so what have the networks been up to this year? dr martin james – stroke physician, royal devon...
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So what have the Networks been up to this year?
Dr Martin James – Stroke Physician, Royal Devon & Exeter Hospital
The South West Stroke Research
Network
Population 5.05M
17 acute sites
8 community sites
476
Baseline
112
300
555
1008
1497
Expansion to Western CLRN area
Year on year recruitment from original and extended areas
South West SRN RecruitmentSouth West SRN Recruitment
300
555
1497
Baseline 112
476
1008Expansion to Western
CLRN area
Year on year recruitment by CLRN area
South West SRN RecruitmentSouth West SRN Recruitment
SW SRN Recruitment per Trial2011/2012
199
46
93
189
94116
380
166
109
391
0
50
100
150
200
250
300
350
400
450
ARUBAAVER
TBUCS
CADISS
CLOTS
3
CROMISDARS
DIAS-4
DNA Lac
ECHO PIV Contro
ls
ECHO PIV Pati
ents
ENOS
FABRY'S
FACE
TIA
GOSH
Hemispati
al negle
ct
IMPROVE
INF
INTE
RACT 2
INTE
RSTROKE
IRISIST
-3OTC
H
PODCAST
Reach to
GraspREV
EAL
SOSST
ASH
TARDIS
VISION
VIST Wii
TOMAS
Reach
Past BP
Prediction
11/12 tota l
Top 5 Recruiting Studies1. SOS 26%2. Fabry's 13%3. CLOTS-3 11%4. OTCH 7%5. CROMIS 6%
34 studies open during 2011/1261% RCT
SWSRN Recruitment by siteSWSRN Recruitment by site
Peninsula Region Recruitment per Year
171
77
144
102115
259
38
127
59
110 10586
165
2150 41
8457
7995
11
53 52 55 58 69
107
03
3620
5736
49
0019
2 0 015
00
50
100
150
200
250
300
Plymouth/Mt Gould Yeovil Truro Torbay Taunton /Will Exeter North Devon
2011/12
2010/11
2009/10
2008/9
2007/8
2006/7
SWSRN sites have recruited over 40% of the total to CROMIS-2 and have been asked to present at the CROMIS investigators meeting
SWSRN sites have recruited 40% of IRIS patients in the UK - Bournemouth, Bath and Torbay are the top 3 recruiting sites
SWSRN sites have recruited 40% of AVERT UK recruitment in 2012 SWSRN sites have recruited 37% of the INTERACT2 recruitment in the
UK - from 4 of the 20 UK sites – Bath (top UK recruiter), Exeter, Bournemouth and Taunton
Truro the first to recruit to PODCAST outside the investigator’s site CLOTS-3 heroes this month – Salisbury and Gloucester (others in the
past) INTERSTROKE set up in collaboration between the Exeter SRN team and
the NIHR Clinical Research Facility PCPI – over 300 people now on the database; April newsletter on the
new look website http://www.southweststroke.nihr.ac.uk
SWSRN Highlights from 2011/12SWSRN Highlights from 2011/12
Network Population (M)
Total Q2 rec overall
rec per M popn
Total Q2 rec to RCT's
RCT rec per M popn
Thames 10.13 891 88 425 42
South East 8.81 864 98 491 56
Trent 7.61 543 71 324 43
North West 6.86 684 100 661 96
West Midlands 5.33 1013 190 596 112
South West 5.05 700 (4th) 139 (2nd) 516 (3rd) 102 (2nd)
Yorkshire 3.76 292 73 273 73
North East 2.55 287 113 230 90
4th recruitment overall (6th in population size) 3rd in recruitment to RCT’s
2nd in recruitment per population
SWSRN Performance
34 studies open during 2011/1261% RCT
Network Population (M)
Total Q2 rec overall
rec per M popn
Total Q2 rec to RCT's
RCT rec per M popn
West Midlands 5.33 1013 190 596 112
Thames 10.13 891 88 425 42
South East 8.81 864 98 491 56
South West 5.05 700 (4th) 139 (2nd) 516 (3rd) 102 (2nd)
North West 6.86 684 100 661 96
Trent 7.61 543 71 324 43
Yorkshire 3.76 292 73 273 73
North East 2.55 287 113 230 90
4th recruitment overall (6th in population size) 3rd in recruitment to RCT’s
2nd in recruitment per population
34 studies open during 2011/1261% RCT
SWSRN Performance
Network Population (M)
Total Q2 rec overall
rec per M popn
Total Q2 rec to RCT's
RCT rec per M popn
West Midlands 5.33 1013 190 596 112
South West 5.05 700 (4th) 139 (2nd) 516 (3rd) 102 (2nd)
North East 2.55 287 113 230 90
North West 6.86 684 100 661 96
South East 8.81 864 98 491 56
Thames 10.13 891 88 425 42
Yorkshire 3.76 292 73 273 73
Trent 7.61 543 71 324 43
4th recruitment overall (6th in population size) 3rd in recruitment to RCT’s
2nd in recruitment per population
34 studies open during 2011/1261% RCT
SWSRN Performance
• TWIST – all 7 Peninsula centres now open• IMPROVE-Stroke – all but completed, study team now
working on HTA funding bid for full study• LAST – just opened in Exeter• ECHO-PIV – highest recruiting study in Exeter• Reach-to-Grasp – two centres now open in Western
CLRN area (Bristol and North Somerset)• PenCLAHRC thrombolysis modelling
– Platform and poster at European Stroke Conference, Lisbon
• ReTrain – IGO study now open
South West StudiesSouth West Studies
Peninsula Heart & Stroke Network
Avon, Gloucestershire, Wiltshire and Somerset Cardiac & Stroke Network
Dorset Cardiac & Stroke Network
PENINSULA HEART & STROKE NETWORK
Implementing Implementing Best Practice in Best Practice in
Acute CareAcute Care
Improving Improving Post Hospital and Post Hospital and
Long Term CareLong Term Care
Joining Up Joining Up PreventionPrevention
Domains
Early Supported Discharge
Joint Care Plans using Single Assessment Process
Review at 6/52, 6/12 and yearly
Carers’ Assessment
Psychological Support
Key
Area
s of
Ke
y Ar
eas
of
Focu
sFo
cus
Direct Admission to a Stroke Unit
Timely Brain Scan
AF Detection and Treatment
Timely and effective management of TIA
Accelerating Stroke Improvement
How can the NHS respond to the new challenges?
• Quality– Supporting centres to improve their ‘90% stay’
performance measure – from 50% in 2009 to 79% for 2012
– Psychological support – developing and supporting the implementation of a Peninsula wide, 4-tier model of psychological and emotional support
– Nursing home education framework/training and assessment
– Supporting quality data monitoring with Peninsula Stroke database/SINAP → SSNAP
– Transparency – publicly available performance information on ‘OurHealth’ website
Network update - supporting QIPP in 2011/12Network update - supporting QIPP in 2011/12Network update - supporting QIPP in 2011-12Network update - supporting QIPP in 2011-12
PENINSULA HEART & STROKE NETWORK
• Innovation Simulation Modelling with PenCHORD/ PenCLAHRC to inform commissioning & change clinical practice
– Thrombolysis – increasing access to alteplase– TIA – reviewing service models and delivery – Demand and capacity planning along the whole
pathway– Scenario modelling to predict the impact of
change e.g. Early Supported Discharge (ESD)
Network update - supporting QIPP in 2011-12Network update - supporting QIPP in 2011-12
PENINSULA HEART & STROKE NETWORK
• Productivity– Standard service specifications (TIA, Acute,
Community Rehabilitation and ESD)– Early Supported Discharge – support pilots and
evaluation of various models with local Service Improvement Managers (SIMs)
– Specialist ‘generic’ cardiac nurses supporting the implementation of Stroke Strategy Quality Marker 1 (raising awareness, manual pulse checks and risk stratification etc.)
– Working with SWAST to increase direct access to TIA clinics
Network update - supporting QIPP in 2011/12Network update - supporting QIPP in 2011/12
PENINSULA HEART & STROKE NETWORK
• Prevention – Atrial Fibrillation– Development and dissemination of GP
information packages– Network Anticoagulation Guidance– Promoting the GRASP-AF tool (medicines
management) and opportunistic pulse checking (local GP incentives)
– Introducing pilot of INRstar software linkage from an acute trust to Primary Care
Network update - supporting QIPP in 2011/12Network update - supporting QIPP in 2011/12
PENINSULA HEART & STROKE NETWORK
• Quality ASSIST2 Programme – 8 participating trusts:
– Reducing 7-day inpatient mortality by 25%– Increasing the proportion of patients who receive all of the 9 Sentinel key indicators by 80%– A doubling in patients receiving Early Supported Discharge – 85% increase in the proportion of ischaemic stroke patients who receive thrombolysis
24/7 Stroke Thrombolysis rota• Collaboration between 9 acute trusts (one outside the
network) – 14 clinicians. This year in AGWS, over 1000 patients assessed, 256 thrombolysed, 25% with support from the Network rota
Innovation – Personal Health Budgets for Stroke• Pilot has recruited 115 stroke patients - 50% receiving
personal health budgets, 50% controls. Some amazing recovery stories, enabling patients and families to regain control of their lives
• Prevention‘Strike at Stroke – Anticoagulate’ – the largest AF programme in the country – 33,565 AF patients (19,457 High Risk) • Over 200 GP practices participated• 2.6% increase in anticoagulation• Maximum increase achieved +16%• Highest practice level of prescribing – 79% on anticoagulation• 601 additional patients anticoagulated• 24 strokes potentially avoided
Dorset Stroke Network 2011-12Dorset Stroke Network 2011-12
• AF Strategy– Continued enrolment of GP practices to GRASP-AF– Review of anticoagulation pathways– Continued public awareness campaigns for ‘Know Your Pulse’– AF-INCH (Atrial Fibrillation in Nursing and Care Homes) project underway
• Patient and Public Involvement Model– Now covering CVD as a whole to support CVD Clinical Commissioning Programme:
Stroke, Cardiac, Diabetes – vascular services coming online this year
• Development of Hyperacute Service at Dorset County Hosp– Hyperacute stroke services launched at DCH in November 2011
• Delivery of 7/7 TIA Services at Dorset County Hospital– 7/7 TIA services launched in March 2012
Dorset Stroke Network 2011-12Dorset Stroke Network 2011-12
• Improving Psychological Support after Stroke– showing significant improvements in psychological screening and support in
the community, with better collaborative working within existing teams– Now rolling out to be county wide– Expanding project to psychological support for all long-term conditions
• Early Supported Discharge Pilots– Poole and Royal Bournemouth pilots completed and evaluated– NHS Dorset pilot due to complete in June– High levels of patient and carer satisfaction– Excellent outcomes, significant bed day savings
• Integrating the Network into CVD Clinical Commissioning Programme– Network supporting Commissioning through transition to CCGs– Work programme prioritised in line with regional and national objectives
Joining Forces 2012Joining Forces 2012
some final commentssome final comments
The South West Stroke Research NetworkThe South West Stroke Research Networkand and
The South of England SHA and Heart & Stroke The South of England SHA and Heart & Stroke NetworksNetworks
Joint Annual EventJoint Annual Event