Stroke Single Point of Access Project Group at Manchester University Foundation Trust

Clinical challenge
To create a single point of access (SPA) to improve patient flow in the stroke pathway for patients being transferred from a hyper-acute stroke unit (HASU) to a district stroke centre(DSC) in Manchester Foundation Trust. The aims being, to reduce the number of breaches that occur, improve timely access to stroke assessment & treatment to meet the SSNAP 90% Length of stay target and reduce overall length of stay.

Solution
A pilot SPA in June 2018 analysed the potential to prevent breaches in patient transfers when a bed base is shared across three sites (Wythenshawe; Trafford; Central Manchester). This was a ‘virtual’ pilot, however had this system been operational, this would have prevented 8 pathway breaches during this time. Utilising the PDSA model for improvement:

• Baseline SSNAP data gathered on 90% LOS and LOS
• A ‘road show’ was held at each hospital site to launch the SPA model
• A standard operating procedure (SOP) was agreed and distributed to all relevant teams.
• The process was presented to Executive teams at each site to gain agreement on the SOP and gain senior ‘buy in’ to the process.
• A single NHS.net account was created to allow the HASU’s to share patient lists in one place.
• An excel spreadsheet was created for the DSC to communicate their bed states daily with each other
• A ‘host site’ was identified who were responsible for coordinating the day to day running of the SPA.

The model was launched on 1^st October 2018 and its progress shared in MFT’s iNews to build awareness of stroke services. The first months data will be reviewed in the monthly project group & shared widely with clinical & managerial teams.

Impact
To date, there has been 1 breach of the pathway in October 2018 across MFT. This is compared to 20  breaches in the month of june when the virtual pilot gathered data.One patient has been redirected to prevent a breach where a bed could not be made available in their local DSC.
 
The ability of the host site to know the bed state across MFT has improved communication with the HASU as it reduces the number a calls needing to be made to facilitate a transfer. There is now an active stroke bed management system in place that proactively manages beds and pulls patients through from the HASU
 
Teams across the three sites are now working collaboratively & forging better working relationships. A project group meets monthly to review processes & discuss any operational issues which need to be acted on.

Reflection
Whilst the project is still in its infancy, we are already seeing the benefit of the SPA as patients are being repatriated to the right bed at the right time. The knock on effect of this positively impacts the flow at the HASU, allowing other patients to access hyper-acute care in a timely manner.
 
Future work will develop this collaboration further as more data becomes available. We aim to track the care of those patients who are placed in a DSC (which is not their local DSC) to understand the implications on social care/discharge planning. It is hoped this will influence the involvement of social care & improve standards across the three sites.