Stroke and DysphagiaFinancial bid

Stroke

Stroke is a clinical event that results in cerebral damage, affecting brain function

There are 2 types of stroke: Ischaemic Haemorrahagic

Stroke is the third leading cause of death and disability

At 75 years of age, 1 in 5 women and 1 in 6 men will have a stroke

What is stroke?

Approximately 1/3 of stroke survivors have communication difficulties, including: Aphasia Dysarthria Apraxia

Other consequences can include: Dysphagia Physical disability Changes in mood and personality

Consequences of stroke

Overall aim: reduce incidence of stroke and provide those who have had a stroke with prompt access to integrated stroke care services.

Four main components: 1) Prevention 2) Immediate care3) Early and continuing rehabilitation4) Long-term support

National Service Framework for Stroke

National Service Framework - for Older People (2002) pp. 70

SLTs are the only professionals qualified to diagnose, assess and provide a programme of care to address these communication and swallowing needs.

SLTs play a vital role at all stages along the care pathway. SLTs are the core members of the team in the immediate care, and long-term rehabilitation of stroke survivors.

SLTs have a role in training other clinical staff to develop their skills needed to understand the communication needs of stroke survivors.

Dysphagia management Communication disability management Transfer of care to the community Rehabilitation within the community Completion of therapy and review

SLT role within the care pathway

This was devised by six expert groups comprised of representatives from the wide range of professionals who support people with stroke, people who have had a stroke, carers and voluntary associations.

It’s intended to ‘provide a quality framework to secure improvements to stroke services , to provide guidance and support to commissioners and strategic health authorities and social care, and inform the expectations of patients and their families by providing a guide to high quality health/social care services.

National Stroke Strategy (2007) : Department of Health

1. Awareness2. Preventing Stroke3. Involvement4. Acting on the warnings5. Stroke as a medical emergency6. Stroke unit quality7. Rehabilitation and community support8. Participation9. Workforce10.Service Improvement

Stroke Strategy Action Plan

Voluntary sector

The Stroke Association services can: Reduce hospital readmissions Shorten hospital stays Facilitate better integration of

care Save other statutory

expenditure Meet current government

imperitives Meet the requirements of the

national stroke strategies across the UK

Voluntary Sector

Connect works with individuals with aphasia and their families

They aim to develop communication and rebuild confidence

Access to Life services

A clinical commissioner's guide to the voluntary sector (Girach, Hardisty & Massey, 2012)

Clinical Commissioners Groups that engage with the voluntary sector can lead to: Better outcomes for peopleMore cost effective use of NHS resources,

generating value for moneyWidening of the local provider base

Voluntary Sector

The stroke pathway has developed significantly since 2010 In 2013, it was awarded with a Level 1 accreditation Introduced regional network to allow specialist stroke

consultants to connect Thrombolysis available to suitable stroke patients 24 hours

a day Top performer in accural targets out of 21 stroke sites Consistently maintain targets for inpatient stay Identified areas to target to streamline stroke pathway and

reduce length of stay Aim for 2015 to implement improvements, allowing bed

reductions by improving patient discharge into community and social care services as agreed and supported by the Right First Time Programme

NHS Annual Report

Dysphagia

Dysphagia is the medical term describing difficulty in swallowing.

Dysphagia can vary significantly in its severity and can affect individuals of all ages.

It may occur as a congenital or acquired condition.

Dysphagia can be a transient, persistent or deteriorating symptom according to the underlying pathology.

What is dysphagia?

Incidence/Prevalence of Dysphagia

The national framework for dysphagia suggests:- Treatment and care must include Vigilant observation and early management of possible

complications, such as chest infections, pneumonia A formal swallowing assessment and a plan for safe

hydration, feeding and medication. Early and continuing rehabilitation including SLT for

swallowing difficulties Specialist dysphagia services should provide training

and advise to all professions and service providers for swallowing and nutritional needs

Dysphagia Framework

SLT role within the care pathway

Acute Setting - SLT has key role in management of eating, drinking

and swallowing in hours and days after stroke. SLT intervention reduces occurrence of respiratory

infection and malnutrition whilst improving quality of life and functional outcomes e.g. returning to work.

Transfer to Community – Swallowing difficulties persist in 11% of patients 6

months post-stroke. Pneumonia, pressure sores can be reduced with

appropriate SLT intervention

SLT role within the care pathway

Rehab within community – SLT has role in continued management of patients with

persisting dyspagia Able to prevent further health conditions, unnecessary

readmission to hospital and reduce mortality rates.

Recommendations – At least 1 SLT per 10 beds in every stroke unit (RCSLT,

2007) Staffing should be flexible and must address

demographics of area accounting for physical geography Flexible working hours incl. weekends can reduce referral

to treatment period (Sheffield Primary Care Trust)

Key points from RCSLT resource manual for commissioning and planning services for SLCN (RCSLT, 2009)

There is evidence that: Appropriate identification and management of

dysphagia by SLTs reduces morbidity, mortality and improves quality of life.

Interventions used by SLTs in treatment of dysphagia are effective.

Appropriate management of dysphagia can reduce complications and length of hospital stays.

What research is telling us

Risk In 67% stroke patients, pneumonia manifests within

48hrs (Hassan et al, 2006) Impact

Difficulty swallowing caused anxiety at meal times. (Costa Bandeira et al, 2008)

Elderly patients with dysphagia had significantly more frequent chest pain, heart burn & regurgitation. (Tibbling & Gustafsson, 1991).

Cost Length of stay in hospital longer for stroke patients

with dysphagia; patients with dysphagia twice as likely to be discharged to nursing home. (Odderson et al, 1995).

What research is telling us

Supporting timely and effective intervention:

Hospital comparison study (Lucas & Rogers, 1998) Found hospital with SLT dysphagia service for inpatients

provided much higher standard of dysphagia treatment than hospital with no SLT service.

Bedside assessment review (Ramsey, Smithard & Kalra, 2003) Conclusion – more refinement of assessments needed to

improve accuracy Early swallow screen (Odderson, Keaton & McKenna, 1995)

Completed within one day of admission, 39% patients failed and needed dietary intervention.

What research is telling us

The SLT plays a vital role in the treatment of stroke and dysphagia, including assessment, management, intervention and training staff.

The research supports the importance of early dysphagia intervention, with effective and early initial swallow screening reducing risk of aspiration pneumonia and consequently the length and cost of hospital stays.

It is more cost effective to invest in quality care at the beginning of the pathway in order to obtain an early diagnosis and provide effective treatment, both reducing costs and improving patients’ quality of life.

Conclusion

Thank you