Stroke Clinical Variation Statewide Strategy (SCVSS) & Stroke Clinical Audit Process (SCAP) V2

Aim

The SCVSS will ensure the delivery of best quality care through a process which regularly assesses clinical variation , determining and  correcting its causes through a quality improvement process on a site by site basis.

The SCAP V2 will provide data analysis and support to LHDs to improve service delivery through the development of quality improvement action plans and forums for shared improvement strategies and learning across NSW.

Benefits

Reduction in mortality and functional outcomes for stroke (ischaemic and haemorrhagic) patients admitted to NSW public hospitals.

Summary

Bureau of Health Information (BHI) data on 30 day mortality after ischaemic and haemorrhagic stroke was published in Health in Focus 2012.

The overall NSW outcomes compared well with most OECD countries. However the main BHI analysis identified significant clinical outcome variation, measured against a statewide-wide arithmetic average of adjusted 30 day mortality

The ACI Unwarranted Clinical Variation (UCV) Taskforce hosted a workshop engaging with LHD clinicians and managers to examine the 30 day mortality data.

The consensus from the workshop was to develop a Stroke Expert Reference Group (SERG).

The SERG role was to undertake audit at six sites utilising a revised NSW Stroke Clinical Audit tool. The audit data was analysed by the Florey Institute-Monash University Victoria.

The six sites were revisited by the SERG, analysed data presented and discussion undertaken in consultation with the clinicians and managers to develop strategies and processes which will address UCV and patient outcomes

The SCVSS will now be supported by the SCAP V2.

SCAP V2 is a clinical audit process that will be implemented across 30 facilities that provide care to people with stroke to identify gaps in services which contribute to UCV.

Background

The ACI Stroke network has been participating in clinical audit of the services (see following publications) that comprise the network since 2003.This extensive experience that has been managed through the network coordinating committee and facilitated by the network manager and now delivers the clinical audit platform for the SCVSS/SCAP V2 program

References/publications

NSW Health Department (2001) Report of the Greater Metropolitan Services implementation group. NSW Government June. ISBN 073473296

National Heart Stroke and Vascular Health Strategies Group. National strategy for heart, stroke and vascular health in Australia. Canberra: Australian Government Department of Health and Ageing, 2004:31.

Cadilhac, D., Pearce, D., and Donnan, DA. Evaluation of the New South Wales Greater Metropolitan Transition Taskforce Stroke Unit Initiative 2003/2004: Final report.2004, National Stroke Research Institute; Melbourne, pages 88.

Gill M, Cadilhac DA, Pollack M, Levi CR. Evaluation of the NSW Rural stroke services 2006 - Phase 1 of the NSW Rural Stroke Program. Hunter New England Area Health Service: NSW Institute of Rural Clinical Services and Teaching and NSW Health, 2007:92.

Cadilhac DA, Pearce DC, Levi CR, Donnan GA and on behalf of the greater Metropolitan Clinical Taskforce and New South Wales Stroke Services Coordinating Committee Qual.Saf.Health Care 2008; 17;329-333 doi:10.1136/qshc.2007.024604.

Cadilhac DA, Moss K, Kilkenny M, Paice K, Purvis, T. Evaluation of rural New South Wales stroke services: New South Wales Rural Stroke Project 15 May 2010.

Cadilhac DA, Kilkenny MF, Longworth M, Pollack M, Levi CR; on behalf of Greater Metropolitan Clinical Taskforce and Stroke Services New South Wales Coordinating Committee. Metropolitan-rural divide for stroke outcomes: do stroke units make a difference? Internal Medicine Journal June 2010 7 doi;10.1111/j.1445-5994.2010.02280.

Cadilhac DA, Purvis T, Kilkenny MF, Longworth M, Mohr K, Pollack M, Levi CR; New South Wales Strokes Service Coordinating Committee; Agency for Clinical Innovation. Evaluation of rural stroke services: does implementation of coordinators and pathways improve care in rural hospitals? STROKE PMID: 23950561

Partnerships

Details of who we have worked with to deliver the initiative to the health system:

Key Dates

Pilot Sites

Illawarra Shoalhaven Local Health DistrictShellharbour Hospital

SCVSS/Audit & Feedback Site
Audit: September 2014
Feedback: December 2014


Wollongong Hospital

SCVSS/Audit & Feedback Site
Audit: April 2015


Shoalhaven Hospital

SCVSS/Audit & Feedback Site
Audit: May 2015


Milton Ulladulla Hospital

SCVSS/Audit & Feedback Site
Audit: May 2015


Mid North Coast Local Health DistrictPort Macquarie Base Hospital

SCVSS/Audit & Feedback Site
Audit: November 2014
Feedback: May 2015


Coffs Harbour Base Hospital

SCVSS/SCAP V2 Pilot Site
Audit: July 2014
Feedback session: November 2014


Murrumbidgee Local Health DistrictWagga Wagga Base Hospital

SCVSS/SCAP V2 Pilot Site
Audit: July 2013
Feedback session: August 2013


Wagga Wagga Base Hospital

SCVSS/Audit & Feedback Site
Audit: September 2014
Feedback: November 2014


Griffith Base Hospital

SCVSS/Audit & Feedback Site
Audit: December 2014
Feedback: May 2015


Nepean Blue Mountains Local Health DistrictNepean Hospital

SCVSS/Audit & Feedback Site
Audit: May 2015


Northern NSW Local Health DistrictLismore Base Hospital

SCVSS/SCAP V2 Pilot Site
Audit: July 2013
Feedback session: August 2013


Grafton Base Hospital

SCVSS/Audit & Feedback Site
Audit: September 2014
Feedback: February 2014


Northern Sydney Local Health DistrictManly Hospital

SCVSS/SCAP V2 Pilot Site
Audit: July 2013
Feedback session: August 2013


Manly Hospital

SCVSS/Audit & Feedback Site
Audit: March 2015
Feedback: July 2015


South Eastern Sydney Local Health DistrictSt George Hospital

SCVSS/Audit & Feedback Site
Audit: April 2015
Feedback: July 2015


South Western Sydney Local Health DistrictBankstown Lidcombe Hospital

SCVSS/Audit & Feedback Site
Audit: March 2015


Fairfield Hospital

SCVSS/Audit & Feedback Site
Audit: August 2015


Bowral Hospital

SCVSS/Audit & Feedback Site
Audit: August 2015


Liverpool Hospital

SCVSS/Audit & Feedback Site
Audit: August 2015


Campbelltown Hospital

SCVSS/SCAP V2 Pilot Site
Audit: June 2015


Southern NSW Local Health DistrictBateman's Bay District Hospital

SCVSS/SCAP V2 Pilot Site
Audit: July 2013
Feedback session: August 2013


Cooma Hospital and Health Service

SCVSS/Audit & Feedback Site
Audit: May 2014
Feedback: March 2015


St Vincent's Health NetworkSt Vincent's Hospital

SCVSS/SCAP V2 Pilot Site
Audit: July 2013
Feedback session: August 2013


Sydney Local Health DistrictRoyal Prince Alfred Hospital

SCVSS/SCAP V2 Pilot Site
Audit: July 2013
Feedback session: August 2013


Western NSW Local Health DistrictCowra District Hospital

SCVSS/Audit & Feedback Site
Audit: July 2014
Feedback: March 2015


Dubbo Base Hospital

SCVSS/Audit & Feedback Site
Audit: July 2014
Feedback: March 2015


Orange Health Service

SCVSS/Audit & Feedback Site
Audit: November 2014
Feedback: March 2014


Bathurst Base Hospital

SCVSS/Audit & Feedback Site
Audit: November 2014
Feedback: March 2014


Implementation Sites

Evaluation

The evaluation of the SCVSS/SCAP V2 will be undertaken in consultation with the ACI Health Economics and Evaluation Team and The Florey Institute Monash University

Related Initiatives

Further Details

Contact

Mark Longworth
Network Manager - Stroke
mark.longworth@health.nsw.gov.au
02 9464 4614

Daniel Comerford
Director, Acute Care
daniel.comerford@health.nsw.gov.au
02 9464 4602

Page Top | Added: 30 June 2015 | Last modified: 14 July 2015

ACI
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Contact:
Mark Longworth
Network Manager - Stroke
Email
02 9464 4614
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