The fourth annual Sentinel Stroke National Audit Programme (SSNAP) report, Rising to the Challenge, celebrates the concerted efforts made by stroke services in England, Wales and Northern Ireland in using robust SSNAP data and evidence-based standards to continuously improve patient care, experience and outcomes after stroke.
Despite the resource and financial challenges faced by health providers across the nation, stroke care has improved since the SSNAP audit began in 2013. This report illustrates the power of SSNAP data and demonstrates how it can be used to influence future processes of services for stroke patients, policy decisions, and decisions on the future direction of stroke within the NHS.
Headlines from the report
- There has been remarkable improvements in stroke care since guidelines for stroke were first produced which stroke services were subsequently audited against nearly 20 years ago. SSNAP results since January 2013 have shown that these improvements have continued in recent years as demonstrated in an accompanying 4 years national summary report also available here www.strokeaudit.org/annualreport For eg, brain scanning times continue to improve: (51.3%) of people are now scanned within an hour of arrival in hospital, (compared to 41.9% in 2014), and more than 90% of patients are scanned within 12 hours of arrival
- There is fantastic QI work happening in stroke care across the country today with many local providers making sustained efforts to improve the care that they provide to their patients. Details about this work is available in the report and online: https://www.strokeaudit.org/annualreport/casestudies
- Recent research findings indicate that more interventions for treating intracerebral haemorrhage (ICH) are available than previously thought which increases the stroke patients’ chances of survival after stroke.
- Thrombectomy, which involves direct removal of clot using a device passed up into the blocked artery, is an exciting new development in ischaemic stroke and will have a profound impact on how acute stroke is managed in the years ahead. However rolling out services to ensure this intervention is available to everyone will be a logistical challenge for the NHS. A full thrombectomy report is available to download here: https://www.strokeaudit.org/results/Clinical-audit/National-Results.aspx
- Despite undoubted improvements over time there are still a number of aspects of stroke care which need to be addressed, both in the acute and rehabilitation pathways. The case studies included in this report highlight how different stroke services have addressed some of these challenges and can be used as an exemplar of best practice by others.
- For example, more than 40% of patients are still not admitted to a stroke unit within 4 hours of arriving at hospital. This measure has marginally deteriorated over time highlighting pressures in A&E and availability of beds
- Psychological treatment after stroke is lacking, with those deemed as requiring treatment only receiving an average of 3.6 minutes psychology per day
- Only 20% of patients are having intermittent pneumatic compression applied, which has been shown to reduce the frequency of deep vein thrombosis, which is a much lower than expected uptake.
- Only a minority of patients are being assessed at six months after stroke to review recovery progress and decide if further care is needed
Professor Pippa Tyrrell Professor of Stroke Medicine and Consultant Stroke Physician, Salford Royal NHS Foundation Trust said:
It is encouraging to see the continued improvement in stroke services in the NHS and the SSNAP audit provides us with so much data on nearly everyone admitted to acute stroke services that we can now show how improved care saves lives and reduces disability. The case studies on how local stroke services are actively pursuing quality improvement initiatives to provide better care to their patients are inspiring, and reinforce the amazing wor that is being done by busy clinicians every day in the NHS. However, there is still a great deal to be done to ensure that everyone with acute stroke gets the evidence based care that they need, and that they and their carers feel well supported.
For further information or to arrange an interview, please contact Joanna Morgan, communications manager, RCP Care Quality Improvement Department, on +44 (0) 20 3075 1354
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 therefore enable patients, staff, academics and others to make informed decisions about healthcare services.
The SSNAP annual report is available on the RCP website from 29 November 2017 at www.strokeaudit.org/annualreport
More information on the Sentinel Stroke National Audit Programme (SSNAP)
SSNAP measures both the processes of care (clinical audit) provided to stroke patients, as well as the structure of stroke services (organisational audit) against evidence based standards. The overall aim of SSNAP is to provide timely information to clinicians, commissioners, patients, and the public on how well stroke care is being delivered so it can be used as a tool to improve the quality of care that is provided to patients. Latest results are available here: www.strokeaudit.org/results
Since SSNAP started in January 2013 more than 300,000 stroke patient records have been analysed and reported on. Over 90% of expected stroke cases are being entered to SSNAP by providers in England and Wales, with case ascertainment in Northern Ireland now steadily improving. This means that the data presented in this report are complete and robust.
The 4th SSNAP Annual Report has been written in collaboration with patient representatives, stroke clinicians, and stroke research professionals. It investigates how hospital trusts have made real change happen, and what lessons can be learned from those teams that have continued to improve the care they provide to patients over time. The report includes numerous case studies which provide real world examples of how providers have used a data driven approach for quality improvement projects at local and regional level. Additional case studies are available via our website www.strokeaudit.org.
About HQIP, the National Clinical Audit and Patient Outcomes 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 and Patient Outcomes Programme (NCAPOP), comprising more than 40 clinical audits and outcome review programmes that cover care provided to and mortality results from 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 programmes, also funded by the Health Departments of the Scotland, Northern Ireland and the Channel Islands. www.hqip.org.uk.