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18% of hospitals now achieving the highest possible score in the Sentinel Stroke National Audit Programme, indicating a world class stroke service

Latest stroke audit results for April-July 2016 reveal that 42 (18%) of all inpatient stroke services in England, Wales, and Northern Ireland achieved an “A” score indicating a world class stroke service, with a further 59 teams (26%) achieving a “B” score. That only 12 (5%) stroke services scored in the lowest “E” banding shows that despite stringent targets much progress has been made in stroke care in recent years.

As SSNAP approaches its fifth year of collecting and reporting on stroke care, it is an opportune time to reflect on how clinical teams have actively used the information made available to them to make tangible and sustained improvements to the quality of stroke services available to patients. Progress has been steady and continuous, and it relates to both the first 72 hours of care and post-acute stroke care processes.

These improvements in performance can be succinctly represented by the changes to the distribution of SSNAP’s “A” (best) to “E” (worst) scoring of inpatient stroke care providers over time as highlighted in the graph below. Examples of aspects of care which have substantially improved are provided in the accompanying appendix.

Professor Pippa Tyrrell Quote:

Since we began running the SSNAP audit we have seen a genuine commitment from stroke services to submit timely, complete data, making the results robust and meaningful. The fact that clinical teams are reviewing and acting on the data available to them to improve patient care in addition to their already busy work schedules is hugely encouraging and should be celebrated. 

The positive quarter on quarter trends we witnessed, even in the early periods of SSNAP scoring, reinforced our belief from the outset that despite the stringent, aspirational targets, change was possible.

SSNAP Scores – Key Milestones

  • Scoring was introduced for the July-September 2013 period; 0 teams achieved an “A” score, while only 8 teams (4%) achieved a “B” score.
  • In this period 77 teams achieved an “E” score and 74 teams achieved a “D” score, meaning 151 (85%) of hospitals fell within the two lowest possible bandings.
  • The first ever “A” scores were achieved by 6 teams in April-June 2014, almost 1 year after the scoring system was introduced.
  • Since then the number of “A” rated stroke services has increased steadily; 16 teams (8%) scored “A” in Oct-Dec 2014 and 26 teams (12%) in Oct-Dec 2015.
  • The latest results for April-July 2016 have revealed that 42 teams (18%) have now achieved an “A” score and 59 teams (26%) have achieved a “B” score; over 40% of stroke services are now in the top two bandings.
  • Additionally only 12 teams (5%) scored an “E”, 4 of which are based in Northern Ireland who are relatively new to SSNAP while 62 teams (27%) have scored a “D” overall. 
  •  Our 3rd Annual Report for 2016 will include a number of quality improvement initiatives employed by hospital trusts to improve the level of care provided to stroke patients.

Details of these published SSNAP reports

The report published today relates to patients admitted between April and July 2016 and includes named hospital results for the entire inpatient care pathway. The results will be available online at the SSNAP Results Portal from 7.30am on November 14.

Participation remains an unprecedented success. 28,003 patient records were submitted for analysis within the 72 hour results – this is over 100% of the expected stroke cases for this period – while 85% of stroke services are now achieving the highest case ascertainment band, demonstrating the incredible commitment of clinical teams to enter prospective, complete data to SSNAP.

The power of SSNAP data is huge and has enabled a much stronger case to be made for improvements to stroke services, which is allowing commissioners and clinicians alike to offer the best possible care to patients.

However more work still needs to be done. Despite these steady improvements in stroke high quality stroke care is not being provided universally. Unacceptable regional variation in stroke services still exists and more needs to be done to ensure the time or day of admission to hospital does not impact the level of acute care provided to patients.

SSNAP is commissioned by the Healthcare Quality Improvement Partnership (HQIP)*, as part of the National Clinical Audit Programme (NCA)*. The audit is led by the Royal College of Physicians, Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party.

The SSNAP audit report will be available here: SSNAP Results Portal from 7.30am on November 14. For a copy of the report before this time please contact Jessica.smith@rcpLondon.ac.uk.

Notes to editors

Explaining SSNAP Scores

An absolute scoring system for hospitals was introduced for the July-September 2013 cohort of patients following a six month pilot reporting period. Absolute scoring means that all hospitals can show improvement over time regardless of how other participating hospitals perform from one period to the next. Hospitals achieve a score ranging from “A” to “E” with “A” indicating a ‘world class service’

  • 44 Key Indicators have been chosen by a multidisciplinary steering group on stroke as representative of high quality stroke care which are supported against evidence based standards. 
  • Key indicators are grouped into 10 domains covering key aspects of the process of stroke care.
  • Each domain is given a performance level (level A to E) and a total key indicator score is calculated based on the average of the 10 domain levels for both patient‑centred and team centred domains.
  • A combined total key indicator score is calculated by averaging the total key indicator scores.
  • This combined total key indicator score is adjusted for data quality and number of patient records submitted to SSNAP over the period.

Reporting Frequency

This is the first SSNAP reporting period which spans across a four month rather than a three month data collection period. This report contains complete data for stroke patients admitted to and/or stroke patients discharged from inpatient care between 1 April and 31 July 2016. The 42 ‘A’-grades are out of 228 inpatient teams who submitted enough data to receive an overall SSNAP score for the period.

Overview of SSNAP

SSNAP is the first national stroke register in the world to collect information across the entire stroke pathway, from admittance to hospital, through care provided in the post-acute setting, to the six month follow-up appointment.  SSNAP aims to improve stroke care by measuring the quality of services against evidence-based standards and supporting staff to make improvements. SSNAP results are updated every four months, and cover all hospitals treating stroke patients in England and Wales, together with eight hospitals in Northern Ireland. It is the most comprehensive and reliable source of information about the performance of stroke services.

Additional Information

There are various data visualisation resources that exhibit SSNAP’s latest results, including: interactive maps (available here), regionalised performance tables, slideshows, and ‘Easy Access Version’ reports designed for, and developed with, 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.