Oxfordshire Stroke Rehabilitation Unit, Oxford Health NHS Foundation Trust

Clinical challenge
Following poor performance in the Sentinel Stroke National Audit Program (SSNAP) and local key performance indicators (KPIs), Oxford Health NHS Foundation Trust (OHFT) committed to a Stroke Quality Improvement Project. The premise was to enhance service quality for patients requiring bed-based rehabilitation, as part of the Oxfordshire Stroke Pathway.

Solution
Aligning service provision with that recommended in the Royal College of Physicians National Clinical Guideline for Stroke (2016) required consolidation of two stroke units, 14 miles apart, into one specialist stroke rehabilitation ward. A Stroke Quality meeting was initiated. Teams reviewed current care, stroke guidelines and the relevant evidence base, and a multi-professional improvement plan was developed. 10 beds were moved from Town A to Town B in February 2018 with as little disruption to patient care as possible. SSNAP data was used to measure the impact of the project, alongside local KPIs.

Impact
The Stroke Quality Improvement Project is part way through implementation. Relocation of the wards to a single specialist rehabilitation unit has been completed. There has been an increase in compliance with RCP recommended therapy staffing from 73.7% to 85%. Therapy performance has also improved with both occupational therapy and physiotherapy consistently delivering 45 minutes of therapy per working day. Average number of days on which patients received occupational therapy during admission increased from 43.5% to 69%. Physiotherapy increased from 46.5% to 70%. Discharge processes have been streamlined but further improvement is still required. Patient outcomes have also improved. Average improvement on the Barthel Index from admission to discharge increased from 5.73 to 6.69.

This improvement was reflected in the SSNAP audit from August 2017 to June 2018:

• Physiotherapy and Occupational Therapy performance has improved from ‘B’ to ‘A’ rating for the last 2 reporting segments
• Unit performance overall has improved from ‘D’ rating to ‘B’

Next steps
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 feedback and instigation of a psychology service and 6-month review process. There is also a need to review other elements of the Oxfordshire Stroke Pathway and community services, to enhance rehabilitation delivered on discharge.