CLAHRC Question Time – What we have learned about implementing

evidence?

Peter Clegg:My experience of Early Supported

Discharge

Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire

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A partnership between

Nottinghamshire Healthcare NHS Trust

and the University of Nottingham

Implementing Evidence

Stroke Early Supported Discharge

Rebecca Fisher, Marion Walker& ESD research team

A partnership between

Nottinghamshire Healthcare NHS Trust

and the University of Nottingham

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Life after Stroke

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Services “need to improve the care and support they provide in the longer term. We have found wide levels of variation both between and within different PCTs in the accessibility and quality of care and support provided to people after they have been transferred home. The level of variation we have found is a concern...”

Context: Community stroke care

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Care Quality Commission: Supporting Life after Stroke 2011

• Facilitate the implementation of evidence based Early Supported Discharge Services– Conduct high quality applied health research– Implement the findings from this research into practice– Increase the capacity of NHS organisations to engage with and apply

research

• Define what the evidence tells us• Understand what challenges are faced on the ground• How we supported use of the evidence

Role of CLAHRC

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• Research into practice• Hard scientific core• Soft, context-specific peripheryDamshroder et al. Improvement Science 2009, 4:50Walker et al. International Journal of Stroke, 2013; 8(1):11-17

• Core evidence based elements of ESD services• Context dependent characteristics - flexibility

Implementing ESD: Olive Analogy

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• Expert Consensus: key messages from research trials• ESD core components (Fisher et al 2011; Stroke 42:1392-1397)

– Eligibility criteria: mild to moderate stroke survivors– Multidisciplinary team composition (inc. physician, nurse, social

worker)– Stroke specialist– Responsive: facilitate discharge, reduce length of hospital stay– Intensive rehabilitation

• Variable context– Geography (rural, urban)– Base (hospital, community)

Consensus: core elements

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NHS Improvement 2010/2011

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Mapping context: flexibility

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• Topic specific workshops with hospital and community based ESD teams: promoting evidence based practice– Improving decision making around eligibility for ESD– Measuring the impact of ESD – effective data handling

• Health Innovation Education Cluster (HIEC) funded programme– Multidisciplinary team working– Measuring community stroke team effectiveness

• East Midlands roll-out in Academic Health Science Network

IMPACT: Implementation workshops

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East Midlands review 2012/2013

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• East Midlands 2013: ESD service review• 8 teams offering ESD• Evidence based components: eligibility criteria, stroke

specialist, intensity of intervention• Different models & contexts: 4 hospital based, 4

community based; rural and urban; community stroke service provision

• Evidence based service improvement – impact!

Thanks to the Team

Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire

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• Marion Walker• Christine Cobley• Fiona Nouri• Nikki Chouliara• Iskra Potgieter• Amy Moody• Brian Crosbie• Meghan Thurston• Catherine Gaynor

• Jo James• Rebecca Larder• Ian Golton• Damian Jenkinson

Thank you for listening

rebecca.fisher@nottingham.ac.uk

www.clahrc-ndl.nihr.ac.uk

Twitter: @CLAHRC_NDL

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Measuring the impact of ESD-getting the best out of routine data

Dr Kay Gaynor, Stroke Consultant and CLAHRC Diffusion Fellow

A partnership between

Nottinghamshire Healthcare NHS Trust

and the University of Nottingham

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• Background

• Task and Finish Group

• Solutions

• Outcomes

Overview

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• Good quality routine data essential for service evaluation.

• ESD teams – ASI metrics

• 40% of stroke population supported by ESD.

• Jan 2012 – Stroke Network Board recommended improved data exchange between NUH and Citycare ESD.

Background

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• NUH Data team• NUH Discharge Co-ordinator (DisCo)• Citycare ESD team manager• SOS team manager• Stroke Consultant• CLAHRC researcher• NUH Head of Service• East Midlands Cardiovascular network representative

Task and Finish Group

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• First meeting February 2012

• Three meetings, held every two months

• Aim – to identify data issues and facilitate methods to address and improve these issues.

Task and Finish Group

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• Data recording on NUH database (quality and quantity)

• Data exchange between NUH and CityCare ESD

Problems identified

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• NUH database

• Discharge data

• “Provider of rehabilitation” – regional screen

• 4 generic choices – confusing

Data recording on NUH database

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• New local screen

• 13 options covering all available stroke rehabilitation on discharge

Data recording on NUH database

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• Problems with Annual Leave Cover

• Lack of support from other members of staff

• High turnover of patients on hyperacute ward

Discharge Co-ordinators

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• Meeting with ward managers• Cross cover for Annual Leave

• Presentation from data team to DisCos and ward staff on the importance of the database.

• Therapists on hyperacute ward to enter data on database

Discharge Co-ordinators

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• Limited data exchange

• ESD unable to calculate ASI metrics due to lack of data

Data exchange

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• NUH Datateam send • -no. of stroke patients discharged within City PCT,• -no. of stroke patients discharged with ESD,

• ESD team leader (KH) and Stroke Consultant (KG) compare names of patients discharged with ESD follow up on NUH database vs actual patients receiving ESD.

Data exchange

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• Improved quality and quantity of data on NUH database.

• Increased awareness of the importance of good data handling amongst staff.

• ESD can calculate ASI metrics accurately (and meet the 40% target every month!)

• 3 further meetings following end of Task and Finish Group

• Ongoing monthly meetings between KH and KG

Outcomes

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• Good data handling vital for proper service evaluation

• Enthusiastic staff willing to seek solutions.

• One meeting will not sort the problems out!

• Diffusion Fellow role

Conclusion

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Thank you for listening

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We welcome your questions

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