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Spotlight on timely stroke care: award-winning project published in BMJ Open Quality

19 May 2025

We’re proud to highlight the award-winning improvement work of Dr Manju Krishnan, Consultant Stroke Physician at Swansea Bay University Health Board. Her project, focused on improving the timeliness and safety of nasogastric (NG) tube insertions for stroke patients – and has now been published in BMJ Open Quality.

In 2023-24, Manju completed the Scottish Improvement Leader (ScIL) programme with the Improvement Cymru Academy. As part of her learning, she led a project to reduce delays in NG tube insertions, a vital intervention for stroke patients who cannot swallow safely.

Working with her team, Dr. Krishnan implemented a structured approach that included:

  • Staff education and awareness sessions.
  • A decision tool to support risk-benefit discussions.
  • Regular multidisciplinary team (MDT) meetings to monitor progress.​

Snapshot of the outcomes:

  • NG insertion time reduced from 5.2 hours to 1.7 hours following MDT decision.
  • Documentation of risk-benefit discussions improved from 0% to 80%.
  • NG decision tool usage achieved 80%, surpassing the 50% aim.
  • 90% of staff reported that the changes improved care without increasing workload
“The improvement training gave me the space and support to lead this work with confidence. We’ve made a lasting difference to how we manage stroke risk - and to patient care.” - Manju Krishnan

The work has also gained international recognition: it has been accepted as a poster presentation at the upcoming European Stroke Organisation Conference, with the abstract to be published in the European Journal of Stroke.

The ScIL course was previously delivered in partnership by Improvement Cymru and NHS Education for Scotland. Building on its success, the Improvement Cymru Academy now offers a growing portfolio of improvement training courses - including Improvement Advisor Cymru (IAC), a fully Welsh-led programme - to equip professionals across Wales with the skills to lead meaningful change.

Congratulations to Manju and the team for their commitment to safer, more timely stroke care.

Read the full project: BMJ Open Quality – Published Article
Contact Manju: Manju.Krishnan@wales.nhs.uk