BMJ Quality Improvement Reports 2013; , No. u201040.w687 doi: 10.1136/bmjquality.u201040.w687 Bidding for and setting up a Comprehensive Stroke Unit

Northwick Park is a district teaching hospital in NW London. In Jul 2009, Healthcare for London agreed to commission hyperacute stroke care in only eight units. These had to provide guaranteed minimum staffing levels, daily ward rounds including weekends and public holidays, and thrombolysis (clotbusting) treatment) 24/7. We were the only unit to bid that was not already a major neurology centre. Our successful bid had to be implemented to a very tight timetable and has now been operating for three years. Our results are audited nationally and demonstrate the success of the project. Before the project the Unit had 20 beds, one consultant and only three whole time equivalent therapists. We had thrombolysed 12 patients in two years. Patients did not go straight to the Stroke Unit from A&E. Although our rehabilitation processes were good we were limited by patients having to wait to get onto the Unit and by staff numbers. Now, there are 50 beds and over 130 staff. Performance is intensively monitored by the Stroke Network. Every patient is entered into the Royal College of Physicians continuous audit, and assessed against national standards. Our reputation is national and we have hosted teams from many units in the UK and abroad to demonstrate our processes and pathways. We conclude that with good planning, robust care pathways and a strong local management team backed by financial and Board level support, it is possible to implement a widespread change in treatment of a common and disabling condition. Problem Stroke care in London was, until recently, provided by almost al