The National Institute for Health and Care Excellence (NICE) defines a number of quality standards (QS) for stroke care. These aim to provide descriptors to patients and healthcare professionals of what defines high quality care. A number of these standards are covered by data collected in the Stroke Audits.
Several aspects of the stroke quality statement relate to how quickly and effectively those with suspected stroke are admitted to hospital. Here, we look at those admitted to a stroke unit and how quickly people receive a brain scan.
The proportion of patients who were admitted directly to a stroke unit within four hours and received thrombolysis if needed has been steady over time, with 56.6% of patients meeting the criterion 2013/2014 compared with 58% in 2015/16. NICE clinical guidelines state that patients with stroke (who meet the criteria) should have a brain scan immediately on arrival to hospital and there is an associated target that this should happen for 50% of stroke patients within one hour. The target has been consistently missed, but the proportion of patients having their scan within an hour has increased from 41.9% 2013/14 to 47.5% in 2015/16.
As well as immediate assessments on arrival to hospital, much of the quality statement also highlights the importance of the patient being assessed by the right professionals in a timely manner. Patients who have had an acute stroke should have their swallowing assessed within four hours of admission to hospital. The proportion that undergoes this assessment has increased from 63.6% in 2013/14 to 71.6% in 2015/16.
Understanding the assessment and management of stroke combines a number of measures. Here the quality statement looks at the proportion of patients with stroke that are assessed and managed by stroke nursing staff and at least one member of the specialist rehabilitation team within 24 hours of admission to hospital, and by all relevant members of the specialist rehabilitation team within 72 hours, with documented multidisciplinary goals agreed within five days. Again, compliance with this measure has increased over time, from 44.1% in 2013/14 to 56.4% in 2015/16.
High quality ongoing rehabilitation requires input from a number of key individuals to a patient's care. The NICE quality statement states that patients with stroke are offered a minimum of 45 minutes of each active therapy that is required, for a minimum of five days a week, at a level that enables the patient to meet their rehabilitation goals for as long as they are continuing to benefit from the therapy and are able to tolerate it.
Here we look at performance of occupational therapy, physiotherapy and speech and language therapy separately. Although there is no measure to look at these combined to accurately assess performance against the quality standard, these three measures can be used as a proxy. Overall, performance for speech and language therapy is lower compared to physiotherapy and occupational therapy. In 2015/16, it was 41.6% compared with 73.5% for physiotherapy and 79.6% for occupational therapy. All measures increased performance over time, with the biggest improvement seen in occupational therapy, which increased by 23.8 percentage points since 2013/14.
Assessing the cause of and providing ongoing support and treatment for loss of bladder control is essential to high-quality stroke care. Although these measures do not exactly match the quality statement relating to them they can be used as an indication of how well continence management and mood and cognition are incorporated into stroke care. The proportion of eligible patients who have a continence plan within three weeks of admission has increased over time and reached 89.3% in 2015/16. Similarly, those who'd had a mood and cognition screening on discharge was high in all time points and was 89.3% in 2015/16.
About this data
SSNAP is a national audit programme, consisting of two complementary audits. The first is a clinical audit, which collects information on the care of patients after they are admitted to hospital until six months following their stroke. The second is an acute organisational audit, which measures the structure of stroke services, for example, what kind of services are provided and how many staff they have. The second SSNAP Annual Report.
The data is collected quarterly and here the results are set out for 2013/14, 2014/15 and 2015/16 to allow for easy comparison.