Nineteen per cent of hospitals are now achieving the highest possible score in the Sentinel Stroke National Audit Programme (SSNAP), showing that a world-class stroke care service is achievable.
Latest stroke audit results for August–November 2016 reveal that 41 (19%) of all participating inpatient stroke services in England, Wales and Northern Ireland achieved an “A” score indicating a world-class stroke service, with a further 60 teams (28%) achieving a “B” score.
Only four stroke services (2%) scored in the lowest “E” banding – the lowest number since the audit began – showing that, despite stringent targets, much progress has been made in stroke care in recent years.
SSNAP is the single source of stroke data in England, Wales and Northern Ireland. Since it started measuring and reporting on the quality of stroke care provision considerable improvements have been made:
- over half of all stroke patients now receive a brain scan within 1 hour of arriving at hospital
- almost 90% of eligible patients are receiving thrombolysis (clot-busting) treatment
- 92% of applicable patients have a continence plan drawn up within 3 weeks of arriving at hospital (a big improvement on the 75% of patients that received this between April 2013 and March 2014).
The overall improvement in performance, represented by the changes to the distribution of SSNAP’s “A” (best) to “E” (worst) scoring of inpatient stroke care providers over time, is recorded in the SSNAP results portal. Examples of aspects of care which have substantially improved are provided in the accompanying appendix.
Professor Pippa Tyrrell, associate director of the Stroke Programme at the Royal College of Physicians, said:
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 – no teams achieved an “A” score, while only eight 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 six 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 October–December 2014 and the highest ever achieved, 42 teams (18%), in April–July 2016.
- The latest results for August–November 2016 have revealed that 41 teams (19%) are achieving an “A” score and 60 teams (28%) have achieved a “B” score; over 45% of stroke services are now in the top two bandings.
- Additionally, only four teams (2%) scored an “E”, while 49 teams (22%) have scored a “D” overall.
- The third SSNAP annual report, Mind the gap!, was published in 2016 and included examples of a number of quality improvement initiatives employed by hospital trusts to improve the level of care provided to stroke patients.
More details from the SSNAP report
The report published today relates to patients admitted and/or discharged between August and November 2016 and includes named hospital results for the entire inpatient care pathway. The results are available online at the SSNAP results portal.
Participation remains an unprecedented success: 27,327 patient records were submitted for analysis within the 72-hour results (covering admission and the first 72 hours of care) and over 80% of stroke services are now achieving the highest case ascertainment band (90%+ of expected stroke cases), demonstrating the incredible commitment of clinical teams to enter prospective, complete data to SSNAP and drive quality improvement.
The power of complete, robust data reported on by SSNAP allows clinicians, managers, commissioners, and the public to monitor the performance of stroke services over time, enabling a much stronger case for further improvements in stroke care to be made. This has helped clinical teams to ensure that they offer the best possible care to patients, and has provided the organisations that fund stroke services with information that allows them to understand where progress has been made in stroke care and where more work is required.
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 RCP's Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party.
For more information please contact Jane McCormick:
