Mind the gap!

The Third SSNAP Annual Report

Case Study: Restructuring of stroke services in focus

This case study was submitted by Dr Matthew Burn, Consultant Stroke Physician at Wycombe
General Hospital and Stroke Clinical Network (SCN) lead for Thames Valley.
Stroke services in Thames Valley were reconfigured in 2010/11 with patients going to a Hyperacute Stroke Unit (HASU) if they arrived at hospital within 4 hours of stroke onset and hence were potentially eligible for stroke thrombolysis. Three hospitals were designated as HASUs, each with 550-700 stroke patients a year. Three other sites were designated Acute Stroke Units and received between 100-350 patients a year.
Evidence since then suggests that better outcomes are achieved with a centralised model, ie taking all patients to a HASU regardless of time of onset. SSNAP data has allowed us to assess the efficacy of the 2010/11 reconfiguration locally. We found a striking difference between the HASUs and non-HASUs particularly for those aspects of care particularly relevant to the first 72 hours of admission.
More recent data has shown that both HASUs and non-HASUs have shown improvement in the non-hyperacute domains, but the non-HASUs have had limited success in improving the hyperacute domains, suggesting that centralisation will be necessary to improve hyperacute stroke care.
This combination of published evidence and local performance data, both telling the same story, prompted commissioners and the Senate to look to develop a centralised model in Thames Valley. The pace of change is variable and is affected by local factors in each area, but the ambition is that all patients with stroke in Thames Valley will be managed on a HASU for the first few days of their admission.

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