In 2007, the six month post-stroke review was laid out as a quality marker in the Department of Health’s National Stroke Strategy. The strategy said that people who have had a stroke should receive a review of their health and social care needs six weeks, six months and then annually after their stroke to ensure that they receive the most appropriate rehabilitation and support services.
The need for regular reviews for people following stroke continues to be a high priority within the health service, with the 2014/15 CCG Commissioning Indicator Set stating that all people who have had a stroke should receive a follow up assessment between 4-8 months after their initial admission.
People who have had a stroke should receive a review of their health and social care needs six weeks, six months and then annually
Six week post-stroke reviews are often routinely carried out by hospital-based stroke teams, with annual reviews being undertaken in primary care. However, the National Stroke Strategy offered little detail about:
- Who should carry out the six month review
- What such a review should consist of
- Who it should be led by
- In what setting it should be delivered.
The Greater Manchester Stroke Assessment Tool (GM-SAT), and the way it was developed, evaluated and implemented, aimed to address this very important knowledge gap.
The CLAHRC Greater Manchester team developed and evaluated GM-SAT as a structured assessment tool to identify the specific needs of individual patients and signpost them to relevant support. It encompasses a wide range of potential post-stroke care needs, from medication management and secondary prevention, through to mood and fatigue. Together with its supporting materials, it provides everything needed to undertake a six month review. Our team also developed an easy-access version of GM-SAT suitable for people who have aphasia after their stroke, in collaboration with stroke survivors from Speakeasy, a communication support charity based in Bury.
GM-SAT is tailored to help determine the specific post-stroke care needs for individual stroke survivors. Healthcare, social care and voluntary sector staff were involved in its development, along with stroke survivors and their carers. Designed to reflect local care options alongside national strategies, the tool can help to improve quality of life and outcomes for patients by identifying needs and enabling access to relevant support.
GM-SAT integrates the needs analyses set out in the Care Quality Commission’s Stroke Service Review and fulfils aspects of the NHS CCG Outcomes Indicator Set and the NHS National Stroke Strategy.
- Described by one stroke occupational therapist as “…the best choice to meet the requirements of national guidelines and commissioners of service”
- Flexible design of tool enables tailoring to local service and voluntary sector provision
- Deliberately designed to be used by a range of staff – including Stroke Association Information, Advice and Support Coordinators – enabling clinical staff to focus on clinical assessment
- Patients and their carers report feeling supported in the long-term by having access to more appropriate medical, social and emotional support
- Tool used extensively for post-stroke assessment by the Stroke Association, who have carried out more than 4000 assessments to date
- Integration of the tool into the IT system used by primary and community care providers in Yorkshire and Humber made care more consistent across the area
- Highlights needs of local patient population and areas for targeted professional or service development
- Now used across England.
GM-SAT has been used by the Stroke Association across England to carry out more than 4000 assessments to date
What happened next?
In addition to developing the assessment tool, we also worked with local health and social care organisations to identify how the tool could be used in practice. A number of pilot projects were undertaken to evaluate different delivery models for the review, from stroke specialist nurses reviewing patients in clinics, to Stroke Association coordinators visiting patients in their own homes. Following the success of the pilots, many services went on to implement six month reviews in routine practice.
Building on the success of this work, as the GM-SAT tool was originally developed with community-dwelling stroke survivors in mind, CLAHRC GM are now working to adapt the GM-SAT for use in care homes and evaluate its use, ensuring that all stroke survivors, regardless of their place of residence, have equal and appropriate access to high quality post-stroke reviews.