Latest SSNAP report on stroke services shows further improvement

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:

Notes to editors

Explaining SSNAP scores

An absolute scoring system for hospitals was introduced for the July–September 2013 cohort of patients following a 6-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’:

  • Forty-four 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 (scored "A" to "E") and a combined total key indicator score is calculated based on the average of the 10 domain levels for both patient-centred (based on following patients throughout the pathway) and team-centred (scores that only relate to individual teams) 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 second SSNAP reporting period which spans across a 4-month rather than a 3-month data collection period. This report contains complete data for stroke patients admitted to and/or stroke patients discharged from inpatient care between 1 August and 30 November 2016. The 41 "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 admission to hospital, through care provided in the post-acute setting, to the 6-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 4 months, and cover all hospitals treating stroke patients in England and Wales, together with nine hospitals in Northern Ireland. It is the most comprehensive and reliable source of information about the performance of stroke services.

Additional information

The latest SSNAP audit report is available. There are various data visualisation resources that exhibit SSNAP’s results, including: interactive maps, 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.