Blackpool Teaching Hospitals NHS Foundation Trust

Introduction
At the start of 2022, there was a rapid decline in percentage of patients seen by a stroke specialist consultant within 24 hours due to a lack of weekend and out of hours cover. While Figure 1 indicates that this has been on a steady increase, recent data suggests a plateau in performance with quarter two (July to September 2022) signifying that only 63% of stroke patients were seen by a stroke specialist consultant within 24 hours. Comparatively, SSNAP (2022) reports that the national average during April to June 2022 was 83.3%, demonstrating that Blackpool Victoria Hospital (BVH) is underperforming in this category of stroke care.

Solution

• Appoint a nurse consultant (NC)
• Base NC in A&E to assess patients that are not yet admitted to the stroke unit

Impact
Splitting the month of October into the two categories, without nurse consultant and with nurse consultant, it becomes apparent that the role of nurse consultant is positively impacting the percentage of patients seen by a stroke consultant within 24 hours. From October 1^st to the 9^th of October (period during October without a nurse consultant) only 47% of patients were seen by a stroke specialist consultant within 24 hours. Since the addition of nursing consultant (10^th October 2022 to the 21^st of October), 78% of patients were assessed by a stroke consultant within 24 hours.

A contributing factor to this 31% increase in patients being seen by a stroke consultant within 24 hours is that the stroke nurse consultant is based in A&E. Despite patients arriving to hospital during consulting hours, these patients may not arrive to the stroke unit until after consulting hours. Therefore, basing the nurse consultant in A&E provides opportunity for patients not on the stroke unit to be seen by a stroke specialist consultant, lowering the time for a patient to be assessed by a stroke consultant.

Reflection
Conscious that the introduction of nursing consultant is in its infancy, the benefits are already recognisable since there is an evident reduction in time to stroke consultant. This case study makes apparent that coupling SSNAP with the determined BVH stroke team has been valuable as SSNAP has facilitated identifying areas for improvement and made possible for the stroke staff to monitor the effectiveness of established and implemented practises.