January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
We have struggled to consistently meet the key performance indicators for stroke and TIA
services in the national Vital Signs/Integrated Performance Measures.
One of the key measures (in the Stroke Vital Signs) is the percentage of stroke inpatients
who receive over 90% of their acute care on a designated stroke ward with the national
threshold being 80%. Table 2 below shows our performance against this measure for the
financial year 2010/11 and the first 6 months of 2011/12. It can be seen that our performance
was below the national threshold in two quarters of 2010/11.
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Table 2 – The % of stroke inpatients in who received over 90% of their acute care on a designated
stroke ward
Performance
02010/11
Number of
Patients who
spent >= 90% of
stay on a stroke
ward
Total Stoke
Patients
% Of Stoke
Patients who spent
>= 90% of stay on
a Stroke Ward
Quarter 1 62 76 81.6
Quarter 2 71 92 77.2
Quarter 3 60 78 76.9
Quarter 4 65 77 84.4
2011/12 Q1 57 67 85.1
2011/12 Q2 55 67 82
Another key measure (in TIA Vital Signs) is the percentage of TIA patients with a predicted
high risk of further stroke (ABCD score of 4 or more) who are seen at an Out Patient TIA
clinic within 24hrs of first presentation to a medical professional (GP, A+E etc). The national
threshold is 60%. Table 3 below shows our performance against this measure for the
financial year 2010/11 and the first 6 months of 2011/12. It can be seen that whilst our
performance has improved it remains below the national threshold.
Table 3 – The % of high risk TIA patients seen in a TIA clinic within 24 hours of first presentation to a
doctor
Performance
2010/11
Total High Risk TIA
Patients
Total High Risk
TIA Treated
within 24hrs
% of High Risk
TIAs treated in
24 hours
Quarter 1 34 0 0 %
Quarter 2 50 4 8 %
Quarter 3 26 0 0 %
Quarter 4 18 10 55.6
2011/12 Q1 9 5 55.6
2011/12 Q2 20 11 55
A third key measure is the percentage of patients receiving thrombolysis (where clinically
appropriate). The national standard is 20%. Our performance against this standard has
improved but is currently around 7% with 82% of these patients receiving thrombolysis within
4.5 hours of the onset of symptoms. In addition to access to a hyper acute stroke service a
key factor is the time patients present to hospital from the onset of symptoms. The
consolidation of our acute services and specialist team will also facilitate time for our clinical
team to work with primary care and public health clinicians to raise awareness in our local
population of stoke symptoms and the importance of presenting early to hospital. .
This data does indicate an improving performance but would be improved further through the
reconfiguration of services and related consolidation of specialist skills and expertise and the
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