Hampshire Hospitals NHS Foundation Trust

Clinical challenge
To develop, maintain and continuously improve a specialist ESD service for Hampshire Hospitals.

Solution
Organisational Changes

• Improved integration within the stroke pathway and joint working with other clinical teams along the pathway. The ESD office is based on the stroke unit, making it easy for staff from the ward to discuss patients and share advice. The ESD staff rotate onto the stroke unit allowing greater flexibility in staffing and improved crossteam communication.
• Established a team lead role responsible for coordinating the day to day management and leadership of the ESD service; managing the finances and funding; supporting team members; managing staffing and scheduling

Cultural Changes

• Embedded a clinical psychology service within the ESD team
• Facilitated a trusting and compassionate team culture
• A wide age range of team members brought different life experiences into the roles.
• Included ESD in the stroke strategy forum.
• Ensured team was highly trained with the ability to remain calm in a crisis.

Patient Centred Approach

• Adapted a holistic and individual approach to all patients. From assessment through to discharge the patient’s needs and wishes are always at the centre of our treatment, especially when setting goals and looking at carer strain and acceptance of diagnosis.
• Learned from feedback from patients and carers and by reflecting on case study reviews.

Impact
Since 2012 we have successfully grown the service and it now provides a comprehensive service to 230 patients each year, 40% of Hampshire Hospitals Trust patient cohort.

Patient quotes
“Without their amazing help and support Mr P would never have made his progress and we cannot thank them enough. We feel very privileged to have been offered this opportunity from such dedicated staff.” -Carer

“The ESD team are amazing! They have brought me to a much better condition compared to when I was discharged. If I was not under the ESD team I would not have such improved mobility. When I was discharged from hospital I could barely walk unaided and relied totally on a wheelchair. The team took me back to basics and taught me how to walk with the use of just a cane. My balance is stronger and my confidence has grown so much. If it was not for the team I would not be this more mobile and confident person that I am today. Thank you ESD team you are brilliant."  -Stroke patient at Hampshire ESD team.

Next steps
There are many exciting developments on the horizon including operating over longer hours and over a 7 day period (rather than 6 at present). The team is looking into offering integrated care as part of the ESD time frame (currently provided by CRT/social services). Other wider strategic ideas are being looked into including taking on more complex stroke patients (rather than the traditional mild to moderate group) and for longer periods of time (currently 6 weeks). The future remains challenging but exciting!