Imperial College Healthcare NHS Trust

Clinical challenge
To provide high quality emotional support to patients after their stroke.

Solution

• Held monthly team meeting to review and interpret SSNAP data and understand the current level of service being provided to patients with mood and cognition problems;
• Adopted a ‘bottom to top’ approach where members of the multidisciplinary team (MDT) formed QI groups who worked autonomously on a specific area of care which needed improving searching for solutions independently;
• Ensured the QI projects were driven by patient experience- ‘How are you feeling?’;
• Developed a patient leaflet on emotional issues after stroke which is available to all patients;
• Wrote a piece on psychological issues after stroke for the trust magazine to spread awareness;
• Carried out staff training about the importance of understanding a patient's emotional state after stroke so the team are better equipped to handle problems related to mood and cognition;
• Invited a stroke survivor to talk about the psychological impact of stroke to ensure all members of the MDT appreciated the complexities of the conditions;
• Incorporated mood assessments on electronic documentation.

Impact
This team is now much more aware of emotional problems after stroke and understands the importance of asking the ‘How are you feeling?’ question. The number of referrals to psychology have increased and there are more cross team collaborations, whereby other members of staff such as nurses and doctors contact the psychologist to discuss a patient needs.

If applicable, screened for mood by discharge from inpatient care (Charing Cross HASU):
In 2013/2014: 54.5%
In 2016/2017: 81.3%

Patient quotes
“I’m only 40 years old, yet the threat of having another stroke is constant. I have made a lot of progress but I still need regular cognitive behavioural therapy. If my state of mind hadn’t been picked up by Ismalia and I hadn’t been referred to Graham, I dread to think what emotional state I’d be in today.” - Stroke patient at Charing Cross Hospital

“A form of relief came the day Ismalia, a clinical nurse specialist in stroke, asked me: ‘How are you feeling?’ I burst into tears. With this simple question and the time given for me to explain, I told Ismalia about my anxious state of mind. She referred me to Dr Graham Jensch, the clinical psychologist for stroke patients.” - Stroke patient at Charing Cross Hospital