The National Stroke Audit Rehabilitation Services 2018 comprises

The National Stroke Audit Rehabilitation Services (2018) comprises two elements. . Organisational Survey of stroke rehabilitation services across Australia. Retrospective Clinical Audit of inpatient stroke rehabilitation case notes. • Examining the resources, processes and infrastructure in place to support best practice stroke care • Examines processes of care as outlined and recommended in the Clinical Guidelines • Enables reporting against each required element outlined in the Stroke Rehabilitation Services Framework (2013) • Hospitals reviewed case notes for up to 40 consecutive episodes admitted and discharged between 1 January and 31 December 2017

Maximising use of your hospital’s National Stroke Audit 2018 results. . • Share with other team members and present a clear picture of both the process of care and organisational issues that impact on stroke service delivery at your service. • Benchmark the quality of stroke care in your hospital against other hospitals that manage similar numbers of stroke admissions. • Identify potential strengths and weaknesses in the management of stroke and highlight focus areas for ongoing quality improvement activities.

Populating your hospital’s slide-deck template. . • Your slide-deck should be used to share and present your site’s National Stroke Audit data to the rest of your team and any interested stakeholders. • The template is intended to be interactive, please add or remove slides to suit your hospital’s individual requirements. • To populate, refer to your hospital’s site report (or summary) and the National Stroke Audit - Rehabilitation Services 2018 Report.

Using Inform. Me. . Bringing together a range of resources to support health professionals in delivering the best quality stroke care, this online tool allows hospital staff to easily access. . • Interactive graphs plotting your site’s National Stroke Audit data against national, state and peer hospitals (similar sized service) averages. • National and site-specific reports from current and previous National Stroke Audit cycles. • Support in creating your quality improvement plans in response to your local National Stroke Audit data, plus the opportunity to view plans that other hospitals have submitted. Register now: informme. org. au/sign-up

Where to find your Organisational Survey data. . Step 1. Download your site report: informme. org. au/stroke-data Step 2. Select Tab E along the bottom of your screen Your site’s results are in column B Find aggregated data for service’s of a similar size to yours in column E

Where to find your Clinical Audit data. . Step 1. Download your site report: informme. org. au/stroke-data Step 2. Select Tab B along the bottom of your screen Your site’s results are in column B Find aggregated data for service’s of a similar size to yours in column H

National Stroke Audit Rehabilitation Services 2018 Organisational Survey Assessing the resources required to deliver evidence-based stroke care.

Adherence to the Framework Median number of elements met Plot your hospital’s results below by positioning the dotted line along the X-axis. Then insert your states data by right clicking once on the bar graph, click on edit data & click on edit data in excel to enter your states median number. . 8 Australia (N=120) 7 Your State (N=0) >80 stroke admissions per annum (N=39) 8 30 -79 stroke admissions per annum (N=62) 6 <30 stroke admissions per annum (N=19) 6 0 1 2 3 4 5 6 7 8 9 10

Organisational Survey Framework Element of service Australia n (%) Effective links with acute stroke service providers 85 (71%) Specialised interdisciplinary stroke (or neuro-rehabilitation) team with access to staff education and professional development specific to stroke 78 (65%) Co-located stroke beds within a geographically defined unit 13 (11%) My site Yes/No Similar sized service n (%)

Organisational Survey Framework Element of service Australia n (%) Standardised and early assessment for neurorehabilitation 75 (63%) Written rehabilitation goal setting processes with patients 93 (78%) Routine use of evidence-based guidelines to inform evidencebased therapy for clinicians Best practice and evidence-based intensity of therapy for goal related activity with patients 79 (66%) 82 (68%) My site Yes/No Similar sized service n (%)

Organisational Survey Framework Element of service Australia n (%) Systems for transfer of care, follow -up and re-entry for patients 46 (38%) Support for the person with stroke and carer to maximise community participation and long-term recovery Systems that support quality improvement, i. e. regular review of local audit data by the stroke team to prioritise and drive stroke care improvement 78 (65%) 101 (84%) My site Yes/No Similar sized service n (%)

National Stroke Audit Rehabilitation Services 2018 Clinical Audit Measuring delivery of care as outlined in the Clinical Guidelines for Stroke Management (2010)

Clinical Audit Patient centred care Australia n (%) Goals set with input from team and patient 3, 208 (94%) Patient's mood assessed during admission 2, 057 (56%) My site n (%) Similar sized service n (%)

Clinical Audit Discharge planning Australia n (%) Patient and/or family received information covering stroke, hospital management, secondary prevention and recovery (e. g. My Stroke Journey booklet) 2, 254 (62%) Carer received relevant training 731 (74%) Evidence that care plan was developed with the team and patient (or family alone if patient has severe or cognitive impairments) 2, 666 (80%) My site n (%) Similar sized service n (%)

Clinical Audit Secondary prevention Australia n (%) Patient received education about behaviour change for modifiable risk factors prior to discharge 2, 178 (60%) Patient prescribed antihypertensive 2, 775 (79%) medication on discharge My site n (%) Similar sized service n (%)

Recommendations from the National Stroke Audit Rehabilitation Services 2018 1. Improve integration between acute and rehabilitation services, especially in high volume services, to ensure a streamlined flow of care based on assessment of rehabilitation needs. 2. Ensure all staff within rehabilitation services receive ongoing, stroke-specific education and training. Staff should be encouraged to routinely use the Clinical Guidelines for Stroke Management to guide practice. 3. Greater emphasis on supporting carers of people affected by stroke. This especially involves an assessment of the needs of carers/family members and appropriate training. 4. Ensure the patient receives the recommended amount of practice to maximise recovery during inpatient rehabilitation. 5. Further focus to ensure the psychological needs of all patients are assessed and appropriate support is provided during and after inpatient rehabilitation. 6. Improve provision of information and education to patients and their family/carers. This includes lifestyle advice for secondary prevention, general information about stroke and recovery, information on returning to work (for those of working age), and especially sexuality after stroke. 7. Improve the management of incontinence.

National Stroke Audit 2018 Local implications and discussion points

National Stroke Audit 2016 Where to find out more Download the report at: informme. org. au/stroke-data