Transcript CPD event: Tony Rudd

London Stroke Strategy
and Workforce Issues
Tony Rudd
London Stroke Clinical Director
Date: Monday 8 February 2010
Where are we coming from?
1
Assessment of impairment
•Only 72% of patients are screened to see if they can
swallow safely
•19% of patients have no record in their notes about
whether their visual fields have been affected by the stroke
2
3
Management of continence
•Overall 25% of patients were catheterised following their
stroke. Of these 35% or 10% of all stroke admissions were
catheterised because of urinary incontinence
•Only 60% of patients with incontinence had any evidence
of a written plan to promote continence
4
Therapist response
•25% of patients with swallowing disorders have not been
assessed by a Speech and Language Therapist within 72
hours of admission or 7 days for those with
communication deficits
•16% of patients with motor problems have not seen a
physiotherapist within 72 hours and access to
occupational therapy and social work is even worse
5
2008 Audit. Number of key indicators
achieved per patient
How many staff have we got
and how many do we need?
6
7
Distribution of nursing contact time
per patient on stroke units
8
Nursing time according to disability
score on stroke units
9
Therapist time according to
rehabilitation complexity score
10
CERISE European stroke rehabilitation
study: how much rehabilitation?
Between 7.00am and 5.00pm
The London plan
11
12
HASU, stroke and TIA units
13
Required staffing levels per bed for
stroke services in London
14
‘Before and after’ staffing
requirements for London
15
Estimated additional national staffing
requirements based on London figures
16
Costs
How do we attract nurses
and therapists into stroke?
17
18
Making the case for stroke as a
specialty
• Convince staff that stroke is a treatable disease
• Separate it from geriatrics and neurology
• Include stroke nursing and therapy in curriculum for students
• Genuine inter-disciplinary working
• Wide variety of work
– High dependency stroke nursing
– Stroke rehabilitation
– Palliative care
– Community nursing
– All ages of patients
• Develop a career structure for stroke with properly recognised training
opportunities
19
How do we persuade Commissioners of
the need for higher staffing numbers?
‘Spend to save’
– Fewer complications
– Higher nursing levels should reduce length of hospital
stay and reduce readmissions
– Fewer complaints and better patient and carer
satisfaction
– Good evidence to show that more therapy produces
better results
20
How do we grow a trained workforce?
• Develop and fund demonstration / training centres for
teaching practical skills
• Employ practice development nurses in all major stroke
centres
• Never accept second best!
• Develop stroke training courses in higher education
centres based around a national educational framework
21
Conclusions
• Currently seeing major changes in organisation of
stroke care
• Reorganisation alone will not deliver improvements in
quality of care without a major increase in workforce size
and skills
• Stroke nursing and therapy requires specialist skills. It
cannot be provided effectively without these; hence
stroke patients should not be managed on Coronary Care
Units, MAUs, etc