In the latest of our Spotlight on local innovation series of articles, Dr Sam Sheppard, consultant physician in stroke and care of the elderly and RCP collegiate member writes about how stroke care has been transformed at the Countess of Chester Hospital in the northwest of England.
He presented this work to the RCP president and senior officers at a college trust visit in June 2025.
Here in Chester, we’ve been working hard to adapt to the evolving challenges in stroke medicine – balancing national targets, local capacity and the needs of our patients in an increasingly pressured system.
Our department has a proud record of research and innovation. Each year, the Countess of Chester Hospital enrols more than 1,000 patients into national studies, with the stroke department significantly contributing to this. In recognition of this, our department has won regional awards for our quality improvement work.
That culture of continuous improvement runs through everything we do – from monthly thrombolysis audit meetings, led by one of our SAS doctors, to rehabilitation-focused QI projects led by our therapy colleagues at Ellesmere Port Hospital.
Tackling key challenges
Like many stroke units across the country, two issues have dominated our focus in recent years:
- Timely admission to the stroke unit. National guidelines recommend that patients are admitted within four hours and spend at least 90% of their stay on the unit. Since the pandemic, achieving that target has become increasingly difficult.
- Reperfusion therapies. We’ve been determined to increase the proportion of patients receiving thrombolysis and thrombectomy – and to deliver these treatments as quickly and safely as possible.
Driving improvement through innovation
In response, we’ve implemented a series of changes designed to improve patient flow, treatment speed, and outcomes:
- Extended stroke coordinator hours. The coordinator service now runs until midnight, with a plan to move towards a 24-hour model. Early data shows improved door-to-needle times and more patients being treated.
- Streamlined admissions. Standard operating procedures and ring-fenced trolley spaces have helped us prioritise acute stroke admissions, cutting average admission times by 45 minutes.
- New thrombolytic treatment. We’ve introduced Tenecteplase in line with emerging national guidance – and are already seeing encouraging improvements in outcomes.
- Learning from every case. Monthly reviews of thrombolysis decisions – now including borderline cases – have helped us embed the national optimal imaging pathway and strengthen clinical decision-making.
Measurable progress and what’s next
These efforts are making a real difference. In May 2025, our department achieved an ‘A’ rating for thrombolysis and thrombectomy services, with 14.5% of patients receiving thrombectomy – the highest proportion in the region that month.
Looking ahead, we’re preparing to open a new 24-bed stroke unit featuring a high-acuity area, expanded therapy space, two ring-fenced trolley bays, and an ambulatory clinic. Recruitment is already under way to expand our consultant and stroke coordinator workforce to staff the new facility.
We’re also mindful of the pressures our teams face – especially the demands of out-of-hours work – and are exploring regional collaboration to ensure sustainable cover and equitable care across our area.
Continuing to learn and share
Stroke performance metrics remain a standing item on the trust’s risk register and board agenda, reflecting the organisation’s commitment to continuous improvement.
Our journey shows how a team facing the same challenges as many across the NHS can respond with creativity, evidence-based practice, and a shared determination to deliver the best possible care for our patients. We look forward to continuing to share our learning with colleagues across the region.
Your RCP membership, local to you
RCP hospital visits are an importance part of our ongoing programme of regional engagement. Our aim is to listen to members and fellows across the UK and support them to deliver high-quality patient care.
Supported by our dedicated regional membership team, our 18 networks across England, Wales and Northern Ireland provide members and fellows with access to events, CPD, training and conferences close to home and offer opportunities to connect with other physicians, external stakeholders and RCP officers. Our RCP regional advisers, college tutors and associate college tutors ensure that regional issues are heard at a national level.
Dr Sam Sheppard
Consultant physician in stroke and care of the elderly
