Stroke impacts on every aspect of patients, their carers and the society at large. The majority of stroke patients are elderly and need acute specialist and multi-disciplinary care both in the acute as well as the long-term rehabilitation setting. For a number of years Nottigham University Hospitals NHS Trust (NUH) ran a multidisciplinary educational stroke course targeted mainly at nurses. The course comprised training by stroke physicians, nurses, pharmacists, occupational and physiotherapists, speech & language therapists and former patients.
The key components of this course were its multi-disciplinary emphasis, its traversing of the whole stroke pathway, its accordance with the national SSEF(Stroke Specific Educational Framework) and its collaboration between NUH and the University of Nottingham. The Course has been endorsed by the UKFST (UK Forum for Stroke Training) as ‘an excellent, well planned & impressive course which covers the whole stroke pathway and which should be developed further to benefit more people’.
Unfortunately this was the only multi-disciplinary stroke course delivered in the East Midlands. The aim was to expand it further, and deliver it nationally. The translation of good practice from the MDT staff to the learners was intended to result in improved patient care and survival. The course was evidence-based and designed to be ever-evolving in the years to come, provided additional funding was provided to support this venture.
Following funding and project management support provided by HEEM, the course developed into a comprehensive 3-day programme which was delivered four times throughout 2013.
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The problemStroke is the third most cause of death; 30% of the patients die within a year and 50% are left dependent. NUH currently admits approximately 1500 inpatients with stroke each year. The average age of stroke patients is 78.1 yr and with an ageing population, stroke is likely to cause an even greater impact in the future. These patients require multi-disciplinary (MDT) input for their recovery. In younger stroke patients the challenges can often be greater, hence why stroke teaching has to be multi-disciplinary.
Furthermore, ‘stroke’ is currently not taught as a separate specialty in nursing and medical schools but as part of ‘geriatric’ teaching. There is a great heterogeneity in the care of the stroke patients especially with the dynamic changes in stroke medicine. This highlights the need for an intervention such as the Multi-Professional Stroke Foundation Programme.
Proposed education intervention• A multidisciplinary and evidence-based educational programme.
• A programme that traverses the whole pathway from hyper-acute and acute, through to rehabilitation, community and the incorporation of social care.
• A programme that will stimulate clinical staff to undertake advanced roles in stroke care by closer improving their knowledge and confidence.
• A course that looks at the patient and carer’s perspective, by inviting these individuals to present on the course.
• A programme that will influence the School of Nursing to develop Stroke Nursing as a separate speciality.
• A course that could be adapted to be targeted at undergraduate medical nursing students, reinforcing the importance of MDT working early on in their individuals clinical careers.
Benefit to PatientsPatients are provided with care from staff that are endowed with evidence-based, state of the art knowledge in the care of stroke patients; and who are aware of the whole ‘journey’ of the patient (and carers) through the entire pathway; staff who will pay attention to emergency care, medical, physical, occupational, speech & language, cognitive, social, therapeutic, end-of-life and psychological aspects of their illness.
Not only will NUH patients benefit; those admitted to other hospitals in the East Midlands will see benefit as well once the knowledge base is widened.
Benefits to serviceThe educational course provides high quality multi-professional training in two major aspects of stroke medicine - education & patient care. As the only comprehensive stroke centre in East Midlands, NUH is expected to provide leadership, guidance and education to the whole region and the course provides an excellent opportunity to do so.
Productivity and impactAs part of the assessment of impact of the course, patient quality outcomes were examined including the percentage of stroke patients having a joint care plan and percentage having rehabilitation goals set at five days.
These were taken as an indication of improved co-ordination of working within the MPT, which research has shown is key to quality patient care.
Stroke survivors who commence on a plan of MPT rehabilitation quickly are likely to be more independent and experience less disability. It is also likely that clinical outcomes, e.g. length of stay and patient satisfaction, have the potential to be impacted positively.
Following this educational intervention there was a notable improvement in both indicators. Delegates reported improved communication within their team, better understanding of the distinctive roles and contributions of team members to the care of the patient and greater knowledge and understanding of rehabilitation processes. This combination is believed to have been important in improving patient outcomes.
The majority of delegates attending the course reported that the programme had improved their knowledge and confidence in their ability to provide high quality care for stroke survivors. They also reported that the programme had improved their job satisfaction, which has positive implications for staff retention levels.
The HEEM Innovation team shared information on the programme as part of a poster presentation at the European Stroke Conference in Nice in May 2014. Further to this, they have been asked to give a full paper presentation at the World Stroke Congress, taking place in Turkey, in October 2014. This event will be attended by the leading stroke experts from around the world.
Sunil K Munshi MD, Dip NBE, FRCP Lond, FRCP Edin
Consultant Physician & Foundation Director , Nottingham City Hospital
Honorary Clinical Lecturer , School of Medicine
Nottingham University Hospitals NHS Trust
Hucknall Road, Notts, NG5 1PB
01159691169 x 55657