IMPROVING STROKE UNIT QUALITY IN SOUTH YORKSHIRE A BRIEFING PAPER FROM THE STROKE THEME OF CLAHRC SY

CLAHRC for South Yorkshire

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INTRODUCTION In the past stroke was perceived to be an inevitable risk of growing older, with little that could be done other than to make people comfortable. In recent years there have been considerable advances in medicine and technology, and improvements in how stroke services are organised. Patients are now treated on specialist stroke units rather than on ‘general medicine’ wards, and there is much more emphasis on getting patients into hospital quickly and treating them immediately. In England these changes have been guided by the National Stroke Strategy, a Department of Health policy published in 2007, which sets out the gold standard for stroke care. Researchers from the Collaboration for Leadership in Applied Health Research and Care for South Yorkshire wanted to explore people’s experiences of stroke unit care in light of these changes and find out what aspects of stroke unit care still need improving. We explored the perspectives of a range of stakeholders including stroke patients, their relatives or carers and staff that work on the stroke units.

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WHAT DID THE STUDY INVOLVE? We carried out interviews and focus groups with patients, carers and staff from across South Yorkshire, including Barnsley, Doncaster, Rotherham and Sheffield. Interviews were carried out with stroke survivors and their relatives or carers, to find out about their experiences of receiving care after a stroke. In total 59 people took part in the interviews. Interviews and focus groups were carried out with 66 members of staff working on stroke units in South Yorkshire, including doctors, nurses, therapists, social workers and dieticians. We asked staff what they thought they did well, and where they thought they could do better. We have analysed the responses and whilst there was a lot of praise for the services delivered, some priorities for improvement have been identified.

Barnsley Doncaster

Rotherham Sheffield

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WHAT DID WE FIND? Many of the staff were very proud of the service they provided and many patients and carers praised the good quality care they received.

“We’ve got very committed staff, so I think that’s the strength of our unit, all the nursing staff are very committed and people are very proud of the unit.” Stroke consultant “We want the best for our stroke patients.” Stroke nurse specialist

“I can honestly say, they were perfect in that ward, absolutely perfect and they’d treat you with respect.” Patient

“The expertise and the focus [on stroke] all makes that experience less harrowing on every level because they are dealing with [stroke] day in and day out and they’ve improved the service.” Carer

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WHAT WERE THE JOINT PATIENT, CARER AND STAFF PRIORITIES FOR IMPROVEMENT? 1.Communication needs to be improved between: • staff and patients (staff need to listen to patients more) • staff from different professions and different wards 2.More staff need to be available to provide care for patients 3.People should receive the right amount of rehabilitation to meet their individual needs 4.Psychological support after stroke needs to be improved 5.People need more support when they leave hospital and when they move between wards

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WHAT WAS THE TOP PATIENT AND CARER PRIORITY FOR IMPROVEMENT? Hospitals need to treat stroke as a medical emergency at all times, including evenings and weekends.

“[Stroke] should be treated like a heart attack, a medical emergency.” Patient “[There was] nobody to see us, and I thought that a stroke victim... “Get them in! Get them seen to within the hour!” ...but no, she were on the trolley ‘til gone midnight.” Carer

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WHAT WERE THE OTHER PATIENT AND CARER PRIORITIES FOR IMPROVEMENT? 1.The Act FAST awareness campaign1 helped some people to recognise their stroke, but more education is needed 2.Specialist stroke services are valued and should be accessible to everyone at all times 3.Appropriate information needs to be provided at the right time for the patient and relative or carer 4.Receiving personalised care and building relationships is important in hospital 5.Staff providing care need to take into account the significant impact of stroke 6.Excellent standards of clinical care need to be maintained to ensure patients are treated with dignity and respect

Footnote: 1The Act FAST campaign raises awareness of the signs of stroke, including facial weakness, arm weakness and speech problems, and the importance of accessing emergency treatment immediately. Further details can be found at www.nhs.uk/actfast.

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WHAT WAS THE TOP STAFF PRIORITY FOR IMPROVEMENT? Specialist stroke care is very important Staff felt that the beds on stroke units should only be used for stroke patients They also felt that staff who had specialist training in stroke care should spend most of their time working with stroke patients, rather than having to work on other wards.

“We have challenges. And I think one of the drawbacks is that our beds are not, although they are in theory protected [for stroke patients], they’re not always protected. So sometimes we don’t actually have a bed available and the [stroke] patients end up on the medical admission unit so that’s one of our problems.” Stroke consultant

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WHAT WERE THE OTHER STAFF PRIORITIES FOR IMPROVEMENT? 1.Doctors, nurses and therapists work together as a team, this is a key strength of stroke unit care and needs to continue 2.Staff thought that there was a lot of attention on acute care and that more attention needs to be paid to rehabilitation 3.More time and funding needs to be protected for training and education activities 4.More consistent medical input is needed especially at evenings and weekends 5.Staff think carers would benefit from more support from staff and time to adjust to change 6.More stroke specific community services are needed to help people leave hospital promptly

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FEEDBACK EVENT A feedback event was held with the patients and carers who participated in the research, to share the initial findings of the project, and to confirm that patients and carers agreed with the priorities identified. The event was hugely successful and there was general agreement about the priorities identified. Some of the priorities for improvement were flagged up as being especially important to the participants and some additional suggestions were raised. The priorities for improvement highlighted as being especially important included: Stroke being treated as a medical emergency Increasing recognition of stroke through awareness campaigns, such as the FAST campaign, however it was suggested that the campaign needed to show more of the different signs and symptoms of stroke The right amount of rehabilitation should be delivered to the individual both in hospital and in the community Information provision and communication with patients and carers needs to be improved

Two additional suggestions: Volunteers could play a role befriending patients in hospital to prevent isolation and provide reassurance Patients are waiting too long for follow-up appointments and they need to take place sooner

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WHAT ARE THE NEXT STEPS FOR THE PROJECT? The next stage of this project is to feed the results back to the staff working on all the stroke units in South Yorkshire. We will be working closely with some of the teams to develop ways to improve aspects of the care they provide, in line with the priorities highlighted by this research.

Thank You... We would like to extend our warmest thanks to all of the patients and carers who gave up their time to take part in the interviews. We would like to extend special thanks to those who gave up additional time to attend the successful feedback event. We would also like to thank all of the staff who gave up their time to participate in focus groups and interviews.

If you would like more information about the project please contact:

DESIGN+PHOTOGRAPHY: WWW.TOMPARTRIDGE.CO.UK

WANT MORE INFORMATION ABOUT THE STUDY? Madeleine Harrison Stroke Unit Quality Researcher Room 1.07, The Innovation Centre 217 Portobello, Sheffield S1 4DP 0114 2225424

[email protected]

WANT MORE INFORMATION ABOUT STROKE? The UK Stroke Association provides a wide range of support and advice. www.stroke.org.uk

Acknowledgement and Disclaimer This project was kindly supported by Sheffield Hospitals Charity (Registered Charity No.1059043) via NIHR CLAHRC for South Yorkshire. NIHR CLAHRC for South Yorkshire acknowledges funding from the National Institute of Health Research. The views and opinions expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health. CLAHRC SY would also like to acknowledge the participation and resources of our partner organisations. Further details can be found at www.clahrc-sy.nihr.ac.uk.