So what have the Networks been up to

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So what have the Networks been up to this year? Dr Martin James – So what have the Networks been up to this year? Dr Martin James – Stroke Physician, Royal Devon & Exeter Hospital

The South West Stroke Research Network Population 5. 05 M 17 acute sites 8 The South West Stroke Research Network Population 5. 05 M 17 acute sites 8 community sites

South West SRN Recruitment SW SRN Recruitment Summary 1497 1600 1400 Expansion to Western South West SRN Recruitment SW SRN Recruitment Summary 1497 1600 1400 Expansion to Western CLRN area 1200 1008 591 1000 Extended area 800 476 300 600 Baseline 112 400 76 36 2006/7 Peninsula 335 133 906 673 99 200 0 82 555 394 422 201 2007/8 2008/9 2009/10 2010/11 2011/12 Year on year recruitment from original and extended areas

South West SRN Recruitment SW SRN Recruitment Summary per CLRN 1497 1600 Expansion to South West SRN Recruitment SW SRN Recruitment Summary per CLRN 1497 1600 Expansion to Western CLRN area 1400 1008 1200 783 1000 555 476 800 600 400 203 273 2006/7 253 714 528 171 95 17 Pen CLRN 480 300 Baseline 112 200 0 WCLRN 302 129 2007/8 2008/9 2009/10 2010/11 2011/12 Year on year recruitment by CLRN area

34 studies open during 2011/12 61% RCT 34 studies open during 2011/12 61% RCT

SWSRN Recruitment by site SWSRN Recruitment by site

SWSRN Highlights from 2011/12 ü SWSRN sites have recruited over 40% of the total SWSRN Highlights from 2011/12 ü SWSRN sites have recruited over 40% of the total to CROMIS-2 and have been asked to present at the CROMIS investigators meeting ü SWSRN sites have recruited 40% of IRIS patients in the UK Bournemouth, Bath and Torbay are the top 3 recruiting sites ü SWSRN sites have recruited 40% of AVERT UK recruitment in 2012 ü SWSRN sites have recruited 37% of the INTERACT 2 recruitment in the UK - from 4 of the 20 UK sites – Bath (top UK recruiter), Exeter, Bournemouth and Taunton ü Truro the first to recruit to PODCAST outside the investigator’s site ü CLOTS-3 heroes this month – Salisbury and Gloucester (others in the past) ü INTERSTROKE set up in collaboration between the Exeter SRN team and the NIHR Clinical Research Facility ü PCPI – over 300 people now on the database; April newsletter on the new look website http: //www. southweststroke. nihr. ac. uk

SWSRN Performance Network Population Total Q 2 rec (M) overall rec per M popn SWSRN Performance Network Population Total Q 2 rec (M) overall rec per M popn Total Q 2 rec to RCT's RCT rec per M popn Thames 10. 13 891 88 425 42 South East 8. 81 864 98 491 56 Trent 7. 61 543 71 324 43 North West 6. 86 684 100 661 96 West Midlands 5. 33 1013 190 596 112 South West 5. 05 700 (4 th) 139 (2 nd) 516 (3 rd) 102 (2 nd) Yorkshire 3. 76 292 73 273 73 North East 2. 55 287 113 230 90 4 th recruitment overall (6 th in population size) 3 rd in recruitment to RCT’s 2 nd in recruitment per population 34 studies open during 2011/12 61% RCT

SWSRN Performance Network Population Total Q 2 rec (M) overall rec per M popn SWSRN Performance Network Population Total Q 2 rec (M) overall rec per M popn Total Q 2 rec to RCT's RCT rec per M popn West Midlands 5. 33 1013 190 596 112 Thames 10. 13 891 88 425 42 South East 8. 81 864 98 491 56 South West 5. 05 700 (4 th) 139 (2 nd) 516 (3 rd) 102 (2 nd) North West 6. 86 684 100 661 96 Trent 7. 61 543 71 324 43 Yorkshire 3. 76 292 73 273 73 North East 2. 55 287 113 230 90 4 th recruitment overall (6 th in population size) 3 rd in recruitment to RCT’s 2 nd in recruitment per population 34 studies open during 2011/12 61% RCT

SWSRN Performance Network Population Total Q 2 rec (M) overall rec per M popn SWSRN Performance Network Population Total Q 2 rec (M) overall rec per M popn Total Q 2 rec to RCT's RCT rec per M popn West Midlands 5. 33 1013 190 596 112 South West 5. 05 700 (4 th) 139 (2 nd) 516 (3 rd) 102 (2 nd) North East 2. 55 287 113 230 90 North West 6. 86 684 100 661 96 South East 8. 81 864 98 491 56 Thames 10. 13 891 88 425 42 Yorkshire 3. 76 292 73 273 73 Trent 7. 61 543 71 324 43 4 th recruitment overall (6 th in population size) 3 rd in recruitment to RCT’s 2 nd in recruitment per population 34 studies open during 2011/12 61% RCT

South West Studies • TWIST – all 7 Peninsula centres now open • IMPROVE-Stroke South West Studies • TWIST – all 7 Peninsula centres now open • IMPROVE-Stroke – all but completed, study team now working on HTA funding bid for full study • LAST – just opened in Exeter • ECHO-PIV – highest recruiting study in Exeter • Reach-to-Grasp – two centres now open in Western CLRN area (Bristol and North Somerset) • Pen. CLAHRC thrombolysis modelling – Platform and poster at European Stroke Conference, Lisbon • Re. Train – IGO study now open

PENINSULA HEART & STROKE NETWORK Avon, Gloucestershire, Wiltshire and Somerset Cardiac & Stroke Network PENINSULA HEART & STROKE NETWORK Avon, Gloucestershire, Wiltshire and Somerset Cardiac & Stroke Network Peninsula Heart & Stroke Network Dorset Cardiac & Stroke Network

Accelerating Stroke Improvement Domains Joining Up Prevention · AF Detection and Treatment · Timely Accelerating Stroke Improvement Domains Joining Up Prevention · AF Detection and Treatment · Timely and Key Areas of Focus effective management of TIA Implementing Best Practice in Acute Care · Direct Admission to a Stroke Unit · Timely Brain Scan Improving Post Hospital and Long Term Care · Early Supported Discharge · Joint Care Plans using Single Assessment Process · Review at 6/52, 6/12 and yearly · Carers’ Assessment · Psychological Support

How can the NHS respond to the new challenges? How can the NHS respond to the new challenges?

PENINSULA HEART & STROKE NETWORK Network update - supporting QIPP in 2011/12 2011 -12 PENINSULA HEART & STROKE NETWORK Network update - supporting QIPP in 2011/12 2011 -12 • Quality – Supporting centres to improve their ‘ 90% stay’ performance measure – from 50% in 2009 to 79% for 2012 – Psychological support – developing and supporting the implementation of a Peninsula wide, 4 -tier model of psychological and emotional support – Nursing home education framework/training and assessment – Supporting quality data monitoring with Peninsula Stroke database/SINAP → SSNAP – Transparency – publicly available performance information on ‘Our. Health’ website

PENINSULA HEART & STROKE NETWORK Network update - supporting QIPP in 2011 -12 • PENINSULA HEART & STROKE NETWORK Network update - supporting QIPP in 2011 -12 • Innovation Simulation Modelling with Pen. CHORD/ Pen. CLAHRC to inform commissioning & change clinical practice – Thrombolysis – increasing access to alteplase – TIA – reviewing service models and delivery – Demand capacity planning along the whole pathway – Scenario modelling to predict the impact of change e. g. Early Supported Discharge (ESD)

PENINSULA HEART & STROKE NETWORK Network update - supporting QIPP in 2011/12 • Productivity PENINSULA HEART & STROKE NETWORK Network update - supporting QIPP in 2011/12 • Productivity – Standard service specifications (TIA, Acute, Community Rehabilitation and ESD) – Early Supported Discharge – support pilots and evaluation of various models with local Service Improvement Managers (SIMs) – Specialist ‘generic’ cardiac nurses supporting the implementation of Stroke Strategy Quality Marker 1 (raising awareness, manual pulse checks and risk stratification etc. ) – Working with SWAST to increase direct access to TIA clinics

PENINSULA HEART & STROKE NETWORK Network update - supporting QIPP in 2011/12 • Prevention PENINSULA HEART & STROKE NETWORK Network update - supporting QIPP in 2011/12 • Prevention – Atrial Fibrillation – Development and dissemination of GP information packages – Network Anticoagulation Guidance – Promoting the GRASP-AF tool (medicines management) and opportunistic pulse checking (local GP incentives) – Introducing pilot of INRstar software linkage from an acute trust to Primary Care

 • Quality ASSIST 2 Programme – 8 participating trusts: – Reducing 7 -day • Quality ASSIST 2 Programme – 8 participating trusts: – Reducing 7 -day inpatient mortality by 25% – Increasing the proportion of patients who receive all of the 9 Sentinel key indicators by 80% – A doubling in patients receiving Early Supported Discharge – 85% increase in the proportion of ischaemic stroke patients who receive thrombolysis

24/7 Stroke Thrombolysis rota • Collaboration between 9 acute trusts (one outside the network) 24/7 Stroke Thrombolysis rota • Collaboration between 9 acute trusts (one outside the network) – 14 clinicians. This year in AGWS, over 1000 patients assessed, 256 thrombolysed, 25% with support from the Network rota Innovation – Personal Health Budgets for Stroke • Pilot has recruited 115 stroke patients - 50% receiving personal health budgets, 50% controls. Some amazing recovery stories, enabling patients and families to regain control of their lives

 • Prevention ‘Strike at Stroke – Anticoagulate’ – the largest AF programme in • Prevention ‘Strike at Stroke – Anticoagulate’ – the largest AF programme in the country – 33, 565 AF patients (19, 457 High Risk) • Over 200 GP practices participated • 2. 6% increase in anticoagulation • Maximum increase achieved +16% • Highest practice level of prescribing – 79% on anticoagulation • 601 additional patients anticoagulated • 24 strokes potentially avoided

Dorset Stroke Network 2011 -12 • AF Strategy – – Continued enrolment of GP Dorset Stroke Network 2011 -12 • AF Strategy – – Continued enrolment of GP practices to GRASP-AF Review of anticoagulation pathways Continued public awareness campaigns for ‘Know Your Pulse’ AF-INCH (Atrial Fibrillation in Nursing and Care Homes) project underway • Patient and Public Involvement Model – Now covering CVD as a whole to support CVD Clinical Commissioning Programme: Stroke, Cardiac, Diabetes – vascular services coming online this year • Development of Hyperacute Service at Dorset County Hosp – Hyperacute stroke services launched at DCH in November 2011 • Delivery of 7/7 TIA Services at Dorset County Hospital – 7/7 TIA services launched in March 2012

Dorset Stroke Network 2011 -12 • Improving Psychological Support after Stroke – showing significant Dorset Stroke Network 2011 -12 • Improving Psychological Support after Stroke – showing significant improvements in psychological screening and support in – – the community, with better collaborative working within existing teams Now rolling out to be county wide Expanding project to psychological support for all long-term conditions • Early Supported Discharge Pilots – – Poole and Royal Bournemouth pilots completed and evaluated NHS Dorset pilot due to complete in June High levels of patient and carer satisfaction Excellent outcomes, significant bed day savings • Integrating the Network into CVD Clinical Commissioning Programme – Network supporting Commissioning through transition to CCGs – Work programme prioritised in line with regional and national objectives

Joining Forces 2012 some final comments The South West Stroke Research Network and The Joining Forces 2012 some final comments The South West Stroke Research Network and The South of England SHA and Heart & Stroke Networks Joint Annual Event




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