Developing an Unscheduled Care KPI Acute Stroke Dr Malcolm Alexander Associate Medical Director NHS 24 Dr Lawrence Bidwell Clinical Director Glasgow and Clyde OOH services
Background QIS National Overview 2006 Provision of Safe and Effective Primary Care Services Out of Hours Unscheduled care KPI Steering Group formed. Facilitated by NHS QIS Scotland. Representation from: Public Partners OOH services in Lothian, Borders, Grampian, Greater Glasgow. NHS 24 Scottish Ambulance Service SGPC SCIMP Adastra ISD Scottish Government Health Department
Background Key Drivers: 1. National work on the pre-hospital and immediate admission management of acute stroke- Borders Stroke Study / Info from Scottish Stroke Care Audit / National Audit Office work in England 2. Clear message from patient groups that better advice required in the immediate onset phase of the illness- Chest Heart and Stroke Scotland 3. Variation in type and timing of responses noted in indicator work on referrals from primary care OOH* Acute Stroke pathway identified as one of the key pathways Opportunity should be taken to draft a Key Performance Indicator following the launch of Sign Guidance *Dr M Crooks-The management of Stroke and TIA in Out-of-Hours services
Objectives The draft KPI has 2 main objectives: 1. To ensure a focus on public involvement with the early recognition of potential stroke. 2. To increase the number of patients accessing thrombolysis over a 5 year period to at least 10% of ischaemic strokes.
Key Features of draft KPI The KPI documentation advocates: Monitoring of advice to public on the recognition of acute stroke Local health systems should demonstrate they have a strategy for informing the public on the recognition of stroke. Monitoring of the response times of pre-hospital services: Recognition and transfer of potential acute strokes to facilities capable of managing the initial stages of the diagnosis and treatment. Monitoring of the time to neuro-imaging where appropriate after handover to acute sector. All of this reported on a local systems basis
Key Features of draft KPI FAST Compliant Stroke Contact with Triage Services to Hospital Arrival Total Target Response Time 65 minutes Contact with NHS24 KPI <50% 50-80% >80% 80% of calls received identifying FAST compliant stroke are transferred to SAS within 10 minutes This data can be built from NHS 24 records Can be validated by SAS paramedic face to face Will be reviewed in the coming year with regard to the accuracy of use FAST in telephone triage. Will form part of NHS 24 developing HEAT targets for 2009-10
Key Features of draft KPI FAST Compliant Stroke Contact with Triage Services to Hospital Arrival Total Target Response Time 65 minutes Contact with SAS KPI <50% 50-80% >80% 80% of calls received identifying FAST compliant stroke arrive at hospital within 55 minutes This data can be built from SAS eprf collating the Face to face FAST All times are stamped with SAS systems and are reportable. Will form part of SAS developing HEAT targets in 2009-10
Key Features of draft KPI Local Accident and Emergency / Acute Stroke services FAST Compliant Stroke ARRIVAL AT A/E TO NEURO-IMAGING TARGET RESPONSE TIME 45 MINUTES KPI <50% 50-80% >80% 80% of FAST compliant stroke have neuro-imaging undertaken within 45 minutes of handover from SAS This element is the most challenging to capture The links here will be made with other National stroke audit. Lanarkshire Health Board Stroke data collected in SAIL will map the way forward.
Key Features of draft KPI All presentations of stroke to out-of-hours primary care emergency services FAST compliant stroke KPI <50% 50-80% >80% 80% of patients identified as having FAST compliant stroke arrive at hospital within 65 minutes of receipt of call or self presentation to service 80% of non-fast compliant stroke assessed face to face within 2 hours of receipt of call or self presentation to service Data collection here is quite detailed Generic coding for stroke symptoms needs to be more specific Work with Adastra Software Ltd will improve coding and enable reporting.
Building the Key Performance Indicator Greater Glasgow & Clyde OOH Services Current collaboration between key partners: NHS 24 SAS Clyde Sector of Glasgow and Clyde OOH services Adastra Future collaboration with: Lanarkshire Stroke MCN
Improving Data flows in future NHS 24 Adastra Software In-Hours GP Phone Call OOH Service SAS Receiving A/E Current data transfer links
Improving Data flows in future NHS 24 Adastra Software In-Hours GP New patient information available to GP OOH Service SCI SAS connectivity enhanced SAS Receiving A/E Radiology systems Potential for Enhanced linkages Warning of acute stroke patient arrival documented
638432 6252994 6264296 6265917 6297515 6301017 6305674 6308765 6312921 6333378 6370467 6390654 6390775 6399236 6415290 6418195 100 90 80 70 60 50 40 30 20 10 0 FAST Calls taken by NHS 24 Call Handlers & directly transferred to SAS NHS 24 KPI = 100% SAS KPI = 92% Sum of TOTAL SAS TIME Sum of TOTAL NHS 24 TIME Sum of Duration SAS time NHS 24 time Time from onset Time in Minutes
Calls taken by NHS 24 Nurse Practitioners & referred to primary care SAS KPI = N/A 160 GP KPI =??? 140 GP cons time Time in Minutes 120 100 80 60 40 Travel time 20 NHS 24 time 0
Total time from reported onset to hospital arrival north of Scotland Drop Page Fields Here FAST compliant potential stroke 200 Minutes 180 160 140 120 100 80 Data Thrombolysis limit Target time for hospital arrival Sum of Time to Hosp Mins Sum of TimeOnScene Sum of Response T min Sum of call Duration Minutes 60 40 20 0 674740 675947 677885 678277 679176 681897 682190 682791 683717 688450 2004566 2010049 2322890 2338949 2339805 Sum of Time from onset to call Data incomplete IncidentNumber
Next steps Work with NHS Lanarkshire stroke service: End to end validation of KPI Plan to complete this by end March 2009 Model reports built Plan to complete this by end March 2009 Validation of FAST criteria in telephone triage Plan to complete this by end Dec 2009 Outstanding issues: 1. Further discussion with stakeholders 2. Understanding overall of the resource requirements. 3. Ownership of the KPI once developed 4. Ongoing reporting and report maintenance.