Stroke assessment tool has a national impact
The Greater Manchester Stroke Assessment Tool (GM-SAT) is used across England, and by the Stroke Association, to identify the long-term needs of stroke patients.
The NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester team created a tailored assessment tool to help determine the specific care needs for individual stroke patients. 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 improve quality of life for patients by identifying needs and enabling access to relevant support.
Structured assessment is an important part of post-stroke care so that stroke patients receive the most appropriate rehabilitation and support services. Their long-term quality of life and health depends on them accessing the right resources for their needs.
Professor Ruth Boaden and Professor Pippa Tyrrell, a senior NHS consultant and academic, worked as part of the CLAHRC team to improve post-stroke patient care. The team developed and evaluated a structured assessment tool which identifies the specific needs of individual patients and signposts them to relevant support.
The Greater Manchester Stroke Assessment Tool (GM-SAT) is a free, evidence-based assessment tool designed specifically for a six month post-stroke review. GM-SAT 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, from the questions to ask within the review and algorithms to guide care, through to documentation for recording and communicating review outcomes to other professionals involved in an individual’s care. The 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 integrates the needs analyses set out in the Care Quality Commission’s Stroke Service Review and fulfils aspects of the Department of Health’s Accelerating Stroke Improvement Programme 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 - meaning that other clinical staff are free to carry out clinical assessment
- Patients and their carers report feeling supported in the long-term by having access to more appropriate medical, social and emotional support
- Only tool used 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
A systematic and reflective approach was used to develop GM-SAT, based on data from a mixture of workshops, consultations with staff, patients and carers and literature reviews. Implementation of the tool was guided by a conceptual framework, known as ‘Promoting Action on Research Implementation in Health Services’ (PARIHS), previously developed by Dr Gillian Harvey and others. With this in mind, the researchers ensured that GM-SAT would reflect the context and local availability of support services. The pilot and evaluation phase of the tool’s development focused on capturing feedback and identifying ‘lessons learned’ so that research and improvements would continue to be developed from this work.
- Boaden R. et al. (2008) Quality Improvement: theory and practice in healthcare. NHS Institute for Innovation and Improvement/Alliance Manchester Business School, Coventry: NHS Institute for Innovation and Improvement, ISBN 978-1-906535-33-9
- Walshe K. and Boaden R. (2006) Patient safety: Research into Practice. Open University Press
- Kitson A. et al. (2008) “Evaluating the successful implementation of evidence into practice using the PARIHS framework: theoretical and practical challenges.” Implementation Science 3:1 doi:10.1186/1748-5908-3-1
- Harvey G. et al. (2011) “The NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester: Combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy” Implementation Science 6:1 doi:10.1186/1748-5908-6-96
- Rothwell K. et al. (2013) “Feasibility of assessing the needs of stroke patients after six months using the GM-SAT” Clinical Rehabilitation 27:6 doi:10.1177/0269215512457403
- David Bamford, Katy Rothwell, Pippa Tyrrell, Ruth Boaden, (2013) "Improving care for people after stroke: how change was actively facilitated", Journal of Health Organization and Management, Vol. 27 Iss: 5, pp.548 - 560 10.1108/JHOM-05-2011-0053
Professor Ruth Boaden
Professor Pippa Tyrrell
Dr Gillian Harvey
Ms Katy Rothwell (CLAHRC Greater Manchester)