PenCHORD - Torbay and South Devon stroke care
Torbay and South Devon NHS Foundation Trust requested PenCHORD’s help with understanding the number of beds needed to obtain a good flow of patients through the acute and rehabilitation unit stroke care pathway. The aim is that patients should not be held up at any phase of the care pathway due to lack of beds in the next phase.
People in Torbay and South Devon are served by Torbay Hospital for acute stroke care and Newton Abbot Hospital for rehab care after a stroke. There are three levels of rehab care, each of which requires different resources. Some patients treated by these services will also have received some of their acute care at other hospitals in other regions of the South West.
A diagram of the Torbay and South Devon NHS Foundation Trust’s stroke care pathway is shown below.
The project objective was to model the stroke care pathway system in order to define the resources needed for Torbay and South Devon NHS Foundation Trust to meet best-practice targets for stroke care. These include objectives set by the Sentinel Stroke National Audit Programme (SSNAP) - the single source of stroke data in England, Wales and Northern Ireland.
The model was used to predict the impact of different numbers of beds on SSNAP’s key indicators of performance:
- The proportion of patients directly admitted to a stroke unit within 4 hours of arrival at the acute hospital.
- The median time between arrival at the hospital and arrival at the stroke unit.
- The proportion of patients who spent at least 90% of their stay in hospital on a stroke unit.
The model mapped patient journeys through 4 stages of care:
- Emergency department
- Acute hospital specialist stroke beds (Torbay Hospital, George Earl ward)
- Community hospital rehab beds (Newton Abbot Hospital, Teign ward)
- Therapy at home (‘early supported discharge’)
Additionally, the model allowed the project team to explore the impact of potential changes to the stroke care system, such as ring-fencing beds or combining rehab and acute care in a single hospital location.
The model’s findings have been presented to Torbay and South Devon NHS Foundation Trust in a report describing how the resources available affect the Trust’s ability to meet best-practice targets for stroke care.