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Theme: Evidence for Policy and Practice
Around 940 people in Cornwall have a stroke each year. Immediate treatment is provided at acute hospitals in Truro (Royal Cornwall Hospital), Plymouth (Derriford Hospital) or Barnstaple (North Devon District Hospital). Following this initial treatment, around 40% of patients will require follow-on care in a Rehabilitation Stroke Unit (RSU). These units are based in the community hospitals located in Camborne, Bodmin and Mount Gould (Plymouth).
The current system allows patients to choose which RSU they would like to attend. However, it has been found that patients who choose to attend Bodmin are often unable to access a free bed. These patients are either sent to an alternative RSU, resulting in increased travel times for both patients and their families, or wait in the acute hospital, which can lead to delays in transferring new patients from A&E to a dedicated stroke ward.
PenCHORD worked with The Royal Cornwall Hospitals NHS Trust to explore the current Cornwall acute and rehab stroke treatment system, and to determine whether ring-fencing beds in acute hospitals and RSUs would allow those requiring treatment to have a rehab bed in the location of their choice.
The aims of the project were to:
Using a simulation model (SIMUL8), the team modelled the flow of patients through the Cornwall stroke bed system.
Three versions of the model were created to capture different treatment pathway options:
In addition to these three model versions, there are two further variations; beds in the RSU Mount Gould (i) may, or (ii) may not be available for Cornish patients; and changes to the order patients move through the RSUs, e.g. (iii) patients depart the RSU (and so free up beds) before new RSU patients arrive on the same day (this allows patients to arrive and take a bed that was occupied by a patient who left on the same day), or (iv) patients arrive at the RSU on the same day before patients from the RSU depart (this means that a bed occupied by a patient departing on a given day is only available for a new patient on the following day).
Based on a patient’s home location, acute care demand for each acute unit was compared to the actual emergency stroke admissions (940 per year):
The closest RSU to a patient’s home location was also compared to the actual transfer admissions (376 per year):
Using a model where all patients must wait to go to their closest hospital (either Camborne or Bodmin), with beds capped at current designated levels, the team identified the following delays in the system:
The team concluded that:
Initial results from the project have been shared with stakeholders via the local Stroke Partnership Board. The results and implications of the work will be reviewed from a commissioning perspective, and will be further shared with Plymouth colleagues, so that learning can be disseminated across the areas studied.