The Sentinel Stroke National Audit Programme (SSNAP) is the first national stroke register in the world to collect information about the entire stroke pathway, from being admitted to hospital to the 6 month follow-up appointment. The results are updated every 3 months, and cover all hospitals treating stroke patients in England and Wales, together with two hospitals in Northern Ireland.
The Sentinel Stroke National Audit Programme (SSNAP) is the most comprehensive and reliable source of information about the performance of stroke services in England, Wales and Northern Ireland. SSNAP aims to improve stroke care by measuring the quality of stroke services against evidence based standards and supporting staff to make improvements. The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP)*, as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).
The latest set of results, covering patients admitted from 1 January – 31 March 2014, is now available online at the RCP website. While the results are largely similar to the previous three-quarters, there is still unacceptable variation between hospitals and follow-up care outside hospital. Significant results include:
Acute care:
- 43.2 % of patients were scanned within 1 hour – the target is 50%
- 86.1 % of patients were scanned within 12 hours
- 57.8 % of patients were directly admitted to a stroke unit within 4 hours
- 82.3% of patients spent at least 90% of their stay on a stroke unit
- 74.9% of eligible patients were given clot-busting drugs.
Specialist assessments:
- 75.3% of patients were assessed by a stroke specialist consultant physicians within 24 hours
- 65% of patients had their ability to swallow checked within 4 hours
- 80.9% of patients had a formal swallow assessment within 72 hours.
Need and provision of therapies:
- 80.1% of patients were reported as needing occupational therapy
- 84.7% of patients were reported as needing physiotherapy
- 48% of patients were reported as needing speech and language therapy.
Amount of time therapies were provided on the days they were provided:
- a median of 40 minutes of occupational therapy
- a median of 32.1 minutes of physiotherapy
- a median of 30 minutes of speech and language therapy.
Proportion of days the patients received therapies during their stay in hospital:
- a median of 44% of days of occupational therapy
- a median of 53.6% of physiotherapy
- a median of 26.6% of speech and language therapy.
Discharge planning:
- 74.6% of patients received a joint health and social care plan
- 79.2% of patients received a continence plan within 3 weeks.
Six-month assessment
For the first time, SSNAP is reporting on the proportion of patients receiving a 6 month review. Six month assessments are required by the National Stroke Strategy in England (Welsh Government Stroke Delivery Plan in Wales) and key to assessing the outcomes of stroke care. These results are based on 6 month assessments which were due between October 2013 and March 2014.
Only 15.1% (3,360/22,273) of cases are receiving an assessment at 6 months. Clinical teams and commissioners need to work closely together to see this improve to obtain information about the function of patients post stroke and their needs. By collecting these data in the audit the results can be used for service improvement.
Professor Tony Rudd, chair of the Intercollegiate Stroke Working Party, said:
It is vital to continue to measure the quality of care delivered. There is still a long way to go to say that every patient is receiving ‘perfect’ care, particularly in the community. This is why the SSNAP is pushing to get more and better data for this part of the stroke pathway.
For more information, please contact Morgan Evans, RCP communications and new media adviser, on +44 (0)20 3075 1468 / 0779 508 8253, or email Morgan.Evans@rcplondon.ac.uk
- This report contains complete data for 19,638 stroke patients admitted to and 18,704 stroke patients discharged from inpatient care between 1 January and 31 March 2014.
- SSNAP is leading the way in supporting the data transparency agenda and future improvements in stroke care in England, Wales and Northern Ireland. Transparency and open data is a government initiative that aims to publish information about clinical services and outcomes and so enable patients, staff, academics and others to make informed decisions about healthcare services.
- The SSNAP audit report is available on the RCP website.
- There are various visualisation resources to show the latest SSNAP results, including interactive maps, regionalised performance tables, slideshows, and ‘easy access version’ reports for patients, families and carers.
About HQIP, the National Clinical Audit Programme and how it is funded
The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands.