHFT) committed to a Stroke Quality Improvement (QI) Project to enhance the quality of rehabilitation for patients on the Oxfordshire Stroke Pathway. Following poor performance in the national indicators Sentinel Stroke National Audit Program (SSNAP) and local Key Performance Indicators (KPIs), the Stroke Quality meeting was initiated by the physiotherapy team to review care and develop a multi-professional improvement plan. Aligning service provision with that recommended in the 2016 Royal College of Physicians National Stroke Guidelines required consolidation of two stroke units, 14 miles apart, into one specialist stroke rehabilitation ward. This abstract outlines key objectives of the QI project, describe progress to date, and evaluates the impact on quality delivery and patient outcomes so far. The objective is to share positive experiences and challenges encountered during the project.

Approach

Current stroke guidelines and relevant evidence base were reviewed to inform a stroke quality improvement plan. 10 beds were moved from Town A to Town B with as little disruption to patient care as possible.

Local KPIs for the service were devised to use as measures of success.

  • % of days therapy delivered.
  • average number of therapy minutes per session.
  • % of patients who require therapy.
  • Compliance against national stroke therapy staffing guidance, measured by staffing establishment.
  • Evaluation of patient clinical outcomes using the Barthel Index (BI).
  • Qualitative data from staff, patients and relatives.

Outcomes

The Stroke Quality Improvement Project is part way through implementation. The impact to date on performance and quality measures are:

  • Completion of relocation of wards to a single site.
  • Increase in compliance with RCP recommended stroke rehabilitation therapy staffing from 73.7% to 82.5%
  • Maintenance of 100% of patients requiring occupational therapy and physiotherapy
  • Achievement of an average 45 therapy minutes per session
  • Increase from 46.5% to 65% average days physiotherapy delivered
  • Increase from 43.5% to 51% average days occupational therapy delivered
  • Improvement from admission to discharge on BI has increased from 5.73 point average to 6.69.

The next SSNAP reported data will be included following publication and qualitative data analysis will also be reported on.

Implications

Our work has demonstrated that reallocation and reorganisation of resource onto a single site has resulted in quality improvement of the stroke rehabilitation service. Patients on the Oxfordshire Stroke Pathway receive increased number of days' therapy whilst maintaining average minutes of treatment. Data also demonstrates an improvement in clinical outcomes. Progress to date highlights that despite ongoing resource limitations within the NHS, re-development and innovation is feasible to improve patient outcomes. Further work should look at qualitative data evaluating staff and patient satisfaction.

QI projects are part of the NHS' approach to improving patient care. This project demonstrates QI can be initiated and led by Physiotherapists as part of a multi-disciplinary team.

Fund acknowledgements

This work was not funded.

Additional notes

This work was presented at Physiotherapy UK 2018.