Guy's and St Thomas' NHS Foundation Trust

Clinical challenge
To aid timely and in-depth assessment and management of the mood, behaviour and cognition post stroke.

Solution

• Established an ‘emotion management pathway’ to help patients get the right level of psychological support.
• Refined Mood Screening on the ward with earlier screening, multiple staff trained to administer, and use of stroke friendly measures.
• Trained staff on identification and management of mood issues.
• Staff are encouraged to consult on challenging cases with Psychology.
• Set up reflective practice sessions to explore challenging cases once discharged.

Impact

• SSNAP: “% mood screens completed with required inpatients”
  • Apr-Jun 18 – 87.5% (pre mood pathway)
  • Jan-Mar 19 – 97.4% (post mood pathway)
• SSNAP: “Applicability for patients to receive psychology during inpatient stay”
  • Dec 17-Mar 18 – 19% of cases seen (pre full time psychologist)
  • Jan 19-Mar 19 – 35% of cases seen (post full time psychologist)
• SSNAP: “% of the patient’s days at this team on which it is received by the patient”
  • Dec 17 – Mar 18 – 3.9% of days (pre full time psychologist)
  • Jan 19-Mar 19 – 15.2% of days (post full time psychologist) (9.7% national average)
• Training outcomes indicated: staff’s confidence in conducting mood screens and identifying and managing mood issues increased.

Reflection
Example of feedback at 1 year review: “Introduction of full time psychologist has been fantastic and has raised the awareness and skills of the team in managing mood and cognitive impairment post stroke. As the awareness has improved, it has highlighted the need for more psychology for the Stroke Unit”.