Centralisation of stroke services across Coventry and Warwickshire
Why change was needed
An analysis of stroke services in Coventry and Warwickshire, carried out between 2016 and 2019, identified unwanted variation in the range and quality of service provision. In particular, concerns were raised regarding some patients not receiving hyper acute care within the first 72 hours, the proportion of patients scanned within 1 hour, the median time for patients to be scanned, and the time taken for patients to be admitted to a Stroke Unit.
In addition, there was strong evidence that timeliness of stroke specialist assessment and treatment significantly affected peoples clinical and life outcomes.
We recognised that fundamental changes to the way we delivered stroke services were necessary in order to tackle health inequalities and improve access for stroke patients across Coventry and Warwickshire.
What we did
In order to respond to the issues that were highlighted in the analysis of our stroke services, the decision was made to centralise these services in order to provide high quality and consistent treatment for all our local populations, no matter where they lived.
As this was a significant change to our stroke services, years of planning and engagement with local communities commenced in order to determine how best we adapt stroke services to ensure they delivered better health outcomes.
The new centralised stroke service was launched on 1st September 2022. The new pathway means that all patients who suffer a stroke will initially be treated at a specialist stroke unit at University Hospital, Coventry. Patients who need continued treatment in hospital will be transferred to a bedded rehabilitation unit at either George Eliot Hospital in Nuneaton or Royal Leamington Spa Rehabilitation Hospital in Warwick.
Patients who do not require continued hospital treatment but do need continuing specialist support with their recovery will be treated at home by the Community Stroke Rehabilitation Service.
Previously, patients were treated at a stroke unit at the nearest acute hospital. This was causing inequity in treatment and outcomes depending on which acute hospital the patient was treated at.
The changes bring the stroke pathway in Coventry and Warwickshire in line with other areas of the UK and have support from stroke specialists both nationally and locally.
The stroke centralisation process is an excellent example of how we can utilise the specialisms and expertise we have across our local health system. The 4 NHS Trusts within Coventry and Warwickshire (University Hospitals Coventry and Warwickshire NHS Trust, South Warwickshire NHS Foundation Trust, George Eliot Hospital NHS Trust and Coventry and Warwickshire Partnership NHS Trust) took responsibility for a different part of the new pathway and were able to focus on improving the outcomes in their specified area.
Furthermore, because of how interconnected the various stages of the new stroke pathway are, close working relationships across organisational boundaries were formed between stroke specialists at the various Trusts and within the ICS. This created an environment where constructive conversations can be had about how to better improve the experience of stroke patients and allows us to continually improve the services we offer.
Following the introduction of the new centralised stroke pathway, we have seen marked improvements across a number of key areas identified in the analysis of stroke services in Coventry and Warwickshire. Such as:
- All patients now receive appropriate hyper acute care within 72 hours of suffering a stroke
- The proportion of patients scanned within 1 hour with a suspected Stroke has increased to 52.4%, up from 13% during the analysis.
- The median time taken for patients to be scanned now stands at 54 minutes, a significant reduction from the 2 hours and 43 minutes it took for patients to be scanned previously.
- The total time taken for patients to be admitted to a stroke unit pre centralisation was between 6 and 11 hours during the time the analysis took place. That now stands at 3 hours and 53 minutes for patients across Coventry and Warwickshire.
These dramatic improvements in stroke service metrics highlight just how important the new pathway has been in delivering better outcomes for patients in our area.
We continue to explore ways in which a patient’s journey through the stroke pathway can be improved. Stroke specialists and their teams from across the system continue to meet monthly to highlight any issues, discuss solutions and share best practice to ensure the various parts of the pathway are joined-up and working smoothly.
We will continue to monitor our performance against key metrics and expect these to continue to show improvement. The processes that are now in place will allow us to highlight and act when problems and barriers arise, resolving issues with a collective, system-based approach.