title: Delivery of high quality stroke and vision care: experiences of UK services.
abstract: OBJECTIVE
  We sought to identify exemplars of high quality care provision from established stroke vision services.
  
  
  METHODS
  We identified areas of high quality services across the UK, judged as having integrated stroke/vision care provision for stroke survivors. Healthcare professionals were selected to participate in 1:1 interviews or focus groups. A strengths-weaknesses-opportunities-threats (SWOT) framework was used to lead the discussion in a semi-structured format. Thematic analysis was undertaken.
  
  
  RESULTS
  Interviewees (n = 24) from 14 NHS Trusts included eye clinic managers, nurses, orthoptists, occupational therapists and physiotherapists. Identified strengths of their services included established communication, training provision for stroke team staff, "open access" for referrals, use of standardised screening/referral forms, provision of lay summaries and information sheets, patients assessed on the stroke unit with continued follow-up and initial visual assessments made within 1 week of stroke onset. Weaknesses included lack of funding, insufficient orthoptic cover, and time consuming retraining of stroke staff because of staff rotation and changes. Opportunities included increasing the number (or length) of orthoptic sessions and training of stroke staff. Perceived threats related to funding and increased appointment waiting times.
  
  
  CONCLUSIONS
  Practical elements for improved stroke and vision care provision are highlighted which can be implemented with relatively little financial inputs. Implications for Rehabilitation Integrated vision services within stroke units can improve the detection of visual problems in stroke survivors leading to earlier visual rehabilitation. Orthoptists within core stroke teams are beneficial to the delivery of a high quality service. This study illustrates clear practical elements to support the provision of high quality integrated stroke and vision services. Relatively little financial inputs are required to fund such services but with larger potential to improve patient care.
authors.affiliation: a Department of Health Services Research , University of Liverpool , Liverpool , UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Rowe
authors.affiliation: b Department of Stroke Rehabilitation , University of Nottingham , Nottingham , UK.
authors.forename: Marion
authors.initials: M
authors.lastname: Walker
authors.affiliation: c Speakability North West , London , UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Rockliffe
authors.affiliation: d Nursing, Midwifery and AHP Research Unit, Glasgow Caledonian University , Glasgow , UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Pollock
authors.affiliation: e Department of Ophthalmology , Aintree University Hospital NHS Foundation Trust , Liverpool , UK.
authors.forename: Carmel
authors.initials: C
authors.lastname: Noonan
authors.affiliation: f Department of Orthoptics , Salford Royal NHS Foundation Trust , Manchester , UK , and.
authors.forename: Claire
authors.initials: C
authors.lastname: Howard
authors.affiliation: g Different Strokes (London South East) , Milton Keynes , UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Currie
keywords: Orthoptist; practice; recommendations; service; stroke; vision