In 2006, a stroke project team relocated all the stroke
services in Nottingham onto one site and developed the
hyper acute stroke unit. The service now provides direct
access to patients, bypassing the emergency department.
They also developed a daily fast track service for transient
ischemic attack patients with examination, investigations,
secondary prevention and discharge home on the same
day.
The project team worked closely with patient groups, who
were keen to be involved and undertook observations of
care on all stroke wards. They highlighted areas of good
practice which were incorporated into the new service and
commented on the need for therapy areas to be available
to improve multi-disciplary communication with sharing of
skill and knowledge. Patient representation has continued
in the development of the project with the formation of a
stroke patient group “@astroke”. An important
partnership with East Midlands Ambulance Service has also
been instrumental with the introduction of a validated tool
“FAST”, used for the assessment of patients and a pre-alert
system to the ward team by a dedicated phone link,
bypassing emergency department.
Evaluation of the project has shown significant benefits in
outcomes and an enhanced patient experience. One 38
year old patient has developed an E-diary which
demonstrates the importance of paramedic staff
responding quickly and appropriately to a 999 call using
the FAST tool. In alerting the unit team directly, he arrived
with 30 minutes onto the unit, had medical assessment
and CT scan and thrombolysis treatment within one hour.
He continued his recovery from a large stroke which would
have left him with severe disability if the treatment had not
been provided and was discharged home within four days
with no residual deficit. Six months later, he returned to
work.
For more information on this project, please contact;
Dawn.Good@nuh.nhs.uk
