January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
Appendix 2
LONG LIST OF OPTIONS
The long list of 6 service model options is described below. It should be noted that these are
service models and as such are not specific about hospital site.
Option 1a
Continue with the current service model ‘Do Nothing’- not considered viable due to inability to
meet WMQRS standards to provide 24/7 service, and then clinical risks associated with this.
The risks and issues of this option are fully articulated in the project’s Clinical Case for
Change report and summarised in the section 2.3 above.
Option 1b
Retain the current configuration but introduce new ways of working for medical teams in order
to provide acceptable level of cover at all times- not considered viable within a suitable
timeframe, or sustainable due to medical staffing numbers, their clinical commitments and the
ability to retain and recruit high calibre staff. This model would not achieve critical mass and
would require extra support from nurses, who would require specialist training, which can only
be achieved through a full training programme and clinical mentorship. This would take
considerable time to implement and therefore there would be a delay in the ability to provide
full 24/7 services. The issues raised are explained in the Clinical Case for Change report for
Stroke and TIA services (SWBHT March 2011).
Option 2
Configure a two site model with all emergency hyper-acute care delivered from one site
including the ability to review high risk TIA 24/7. There would also be short stay stroke beds
at this site as part of continuing care within the stroke unit.
Long stay rehabilitation would be delivered at the second site along with OPD clinics
including all follow up and also specific dedicated clinic slots for low risk TIA.
The centralisation of Hyper-acute stroke services will enable patients to have rapid access to
the right skills and equipment and be treated 24/7 on a dedicated stroke unit, staffed by
specialist teams. Hyper-acute units have a number of dedicated assessment beds available
with full cardiac monitoring facilities and appropriate staffing for level 2 monitoring and also a
number of dedicated stroke in-patient beds for short stay. (All alternative Options, that is,
options 2-6 include the development of a Hyper-acute Unit on one site only as this was
a non-negotiable within the project).
Option 3
This is a single site model with all facilities and services located at one site. All hyper-acute,
rehab, imaging and OP services would be provided on the one site, with nothing provided on
the other site. It provides a 24/7 service and incorporates neurology beds within the hyperacute
area. Short and long stay rehabilitation would be provided in a dedicated stroke rehab
ward located at the same site near to the hyper-acute unit.
There would be a telemedicine link from the ED department to the Hyper-acute facility. In
addition there would be early supportive discharge assessment and intervention available on
site from the earliest opportunity.
All TIA patients would be managed on an outpatient basis. TIA services would be enhanced
via inclusion of a telemedicine approach from the Hyper-acute Unit to ED.
Option 4
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