Scottish Ambulance Service SGHD Better Heart Disease & Stroke Care Action Plan SAS Action Plan Introduction Health Improvement Paragraph 3.7 3.39 SGHD Action a range of actions around promoting healthy life styles and reducing health inequalities Pertinent to SAS is.. NHS Boards through their cardiac and stroke s should ensure appropriate Promoting Healthy lifestyles referral to services SAS Action To ensure effective links with NHS Boards Cardiac and Stroke s via the appropriate SAS management / clinical representative. 1) Identified SAS Leads details have been confirmed to local HB Stroke Lead & Clinical Lead. 2) SAS participation is sporadic for local HB Cardiac s 3) Healthy lifestyle promotion for SAS staff could be developed 4) Participation in 3.39 reducing health inequalities BP / ECG recording could be developed Confirm Divisional links with local Stoke stroke & palliative care services/plans Confirm Divisional links with local Cardiac cardiac care services/plans Internal lifestyle promotion through staff education, weekly bulletins, SAMSON External public lifestyle promotion i.e. Stroke awareness through SAS website / health promotion roadshows etc BP/ECG recording for Scottish Government as per 3.39 to reduce health inequalities. SAS reporting process to reflect: 1. Public awareness 2. Staff training 3. Pathway development 4. Cardiac service mapping 5. Resilience & capacity of service Staff feedback / SAMSON. Absence rates Public satisfaction / focus groups etc Measure participation in model and audit numbers/efficacy of mini health checks A MacLean Head of Communications/ SRT SAS Action Plan in response to SGHD Better Heart Disease and Stroke Care Action Plan Page 1 of 7
Heart Disease Paragraph 4.17 SGHD Action The Scottish Ambulance Service should review current arrangements for delivery of prehospital thrombolysis across Scotland, particularly in rural areas, including assessment of staff training Improving delivery of prehospital thrombolysis needs, and submit a report to the National Advisory Committee on Heart Disease. SAS Action As above 1)SAS delivers pre-hospital thrombolysis across Scotland 2) SAS assesses the generic training & development needs for all operational staff Confirm Regional Optimal Reperfusion models of care (esp North of Scotland) Review infrastructure and delivery of PHT by NHS Health Board area Complete assessment of training needs for the delivery of PHT (particularly rural areas) Produce Optimal reperfusion map for NHS Scotland Identify current arrangements for PHT delivery by HB area Complete assessment of training needs for the delivery of PHT (particularly rural areas) March 2010 A MacLean HR (Training & Development ) Paragraph 4.19 Improving delivery of ORT SGHD Action The inter-regional cardiac group will re-convene to ensure consistency of approach across Scotland, for example in relation to Optimal Reperfusion Therapy SAS Action To ensure SAS participation and effective links with Regional Planning Current Status Development Issue Measures Timescale Owner(s) Inter-regional cardiac group is not formally convened Reconvene group with SAS participation Group membership to inform SAS development No target date National Service Redesign Manager / Paragraph 4.24 SGHD Action NHS Boards should seek advice from their cardiac s in considering the introduction Developing approaches to of both static and non-static approaches to public access defibrillation (PAD)in particular whether there public access defibrillation are suitable locations in their area in which the static approach might be beneficial. SAS Action To ensure SAS participation and effective links with Cardiac s. To provide expert advice and provide a lead for non-static PAD. SAS expert in non static PAD through 1 st Responder models and Community Resus. infrastructure Confirm Divisional links with local Cardiac Collaborate with Health Boards on the introduction of PADs Establish PAD map and roll out programme March 2010 1 st Responder lead Community Resuscitation lead SRT SAS Action Plan in response to SGHD Better Heart Disease and Stroke Care Action Plan Page 2 of 7
Paragraph 4.52 Improving palliative care SGHD Action NHS Boards cardiac and palliative care s should jointly undertaken audit of practices implementation of the palliative care Directed Enhanced Service, and collaborate to ensure implementation of Boards Living and Dying Well Delivery Plans SAS Action To ensure SAS participation and effective links with Cardiac s. To provide expert advice and provide a lead for non-static PAD. 1)SAS has generic Living and Dying Well Action Plan 2) SAS participation is sporadic for local HB Cardiac s Confirm Divisional links with local Cardiac Ensure Divisional awareness of SAS Living Well, Dying Well action plan cardiac & palliative care services/plans National & Divisional engagement & progress Amend SAS Living Well & Dying Well action plan as required. End December 2009 Stroke Paragraph 5.1 / 5.61 Improving Stroke Services SGHD Action - NHS Boards, through their stroke s, should ensure that their stroke services are comprehensive and include each of the essential elements identified in this chapter. SAS Action To ensure effective links with NHS Boards Stroke s via the appropriate SAS management representative. 1) SAS Divisional Lead(s) for Stroke Services have been/are being identified. 2) Identified SAS Leads details have been confirmed to local HB Stroke Lead & Clinical Lead Confirm Divisional links with local Stroke Ensure Divisional awareness of SAS Stroke Strategy stroke services/plans National & Divisional engagement & progress Stroke to provide training opportunities e.g. STARS SAS reporting process to reflect: Public awareness Staff training Pathway development Stroke service mapping Resilience & capacity of service SRT SAS Action Plan in response to SGHD Better Heart Disease and Stroke Care Action Plan Page 3 of 7
Paragraph 5.4 Raise public awareness of stroke SGHD Action - NHS Boards, through their stroke Managed Clinical Networks, should continue to support the ongoing (FAST) public awareness campaigns. SAS Action To ensure appropriate links with NHS Boards Stroke s to provide input and support on this issue 1) Divisional Lead(s) for Stroke Services have been/are being identified. 2) Involvement on this topic has already begun e.g. SAS part of the GG&C Awareness Group. Confirm Divisional links with local stroke Ensure Divisional engagement with public awareness campaigns National & Divisional engagement & progress SAS to monitor that element of individual 999 calls which will reflect the publics understanding of stroke and use of FAST e.g. presentation by caller v s assessment of SAS crew. March 2010 Paragraph 5.5 Raising awareness of stroke SGHD Action - NHS 24 staff, primary care staff, ambulance crews and A&E department staff should all receive appropriate stroke awareness training, including FAST. SAS Action To establish stroke as a likely diagnosis by the application of the Face, Arms, Speech Test (FAST) as the consistent screening method. 1) FAST is recognised, but not consistently applied, by SAS crew staff as the screening method for potential stroke patients. 2) s recognise, but have not developed, the need for FAST to be used as a first stage screening tool. 3) SAS Director requires to establish the benefits (or not) of the ROSIER screening method, as piloted in Stornoway, and its possible wider use. SAS to develop a consistent training programme for the use of FAST (incl. EMDC) SAS to agree content of training programme with NHS partners. SAS to develop a range of training methodologies to deliver the FAST programme to staff Divisions to ensure local s are appraised of plans & progress ref implementation of FAST ROSIER pilot (Stornoway) to be evaluated and way forward established. All patients who present to the SAS via 999 or NHS24 must be screened by the FAST method. The SAS should establish a KPI for the application of FAST reflecting an expected accuracy of diagnosis for patients presenting with suspected stroke e.g. 75% of patients assessed by SAS have confirmed diagnosis of stroke. SRT SAS Action Plan in response to SGHD Better Heart Disease and Stroke Care Action Plan Page 4 of 7 Oct 09 Training Dept.
Paragraph 5.17 Improving thrombolysis services SGHD Action - NHS Boards, with advice from their stroke s, should consider appropriate models to facilitate access to thrombolysis for stroke patients, particularly in areas with limited medical cover. SAS Action To identify the availability of thrombolysis services across Scotland and, in collaboration, develop appropriate pathways which reduce avoidable delays to the most appropriate centre. 1) SAS is broadly represented at National & local levels in relation to planning and implementing this service. Divisional engagement has been sporadic but is improving. Consistent attendance and representation is being encouraged & monitored. Paragraph 5.20 SGHD Action - The Regional Planning Groups, in conjunction with the local stroke s, the Scottish Ambulance Service and the Scottish Centre for Telehealth, should consider how to deliver optimal Improving Stroke Care hyper-acute stroke care, including thrombolysis. SAS Action To understand the regional level model in terms of telehealth networks which support territorial Health Board services. 1) SAS is engaged at National level to develop an understanding of the emerging tele-support networks. 2) SAS has begun engaging with Regional level groups to understand and contribute to the detail being discussed ref tele-support for local service models. All SAS Divisions to ensure engagement with local Stroke. SAS Divisions to develop pathways relative to: i) the current service model ii) the interim service model iii) the final service model Patient pathway development requires to consider transport issues for at risk communities National & Divisional engagement & progress SAS to ensure appropriate representation on Regional Planning Groups for Stroke Services. National, Regional & Divisional engagement & progress SAS to establish time of onset of symptoms as a key component of the assessment process for potential stroke patients. The SAS should develop a KPI which reflects it s support and contribution to the proposed door to needle standard of 80% of patients treated within 1 hour. Develop a map of service models and tele-links for Scotland National Service Redesign Manager A. Wemyss Paragraph 5.29 Improving access to imaging SGHD Action - The newly-established Scottish Imaging Managed Diagnostic Network, in conjunction with the SAS and NHS 24, should as a matter of urgency be asked to address whether duplex ultrasound, CT and MRI services can be delivered on a 24-hour basis in all hospitals admitting those who have had a stroke, and the additional neuroradiology capacity required. SRT SAS Action Plan in response to SGHD Better Heart Disease and Stroke Care Action Plan Page 5 of 7
SAS Action To support the development of a more robust model of neurological imaging which will reduce the need for inter-facility transfers for stroke patients (and other neuro associated conditions/injuries) 1) No progress has been made under this topic. Paragraph 5.52 SGHD Action - NHS Boards stroke and palliative care s should collaborate to implement the objectives in NHS Boards Plans, and ensure that the best practice statement on palliative care is Improving palliative care implemented SAS Action To comply with patients palliative care plans in relation to those who suffer stroke. 1. Identified SAS Leads details have been confirmed to local HB Stroke Lead & Clinical Lead. 2. There is no involvement on this topic currently A group requires to be formed to inform & agree with partners ref: I. Current position II. The challenges III. The deliverable(s) IV. The timescale Confirm Divisional links with local Stoke Ensure Divisional awareness of SAS Living Well, Dying Well action plan Collaborate on the development of local stroke & palliative care services/plans Develop a reporting process to capture National & Divisional engagement & progress The reduction of IHT s for potential stroke (& other) patients for the purpose of accessing imaging equipment. Amend SAS Living Well & Dying Well action plan as required. HoS Air Wing SRT SAS Action Plan in response to SGHD Better Heart Disease and Stroke Care Action Plan Page 6 of 7
Data to Support Patient Care Paragraphs 7.7 SGHD Action - NHS QIS, ISD and other relevant bodies such as SAS, are required to establish mechanisms for reporting and publishing data relating to patient care for cardiac conditions Improving HD data collection SAS Action To establish mechanisms for reporting and publishing data for cardiac conditions 1) Report on return of Establish more robust PHT, Measure application of May 2010 Performance Manager spontaneous as part of 4.17 above PHT where appropriate circulation in cardiac?? Response times to?? response to cardiac arrests 2) Pre hospital Thrombolytic therapy (PHT) recorded Cardiac emergencies emergencies Paragraphs 7.10 Improving HD data collection SGHD Action The Scottish Government will establish an ecardiology Strategic Group to develop an action plan for consideration by the ehealth Programme Board SAS Action To participate in Strategic Group 1) Not yet established Ensure participation SAS input into action plan End 2009 ICT General Manager Paragraphs 7.13 Improving HD data collection SGHD Action The ecardiology Strategic Group should look at extending information gathering on cardiology patients to primary care SAS Action To establish mechanisms for capturing, recording and reporting data for cardiac conditions in the primary care environment 1) Electronic reporting established in cab based terminals Establish electronic patient record at the point of contact Capture all pertinent information May 2010 Performance Manager ICT General Manager Paragraphs 7.16 Improving HD data collection SGHD Action The Scottish Ambulance Service, working with other national bodies, should continue to explore mechanisms to link their databases with SCI-CHD, to improve national data collection on the delivery of optimal reperfusion services SAS Action As SGHD action 1) Established SCI gateway demonstration model with Ayrshire & Arran Develop, implement and monitor model in operation Identify effectiveness of model and consider the roll out throughout NHS Scotland None as yet ICT General Manager SRT SAS Action Plan in response to SGHD Better Heart Disease and Stroke Care Action Plan Page 7 of 7