Clinical challenge
To increase access to Speech and Language Therapy on an acute stroke unit where  referrals had fallen to < 30%.

Solution
Change service provision with development and introduction of a short assessment.

Develop a short assessment to be administered to all newly diagnosed stroke patients within the first 72 hours.

To prioritize short assessment delivery over a trial period of 2 months.

To audit outcomes over the trial period with:

• ​point prevalence data
• referral information
• outcomes of short assessment

Short assessment outcomes to be:

• advice given and patient discharged
• further assessment required - communication/swallowing
• No further SLT intervention needed

Maximise on staffing to achieve consistent administration of the short assessment

Impact
For the first month of trialling the short assessment the SLT service delivered an A ( in the SSNAP targets as measured by our own trust) having previously achieved between C- E in previous months . The patient caseload increased by 21 % from the previous month.

There was recognition from the Stroke directorate that innovative changes in clinical delivery and provision of Speech and Language Therapy had led to the improvements in targets.

A full time Stroke SLT post was funded by the trust within the next 8 months.

Reflection
In recognising there were breakdowns in our referral pathway and that patients were being referred by either an alternative pathway or not at all we accepted we were failing on achieving a caseload anywhere near the National average on the SSNAP targets. This meant that in spite of achieving all the other targets of seeing the patient within 72 hours, achieving on average above 35 minutes of therapy and up to 3 times per week, without the caseload of patients we were achieving at best a C and at worse an E.

Trialling a short assessment for all stroke patients, collating a point prevalence of our caseload and auditing the stroke referrals received we were able to capture comprehensively data to support our request for SLT funding for our Stroke Service. When achieving an A rating for a month we were able to demonstrate that innovative clinical practise with staffing delivery could achieve the improvements in quality of service to our patients which ultimately led to the first trust funded SLT post in our service to date. Utilising SSNAP data and our audit findings only strengthened our case.

This case study was written by Kim Rushton, Clinical Lead SLT at Royal Preston Hospital. Clinical Team includes Helen Al- Nufoury  (Consultant SLT and Head of Service) and Emma Critchley (Specialist Speech and Language Therapist in Stroke).


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