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# Sentinel Stroke National Audit Programme (Ssnap)

Clinical audit  
August 2017 - November 2017 Public Report National results March 2018 Based on stroke patients admitted to and/or discharged from hospital between August 2017 - November 2017 
Prepared by Royal College of Physicians, Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party 

Document purpose 
To disseminate results for the process of stroke care for patients admitted and/or discharged in the period between August 2017 - November 2017  
Title 
Sentinel Stroke National Audit Programme (SSNAP) Clinical Audit  August 2017 - November 2017 Public Report  
Author 
Royal College of Physicians, Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party 
Publication 
March 2018 
Target audience 
General public, stroke survivors and carers, health and social care professionals, stroke researchers 
Description 
This is a public report on the clinical component (process of care) of the national stroke audit, the Sentinel Stroke National Audit Programme (SSNAP). It publishes national and named team 
results on the quality of stroke care for patients admitted and/or discharged between 1 August 
and 30th November 2017. It covers many processes of care across the entire inpatient stay 
including comparisons with most recent reporting periods. The report findings enable the processes of stroke services at national level to be compared with national standards outlined 
in the fifth edition of the National Clinical Guideline for Stroke (2016) published by the 
Intercollegiate Stroke Working Party, the NICE (National Institute for Health and Clinical Excellence) Clinical Guidelines, the National Stroke Strategy 2007 and the NICE Quality 
Standards for Stroke (2016). 
Supersedes 
SSNAP Clinical Audit April 2017 - July 2017 public report 
Related publications 
National clinical guideline for stroke 5th edition (Royal College of Physicians, 2016): 
www.strokeaudit.org/guideline   
National clinical guideline for stroke 5th edition patient version 
http://www.strokeaudit.org/Guideline/Patient-Guideline.aspx  
SSNAP Clinical audit public report - August-November2016 
http://www.strokeaudit.org/results/National-Results.aspx  
SSNAP Post-Acute Stroke Service Provider Audit 
https://www.strokeaudit.org/results/PostAcute/National.aspx 
SSNAP Acute Organisational Audit Report - November 2016 
https://www.strokeaudit.org/results/Organisational/National-Organisational.aspx 
NICE Quality Standard for Stroke 2016:  
https://www.nice.org.uk/guidance/qs2 National Stroke Strategy (Department of Health, 2007): http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Public ationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081062 Department of Health: Progress in improving stroke care (National Audit Office, 2010): 
http://www.nao.org.uk/publications/0910/stroke.aspx 
National Cardiovascular Outcomes Strategy: https://www.gov.uk/government/publications/improving-cardiovascular-disease-outcomesstrategy CCG Outcomes Indictor Set: 
https://indicators.hscic.gov.uk/webview/ 
Contact 
ssnap@rcplondon.ac.uk 

Report prepared by: 
Mr Simon Bragg MSc SSNAP Data Coordinator, CEEu, Royal College of Physicians Ms Lizz Paley MSc Stroke Programme Intelligence Manager—Data, CEEu, Royal College of Physicians Mr Mark Kavanagh BA 
SSNAP Programme Manager, CEEu, Royal College of Physicians 

## Ms Victoria Mccurran Mph Ssnap Senior Data Analyst, Ceeu, Royal College Of Physicians

Mrs Alex Hoffman MSc Stroke Programme Manager, CEEu, Royal College of Physicians Professor Anthony Rudd FRCP CBE 
Chair of the Intercollegiate Stroke Working Party, Associate Director for Stroke (CEEu) Consultant Stroke Physician, Guy's and St Thomas' Hospital, London Supported by: 
Mr George Dunn BA SSNAP Project Manager, CEEu, Royal College of Physicians Dr Martin James FRCP Associate Director for Stroke (CEEu) 
Consultant Stroke Physician, Royal Devon and Exeter Hospital, Devon 

## Foreword

This report on the Sentinel Stroke National Audit Programme (SSNAP) uses data collected between August and November 2017.  It includes named hospital results for the entire inpatient care pathway, where the numbers of patients entered in SSNAP for this period make this viable. 

In this reporting period, 44 teams achieved an overall 'A' score in SSNAP, which indicates a worldclass stroke service.  That services are continually improving the stroke care provided to patients is evident from the fact for the January-March 2016 reporting period only 25 teams achieved an A grade. Even more important is that the number of hospitals delivering care rated as D or E. There are now just 28 routinely admitting teams scoring a D and 4 scoring an E or failing to submit any or sufficient data to be included in the report. The improvements in results are symptomatic of the continued efforts made by teams to use SSNAP 
data as a tool for continuously improving the quality of the stroke services they provide to patients. The genuine commitment to submitting timely and complete data each reporting period and acting on audit results to improve clinical care should be celebrated.    Even more teams would have scored an 'A' if they had not been marked down because of issues around the timeliness and quality of data submission, which should be fairly easily solvable.   These latest audit results reinforce our belief that although SSNAP has set stringent, aspirational targets the top score is achievable and sustainable over time. One area of concern is that performance on the 'Stroke Unit' domain has if anything deteriorated over recent reporting periods. Only three routinely admitting teams achieved an 'A'. This I think reflects the increasing pressure there has been in recent months on acute hospitals generally and the consequent problems trying to keep sufficient empty beds on the stroke unit. This is particularly concerning because it is probably the most important intervention a patient receives after a stroke and many of the other measures of quality of care inevitably deteriorate if the patients' admission to specialist care is delayed.  
There is still unacceptable variation across the country. Performance on six month assessments after stroke is still very weak and this is another particular area of concern Congratulations to everyone who has contributed to the data presented in this report.  It is a fantastic achievement that roughly 28,500 patient records are available for analysis this reporting period. We estimate that approximately 85,000 patients are admitted to hospital with stroke per year so we are achieving very high levels of case ascertainment.  Complete and high quality data will be extremely powerful in shaping the future developments in stroke care in England, Wales and Northern Ireland.  They will enable a much stronger case to be made for improvements and greatly help patients, commissioners and clinicians alike get the best out of the services. We have received numerous case studies from stroke care providers outlining how they have used the data to improve their services. It is motivating and encouraging to see that our reporting outputs are valued and we hope to see continued improvements in results in future reporting periods.  
Professor Anthony Rudd FRCP CBE Clinical Director of RCP Stroke Programme 

## Introduction To Ssnap

The Sentinel Stroke National Audit Programme (SSNAP) is the single source of stroke data in England, Wales and Northern Ireland. There are three main components of SSNAP, the clinical audit, acute organisational audit and post-acute organisational audit. This document outlines findings from the clinical audit and through clinical commentary, contextualises this data.  This report presents a national overview of stroke care across England, Wales and Northern Ireland and is intended to be accessed by members of the public with an interest in stroke care as well as by health care professionals.  

## How To Read This Report

National results (out of all patients submitted to the audit in England, Wales, Northern Ireland and the Islands): In this report national results are presented as percentages, medians and interquartile ranges (IQR). The median is the middle point of the data; 50% of patients' results lie on either side. 

The interquartile range is the middle half of values; the bottom 25% of patients' results are below this range and the top 25% of patients' results are above this range. Unless otherwise stated in the report, 100% is the optimal performance and the higher the percentage, the higher the quality of care. For timings, the shorter the median time to intervention the better the care. Clinical Commentary: This report contains clinical commentary from the Stroke Programme Clinical Director, Professor Tony Rudd. 

No, but…answers: The diversity of effects from a stroke creates difficulties for clinical management and for determining overall standards of care. The audit therefore designated specified circumstances where standards would not be applicable. The full wording of questions can be found in Appendix 2. Compliance rates: The compliance rate is recorded as a percentage, with 100% being optimal (unless otherwise stated). The denominators for the compliance rates are those cases for whom the standards applied, i.e. any *No, but*… exceptions have not been included in the calculations of compliance. There are some time-points along the stroke pathway at which the concept of applicability is not relevant (i.e. when all patients are deemed applicable for a standard). Please see the technical guidance on the final tab of the 'Full results portfolio' for more details 
(www.strokeaudit.org/results/national). 

Reference numbers: These refer to the position in the accompanying MS Excel spreadsheets where individual team level results for standards and indicators can be found. 

'Patient-centred' and 'team-centred' results: SSNAP reports on the processes of care and patient outcomes in two ways; 'patient centred' and 'team centred'. 'Patient centred' attribute the results to every team which treated the patient at any point in their care. A team's patient-centred results demonstrate the quality of care that their patients received across the whole inpatient care pathway, regardless of how many teams each patient went to, or which of the teams provided each aspect of care. 'Team centred' attribute the results to the team considered to be most appropriate to assign the responsibility for the measure to. In Section 1 (national level domains and scoring), it is clearly stated whether team- or patient-centred results are being presented. In Section 8 (domains and scoring by named team), both team- and patient-centred results are provided. 

Both patient-centred and team-centred results are presented on separate tabs in the accompanying full results portfolio. For the majority of cases, the national level results in this PDF report will match those in *both* the patient-centred and team-centred results tab in the portfolio. One exception is therapy provision, where the national level patient-centred and team-centred results differ. National level results for therapy intensity in Section 5 of this report are patient centred. For comparisons between an individual team's performance (team-centred results) with the national, please refer to the team-centred national results in the post 72 hour 'team centred' tab of the portfolio. Team type: This report includes data from the following types of team and highlights which team type data are used when appropriate. The team types are as follows:  

- 
Routinely admitting acute teams  (teams which admit stroke patients directly for acute 
stroke care) 
- 
Non-routinely admitting acute teams (teams which do not generally admit stroke patients 
directly but continue to provide care in an acute setting when patients have been transferred from place of initial treatment) 
- 
Non-acute inpatient teams (teams which provide inpatient rehabilitation in a post-acute 
setting e.g. community hospitals) 
- 
Post-acute non inpatient teams (these teams include early supported discharge and community rehabilitation teams) 
- 
Six month assessment providers (community based teams that provide six month reviews) 
100% of routinely admitting teams and non-routinely admitting acute teams in England, Wales, Northern Ireland, and the Islands are registered on SSNAP. Recruitment of post-acute teams and teams providing six month assessments is continuing.  

## Background

The Sentinel Stroke National Audit Programme (SSNAP) has been collecting and reporting on the processes of stroke care since June 2013.  The Clinical Effectiveness and Evaluation Unit (CEEu) in the Care  Quality and Improvement Department of the Royal College of Physicians first conducted the National Sentinel Stroke Audit (NSSA) in 1998 (www.rcplondon.ac.uk/sentinel) and subsequently a total of 7 rounds were undertaken with 100% participation achieved since 2006. SSNAP combines the NSSA and the Stroke Improvement National Audit Programme (SINAP) which audited care in the first 72 hours after stroke between 2010 and 2012. (www.rcplondon.ac.uk/sinap). 

Aims of this report 

- 
To publish national and team level results for the entire inpatient stroke care pathway in the 
public domain. 
- 
To allow comparisons to be made between the latest results and the previous three reporting 
periods. 
- 
To describe the methods for calculating the pre-existing or upcoming national measures for stroke in England: the CCG Outcomes Indicator Set; and NICE Quality Standard for Stroke 
measures. 

## Organisation Of This Report

- 
Summary of overall performance by domains and key indicators (Section 1) 
- 
National level results for patient casemix (Section 2) 
- 
National level results for processes of acute stroke care in the first 72 hours (Section 3) 
- 
National level results for therapy provision (Section 4) 
- 
National level results for processes of care by discharge (Section 5) 
- 
Early Supported Discharge and Community Rehabilitation Results (Section 6) 
- 
Six month follow-up assessments (Section 7) 
- 
SSNAP Performance Tables (by named team) (Section 8) 

## Supplementary Reporting Outputs

With the exception of Section 8, this PDF report presents national level results. Detailed results by named teams are available on the SSNAP Reporting Portal www.strokeaudit.org/Results/National including: 

- 
Summary results spreadsheet: An overview of performance by reporting 44 Key Indicators 
within 10 domains of care by named team. 
- 
Full results portfolio: A very detailed reference document which includes 72 hour and discharge results for SSNAP data item by named team in addition to information about casemix, patient cohorts and pathways, and inter-team variation.   
- 
Regional slideshows: Hospital and ESD/CRT results are grouped by region and presented in graphs. 
- 
Dynamic maps: Allow you to find information about stroke services for your local provider. You can compare different standards of care within your team, and compare your local provider 
to 
other 
providers 
and 
against 
regional 
and 
national 
averages. 
www.strokeaudit.org/results/Clinical-audit/maps 

## Key Indicators, Domains And Scoring

44 Key Indicators have been chosen by the ICSWP as representative of high quality stroke care. 

These include data items included in the CCG Outcomes Indicator Set and NICE Quality Standards (covering England only). The key indicators are grouped into **10 domains** covering key aspects of the process of stroke care. Both patient-centred domain scores (whereby scores are attributed to every team which treated the patient at any point in their care) and team-centred domain scores (whereby scores are attributed to the team considered to be most appropriate to assign the responsibility for the measure to) are calculated.  

## Evidence Based Standards And Indicators

SSNAP is the single source of data for stroke in England and Wales. It provides the data for all other statutory data collections in England including the NICE Quality Standard and is the chosen method for collection of stroke measures in the NHS Outcomes Framework and the CCG Outcomes Indicator Set.  SSNAP metrics are aligned with those in the Cardiovascular Disease Outcomes Strategy.  SSNAP 
data are being used as risk indicators for Care Quality Commission's Intelligent Monitoring and for the Stroke Care in England NHS Marker. The results from this clinical audit compare delivery of care with standards derived from systematically retrieved and critically appraised research evidence and agreed by experts in all disciplines involved in the management of stroke. The strength of evidence is outlined in the guidelines. No references have been quoted in this report for reasons of space. All relevant evidence and standards are available in the following: 

- 
National clinical guideline for stroke 5th edition (Royal College of Physicians, 2016)  
www.strokeaudit.org/guideline    
- 
National clinical guideline for diagnosis and initial management of acute stroke and transient 
ischaemic attack (NICE, 2008) https://www.nice.org.uk/guidance/CG68  
- 
Stroke rehabilitation: Long-term rehabilitation after stroke (NICE 2013): 
www.nice.org.uk/CG162 
- 
NICE Quality Standard for Stroke 2016 https://www.nice.org.uk/guidance/qs2  

## Datasets And Methodology

A core, minimum dataset (Appendix 2) was developed by the ICSWP in collaboration with key stakeholders. Prospective data were collected via a secure web-based tool provided by Net Solving Ltd. Security and confidentiality are maintained through the use of passwords and a person specific registration process. Detailed help notes and FAQs are provided to ensure standard interpretation of the dataset questions across all participants. Data are analysed by the Stroke Programme at the Royal College of Physicians. 

Only 'locked' data are included in SSNAP analysis. The process of locking ensures high data quality and signifies that the data have been signed off by the lead clinician and are ready for central analysis. To view the SSNAP core dataset and help-notes, and for more details about the methods of data collection, submission and analysis, please visit https://www.strokeaudit.org/Support/Datasets.aspx  

## Eligibility And Audit Scope

SSNAP aims to measure the quality of stroke care along the patient pathway from initial admission, through all subsequent locations, up to and including six month assessment. Teams which treat at least 10 stroke patients a year at any point up to six months are eligible to participate. Data are therefore collected by different types of teams along the stroke pathway. These include: 

- 
Routinely admitting acute teams  (teams which admit stroke patients directly for acute 
stroke care) 
- 
Non-routinely admitting acute teams (teams which do not generally admit stroke patients 
directly but continue to provide care in an acute setting when patients have been transferred from place of initial treatment) 
- 
Non-acute inpatient teams (teams which provide inpatient rehabilitation in a post-acute 
setting e.g. community hospitals) 
- 
Post-acute non inpatient teams (these teams include early supported discharge and 
community rehabilitation teams) 
- 
Six month assessment providers. 
100% of routinely admitting teams and non-routinely admitting acute teams in England, Wales, Northern Ireland, and the Islands are registered on SSNAP. Recruitment of post-acute teams and teams providing six month assessments is continuing. Given the fact that these teams have not previously participated in national stroke audit there has been a slower uptake but more post-acute teams are submitting data to the audit each reporting period. 

## Section 1: Executive Summary: Summary Of Domain And Key Indicator Results

This section provides a summary of performance at national level. It is based upon results for 44 key indicators which are grouped into **10 domains** covering key aspects of stroke care (for more information see the section at the end of the report). The section begins with the **overall SSNAP score** calculated as follows:  

- 
Domain levels are combined into separate patient-centred and team-centred total key 
indicator scores 
- 
A **combined total key indicator score** is derived from the average of these two scores  
- 
This combined score is adjusted for **case ascertainment** and **audit compliance**  
Themes covered by the SSNAP domains: 

- 
Domain 1: Scanning 
- 
Domain 2: Stroke unit 
- 
Domain 3: Thrombolysis 
- 
Domain 4: Specialist assessments 
- 
Domain 5: Occupational therapy 
- 
Domain 6: Physiotherapy 
- 
Domain 7: Speech & language therapy 
- 
Domain 8: MDT working 
- 
Domain 9: Standards by discharge 
- 
Domain 10: Discharge processes 
Unless otherwise stated, 100% is the optimal performance. For timings, the shorter the median time to intervention the better. More information is available in the technical annex of the full results portfolio. 

 

Dec 2016-Mar 
SSNAP levels: 
Aug-Nov 2016 
2017 
Apr-Jul 2017 
Aug-Nov 2017 
218 teams 
225 teams 
219 teams 
219 teams 
A                     
41 (19%) 
36 (16%) 
51 (23%) 
44 (20%) 
B                   
60 (28%) 
60 (27%) 
62 (28%) 
79 (36%) 
C                     
64 (29%) 
61 (27%) 
56 (26%) 
49 (22%) 
D               
49 (22%) 
56 (25%) 
45 (21%) 
43 (20%) 
E    
4 (2%) 
12 (5%) 
5 (2%) 
4 (2%) 

A = First class service 
B = good or excellent in many aspects 
C = reasonable overall - some areas require improvement 
D = several areas require improvement 
E = substantial improvement required 
 
National expectation: 

Teams are expected to achieve an A or B SSNAP grade, such scores are indicative of world-class 
stroke care and a good or excellent service in many aspects respectively. A SSNAP score of a C or less 
would suggest that some or several areas of care require improvement. 

The maps below show the SSNAP level achieved by all *inpatient teams* in England, Wales, and Northern Ireland for the last four reporting periods.  Each symbol represents a team, colour coded by the overall score achieved. Teams with insufficient or no records are highlighted with an X. 

## You May Also Be Interested In…

SSNAP domain and key indicator results are also available in the form of interactive maps on the SSNAP Reporting Portal (www.strokeaudit.org/results/Clinical-audit/maps). These dynamic maps  
enable comparisons between standards of care within teams, and compare local providers against regional and national averages. 

## Domain 1: Scanning

What should be done? 

RCP National Clinical Guideline for Stroke, 5th Edition 
2.3.1 
E Acute stroke services should have continuous access to brain imaging including CT angiography and should be capable of undertaking immediate brain imaging when clinically indicated. 3.4.1 B Patients with suspected acute stroke should receive brain imaging urgently and at most within 1 hour of arrival at hospital. Distribution of scores across all inpatient teams for Domain 1 (140 teams) 
The map below shows the team centred performance of all *routinely admitting teams* for Domain 1. 

Each symbol represents a team, colour coded by the overall score achieved.   

 
Quality Improvement Case Study 
 
A good example of how SSNAP data have been used to improve the timeliness of brain scanning has been provided by Mid Yorkshire Hospitals NHS Trust. The model the stroke team implemented to ensure rapid brain scanning of suspected stroke patients could be adapted by other stroke services. It is available to read here: https://www.strokeaudit.org/AnnualReport/Case-Studies.aspx 
What should be done? 

RCP National Clinical Guideline for Stroke, 5th Edition 
2.2.1 B People with an acute neurological presentation suspected to be a stroke should be admitted directly to a hyperacute stroke unit which cares predominantly for stroke patients. C Acute hospitals receiving medical admissions that include people with suspected stroke should have arrangements to admit them directly to a hyperacute stroke unit on site or at a neighbouring hospital, to monitor and regulate basic physiological functions such as neurological status, blood glucose, oxygenation, and blood pressure. D Acute hospitals that admit people with stroke should have immediate access to a specialist stroke rehabilitation unit on site or at a neighbouring hospital. 

2.3.1 B People with suspected acute stroke (including when occurring in people already in hospital) should be admitted directly to a hyperacute stroke unit and be assessed for emergency stroke treatments by a specialist physician without delay. 2.4.1 A People with stroke should be treated on a specialist stroke unit throughout their hospital stay unless their stroke is not the predominant clinical problem. K A facility that provides treatment for in-patients with stroke should include:  

- 
a geographically-defined unit;  
- 
a co-ordinated multi-disciplinary team that meets at least once a week for the exchange of 
information about in-patients with stroke; 
- 
information, advice and support for people with stroke and their family/carers;  
- 
management protocols for common problems, based upon the best available evidence;  
- 
close links and protocols for the transfer of care with other in-patient stroke services, early 
supported discharge teams and community services;  
- 
training for healthcare professionals in the specialty of stroke. 
 
NICE Quality Standards Statement 1: Adults presenting at an accident and emergency (A&E) department with suspected stroke are admitted to a specialist acute stroke unit within 4 hours of arrival. [2010, updated 2016] 
Quality Improvement Case Study on improving stroke unit management 
 
Dr Andrew Hill, Stroke Consultant at Hospital St Helens and Knowsley NHS Trust, provides a powerful example of how SSNAP data have been used to explain locally why there were delays in stroke unit admission and subsequent acute assessments, and describes simple ways in which the stroke team were able to improve their performance without requiring additional resources. It is available here: https://www.strokeaudit.org/AnnualReport/Case-Studies/Using-SSNAP-Data.aspx 

## Distribution Of Scores Across All Inpatient Teams For Domain 2 (221 Teams)

The map below shows the team centred performance of all *inpatient teams* for Domain 2. Each symbol represents a team, colour coded by the overall score achieved. Teams with insufficient records submitted are highlighted with an X symbol. 

What should be done? 

RCP National Clinical Guideline for Stroke, 5th Edition 
3.5.1A Patients with acute ischaemic stroke, regardless of age or stroke severity, in whom treatment can be started within 3 hours of known onset should be considered for treatment with alteplase. 

- 
3.5.1E Alteplase should only be administered within a well-organised stroke service with: 
processes throughout the emergency pathway to minimise delays to treatment, to ensure that thrombolysis is administered as soon as possible after stroke onset;  
− 
staff trained in the delivery of thrombolysis and monitoring for post-thrombolysis 
complications; 
− 
nurse staffing levels equivalent to those required in level 1 or level 2 nursing care with 
training in acute stroke and thrombolysis;  
− 
immediate access to imaging and re-imaging, and staff appropriately trained to interpret the 
images;  
− 
protocols in place for the management of post-thrombolysis complications. 

## Distribution Of Scores Across All Inpatient Teams For Domain 3 (136 Team)

The map below shows the team centred performance of all *routinely admitting teams* for Domain 3. 

Each symbol represents a team, colour coded by the overall score achieved. Teams with insufficient records submitted are highlighted with an X symbol. 

## Domain 4: Specialist Assessments

What should be done? 

RCP National Clinical Guideline for Stroke, 5th Edition 
2.3.1B People with suspected acute stroke (including when occurring in people already in hospital) should be admitted directly to a hyperacute  stroke unit and be assessed for emergency stroke treatments by a specialist physician without delay. 3.10.1E Patients with acute stroke should have their swallowing screened, using a validated screening tool, by a trained healthcare professional within four hours of arrival at hospital and before being given any oral food, fluid or medication. 

 

## Distribution Of Scores Across All Inpatient Teams For Domain 4 (140 Teams)

 
 
The map below shows the team centred performance of all *routinely admitting teams* for Domain 4. 

Each symbol represents a team, colour coded by the overall score achieved. Teams with insufficient records submitted are highlighted with an X symbol 

## Domain 5: Occupational Therapy

 What should be done? 

RCP National Clinical Guideline for Stroke, 5th Edition 
2.11.1A People with stroke should accumulate at least 45 minutes of each appropriate therapy every day, at a frequency that enables them to meet their rehabilitation goals, and for as long as they are willing and capable of participating and showing measurable benefit  from treatment. NICE Quality Standards Statement 2: Adults having stroke rehabilitation in hospital or in the community are offered at least 45 minutes of each relevant therapy for a minimum of 5 days a week.  
[2010, updated 2016] 
The map below shows the patient centred performance of all *inpatient teams* for Domain 5. Each symbol represents a team, colour coded by the overall score achieved. Teams with insufficient records submitted are highlighted with an X symbol. 

## Domain 6: Physiotherapy

What should be done? 

RCP National Clinical Guideline for Stroke, 5th Edition 
2.11.1A People with stroke should accumulate at least 45 minutes of each appropriate therapy every day, at a frequency that enables them to meet their rehabilitation goals, and for as long as they are willing and capable of participating and showing measurable benefit from treatment. NICE Quality Standards Statement 2: Adults having stroke rehabilitation in hospital or in the community are offered at least 45 minutes of each relevant therapy for a minimum of 5 days a week. [2010, updated 2016] 
 
The map below shows the patient centred performance of all *inpatient teams* for Domain 6. Each symbol represents a team, colour coded by the overall score achieved. Teams with insufficient records submitted are highlighted with an X symbol. 

## Domain 7: Speech And Language Therapy

What should be done? 

RCP National Clinical Guideline for Stroke, 5th Edition 
2.11.1A People with stroke should accumulate at least 45 minutes of each appropriate therapy every day, at a frequency that enables them to meet their rehabilitation goals, and for as long as they are willing and capable of participating and showing measurable benefit from treatment. NICE Quality Standards Statement 2: Adults having stroke rehabilitation in hospital or in the community are offered at least 45 minutes of each relevant therapy for a minimum of 5 days a week. [2010, updated 2016] 
 
The map below shows the patient centred performance of all *inpatient teams* for Domain 7. Each symbol represents a team, colour coded by the overall score achieved. Teams with insufficient records submitted are highlighted with an X symbol. 

Domain 8: Multidisciplinary team working  
RCP National Clinical Guideline for Stroke, 5th Edition 
4.4.1.1A People with communication problems after stroke should be assessed by a speech and language therapist to diagnose the problem and to explain the nature and implications to the person, their family/carers and the multidisciplinary team. Reassessment in the first four months should only be undertaken if the results will affect decision making or are required for mental capacity assessment. 

## Distribution Of Scores Across All Inpatient Teams For Domain 8 (140 Teams)

The map below shows the team centred performance of all *routinely admitting* teams for Domain 8. 

Each symbol represents a team, colour coded by the overall score achieved.  
What should be done? 

RCP National Clinical Guideline for Stroke, 5th Edition 
2.12.1F Services for people with stroke should include specialist clinical neuropsychology/clinical psychology provision for severe or persistent symptoms of emotional disturbance, mood or cognition. 4.7.1F Patients with stroke who are unable to maintain adequate nutrition and fluids orally should be: 

− 
referred to a dietitian for specialist nutritional assessment, advice and monitoring; 
− 
 be considered for nasogastric tube feeding within 24 hours of admission; 
− 
assessed for a nasal bridle if the nasogastric tube needs frequent replacement, using locally 
agreed protocols; 
− 
Assessed for gastrostomy if they are unable to tolerate a nasogastric tube with nasal bridle. 
 

## Distribution Of Scores Across All Inpatient Teams For Domain 9 (220 Teams)


The map below shows the team centred performance of all *inpatient teams* for Domain 9. Each symbol represents a team, colour coded by the overall score achieved. Teams with insufficient records submitted are highlighted with an X symbol.  

## Domain 10: Discharge Processes

What should be done? 

RCP National Clinical Guideline for Stroke, 5th Edition 
2.7.1A Hospital in-patients with stroke who have mild to moderate disability should be offered early supported discharge, with treatment at home beginning within 24 hours of discharge NICE Quality Standards Statement 4: Adults who have had a stroke are offered early supported discharge if the core multidisciplinary stroke team assess that it is suitable for them. [2016] 
The map below shows the team centred performance of all *inpatient teams* for Domain 10. Each symbol represents a team, colour coded by the overall score achieved. Teams with insufficient records submitted are highlighted with an X symbol. 

 

## Section 2: Casemix

Casemix describes the characteristics of the group (or cohort) of stroke patients treated by a team. It includes demographics and type of stroke. The figures for casemix are used in other reports to adjust for patient outcomes including mortality. It is therefore extremely important that the casemix data entered is of the highest quality and validated by the lead clinical contact. The casemix figures in this section relate to those patients admitted between April 2016 and March 2017. The casemix of the patients discharged during this current time period are very similar and have not been included in this public report. Comprehensive tables outlining casemix data for the past four reporting periods can be found in the appendix of this report. Teams have the ability to analyse their own casemix during interim periods, they can do so via the downloadable casemix tool.  
In April 2016- March 2017, the percentage of patients newly arriving in hospital was 94.3% and the number of patients that were inpatients at the time of stroke was at 5.7%. 

## 2.1 Patient Numbers

85,122 patients were included in the April 2016 - March 2017 report. Of these 80,235 (94.3%)  
patients were newly arriving in hospital and 4,887 (5.7%) patients were already in hospital at the time of stroke. 

## 2.2 Gender

Of all stroke patients admitted and discharged between April 2016 to March 2017 48.8% have been female and 51.2% have been male. 

## 2.3 Age

The median age for April 2016-March 2017 is 77 years. 

Comment The patients being entered onto SSNAP appear to be very similar in terms of age to previous audits that we have conducted (Sentinel and SINAP). 


## 2.4 Co-Morbidities

The types of co-morbidities for  April 2016 - March 2017 are as follows.  

- 
5.4% Congestive Heart Failure  
- 
53.3% Hypertension  
- 
20.8%Diabetes  
- 
26.1% Stroke/TIA  
- 
19.7% Atrial Fibrillation  
SSNAP collects information on the type of co-morbidity of patients that are admitted with stroke. 

Data for the last four reporting periods suggest that there is very little change in this area (See appendix). 

 

## Overview

The following section discusses atrial fibrillation as reported by SSNAP. Atrial fibrillation, or AF, is a heart condition that causes an irregular and often abnormally fast heartbeat. SSNAP reports on AF status upon admission to hospital, on leaving hospital, and at six months after stroke. SSNAP also provides information on provision of anti-coagulation medication. These are medicines that help prevent blood clots by interrupting the process involved in their formation. Increasing the proportion of people with AF on anticoagulants will reduce the number of people having stroke. 

About 20% of patients have been reported as being in AF before their stroke and this has been largely consistent across the four years of SSNAP reporting. Increasingly fewer patients are being prescribed anti-platelet medication deemed ineffectual for patients with AF which is reassuring. Conversely more than 50% of patients with AF are now on anticoagulant medication, which reduce risk of stroke. This is a substantial increase from only 38% in the first year of SSNAP reporting but much work still needs to be done to ensure all patients who would benefit from anti coagulant medication are prescribed them. More detailed information on atrial fibrillation is provided in the appendix.  

## Atrial Fibrillation On Admission

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
N=5313 
N=5739 
N=5325 
N=5449 
If patient has Atrial Fibrillation, was the patient on antiplatelet medication prior to admission? (Q2.1.6)  
Yes 
22.5% 
21.2% 
19.5% 
17.7% 
F6.6 
No 
64.9% 
65.2% 
65.5% 
67.1% 
F6.8 
No but 
12.6% 
13.6% 
15.0% 
15.2% 
F6.10 

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
N=5313 
N=5739 
N=5325 
N=5449 
If patient had Atrial Fibrillation, was the patient on anticoagulant medication prior to admission? (Q2.1.7) 
Yes 
53.8% 
54.0% 
56.5% 
59.0% 
F6.13 
No 
35.5% 
35.1% 
32.2% 
29.2% 
F6.15 
No but 
10.7% 
10.9% 
11.3% 
11.7% 
F6.17 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
N=5313 
N=5739 
N=5325 
N=5449 
If patient had Atrial Fibrillation, what combination of 
anticoagulant and antiplatelet medication was the patient on prior to admission? 
Anticoagulant AND 
antiplatelet medication 
3.3% 
3.4% 
3.4% 
3.6% 
F6.20 
Anticoagulant medication 
only 
50.5% 
50.6% 
53.1% 
55.5% 
F6.22 
Antiplatelet medication 
only 
19.1% 
17.8% 
16.1% 
14.1% 
F6.24 
Neither medication 
27.1% 
28.2% 
27.4% 
26.9% 
F6.26 
 

Comment: These data are similar to the last National Sentinel Stroke Audit and reveal that there are still major issues in primary and secondary care about ensuring that patients have effective stroke prevention. Approximately one fifth of patients are in atrial fibrillation (AF) on admission. Over  55% of patients in AF on admission are taking anticoagulants with almost 15% taking only antiplatelet drugs which are considered ineffective for patients in AF. Over a quarter of patients have had a prior stroke or TIA. 

## Atrial Fibrillation On Discharge

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
If discharged alive, is patient in  Atrial Fibrillation (AF) (Q7.10) 
N=22834 
N=23749 
N=23951 
N=24232 
Patient in Atrial Fibrillation 
21.3% 
22.6% 
21.6% 
21.9% 
J32.3 


Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
If in AF, patient given anticoagulation (Q7.10.1) 
N=4858 
N=5361 
N=5167 
N=5311 
Yes 
83.3% 
85.0% 
86.2% 
85.7% 
J32.6 
No 
2.1% 
1.8% 
1.6% 
1.7% 
J32.8 
No but 
14.6% 
13.2% 
12.2% 
12.6% 
J32.10 
Applicable for receiving anticoagulation 
15.6% 
16.6% 
16.4% 
16.5% 
J32.13 
Compliant 
97.5% 
98.0% 
98.2% 
98.1% 
J32.16 

 
About 20% of patients are recorded as being in AF upon leaving hospital. Over 95% of patients deemed applicable for anti-coagulant medication are being prescribed these drugs upon leaving hospital which is reassuring. This also represents a 5% increase in anti-coagulation provision since the first year of SSNAP reporting in 2013/14. 

## Atrial Fibrillation At Six Months

SSNAP provides an opportunity to measure the number of patients identified as being in AF six months post admission. From April 2014 a "not known" option was added to the dataset for the following questions, however the percentage of patients for whom "not known" was answered is less than 8. It is important to note that SSNAP only has information on a subset of patients at 6 months, approximately 30-35% of all patients deemed applicable for a six month assessment due to low case ascertainment levels. More details on the rationale and methodology for collecting data on patients at six months after stroke is provided in the six month section of this report. 

 
Between 20-25% of patients are reported to be in AF at six months, with about 80% of these patients taking anti-coagulant medication.  However close to 20% of patients who were prescribed anti-coagulant medication upon leaving hospital were no longer taking them at six months. This is concerning particularly as the percentage has remained quite stable over time. More details on medication at six months including anti-platelets, lipid lowering and anti-hypertensive is provided in the appendix of this report. 


## 2.5 Stroke Type

Stroke Type (Q2.5) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Infarction 
87.1% 
87.2% 
87.9% 
87.2% 
F7.3 
Intracerebral Haemorrhage 
12.5% 
12.3% 
11.5% 
12.3% 
F7.5 
Unknown (not scanned) 
0.4% 
0.5% 
0.5% 
0.4% 
F7.7 

## 2.6 Modified Rankin Scale Scores Before Stroke

This is fully recorded for all patients in this cohort. 

 

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Modified Rankin Scale score before stroke (Q2.2) 
0 (no symptoms) 
55.0% 
54.2% 
54.1% 
53.7% 
F8.3 
1 (no significant disability) 
14.7% 
15.0% 
15.9% 
15.7% 
F8.5 
2 (slight disability) 
10.3% 
10.7% 
10.6% 
10.3% 
F8.7 
3 (moderate disability) 
12.0% 
12.1% 
11.6% 
12.0% 
F8.9 
4 (moderately severe disability) 
6.2% 
6.4% 
5.8% 
6.6% 
F8.11 
5 (severe disability) 
1.8% 
1.6% 
2.0% 
1.8% 
F8.13 
Groups 
  
  
  
  
  
1 or 2 
25.0% 
25.7% 
26.5% 
26.0% 
H1.12 
3, 4 or 5 
20.0% 
20.1% 
19.4% 
20.4% 
H1.13 
 

Comment: These data reinforce the message that stroke often occurs in frail patents. Approximately half of the cohort had restriction of activity before their stroke (Rankin score greater than 0) with approximately one fifth having very significant pre-stroke problems (Rankin Score greater than 2). 

These data will be used in the future to evaluate stroke outcomes at six months to assess how effective treating the stroke has been.  

 

## 2.7 Completion Rate Of Nihss Items

High quality data are needed to assess the severity of stroke at admission. The best way of doing this is by using the National Institutes of Health Stroke Scale (NIHSS). It is a 15 item scale with one item that is mandatory on SSNAP (level of consciousness (LOC)). NIHSS completion is included in the audit compliance score for individual teams with the expectation that completion rates will continue to improve. 

 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Number of NIHSS components completed (Q2.3) 
1 (only the compulsory LOC) 
4.2% 
4.2% 
3.1% 
3.1% 
F9.12 
2-14 
3.9% 
3.6% 
3.8% 
3.3% 
F9.14 
15 (all components) 
91.9% 
92.2% 
93.2% 
93.7% 
F9.16 

Comment: It is encouraging to see a consistent increase in the rate of NIHSS completion each reporting period. Completing an NIHSS for all stroke patients is fundamental in quantifying the level of impairment caused by a stroke and we would expect the level of completion to continue to increase in future reporting periods. 

 

## 2.8 Summary Of Total Nihss Score

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
If NIHSS fully completed, severity groups: 
N=25106 
N=26333 
N=26232 
N=26879 
F9.17 
0 
7.0% 
6.8% 
7.2% 
7.2% 
F9.19 
1-4= minor stroke 
42.1% 
41.0% 
43.2% 
41.9% 
F9.21 
5-15= moderate stroke 
35.0% 
35.7% 
34.4% 
34.7% 
F9.23 
16-20= moderate/severe stroke 
7.4% 
7.6% 
6.7% 
7.4% 
F9.25 
21-42= severe stroke 
8.5% 
8.9% 
8.5% 
8.8% 
F9.27 

 
Median and mean NIHSS scores are publicly available in the full results portfolio, which is available at 
the link below. 
https://www.strokeaudit.org/results/Clinical-audit/National-Results.aspx  

Comment: A score of 0 does not mean that the patient did not have a stroke. There are deficits that are 
unrecorded by the score and some patients will have presented after the first 24 hours following stroke 
and have made a complete recovery. The distribution of the NIHSS scores is in line with what we 
expected again reassuring us that a representative sample of stroke patients is being submitted to 
SSNAP. 

 

## 2.9 Palliative Care Within 72H

All data items collected regarding palliative care can be found within the Full Results Portfolio  within 
the casemix tab. https://www.strokeaudit.org/results/Clinical-audit/National-Results.aspx  
 

Palliative Care Decisions 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
5.5% 
5.7% 
5.3% 
5.7% 
F10.3 
Has it been decided in the first 72 hours that the patient is for palliative care? (Q3.1) 

Comment: About 6% of patients have such severe strokes that a decision is made within the first 72 
hours to palliate. 

 

## 2.10 Onset Of Symptoms

The provision of standards of care within a specific timeframe depends on whether or not the day and time of onset can be obtained. The audit recognises that it may not be possible to identify a precise time for all patients, in which case the 'best estimate' is used. 

 

Date of symptom onset (Q1.11.1) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Precise 
66.1% 
66.1% 
65.8% 
64.7% 
H2.3 
Best estimate 
21.6% 
21.1% 
21.1% 
22.0% 
H2.5 
Stroke during sleep 
12.3% 
12.9% 
13.1% 
13.3% 
H2.7 
 
Time of symptom onset (Q1.11.2) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Known 
68.4% 
68.6% 
68.4% 
68.2% 
H2.17 
Precise 
32.7% 
33.0% 
33.7% 
32.6% 
H2.10 
Best estimate 
35.8% 
35.7% 
34.7% 
35.6% 
H2.12 
Not known 
31.6% 
31.4% 
31.6% 
31.8% 
H2.14 

 Time of onset is an important measure of data quality as it reflects the care taken to ascertain the time of onset as accurately as possible. From a clinical perspective a known time of onset will determine whether patients are appropriate for thrombolysis and intra-arterial treatment. 

Comment: It is notable that a low percentage of patients reported as having stroke during sleep. The data highlights how important it is that specialist services are available 24 hours a day and seven days a week.  
 

## 2.11 Ethnicity

|                                             |        | Ethnicity (Q1.8)    |   April 2015-March 2016  | April 2016-March 2017    |
|---------------------------------------------|--------|---------------------|--------------------------|--------------------------|
| Known                                       | 79069  | 93.9%               |                   79922  | 93.9%                    |
| White                                       | 74408  | 88.4%               |                   75216  | 88.4%                    |
| Mixed / multiple ethnicity group            |   374  | 0.4%                |                     321  | 0.4%                     |
| Asian / Asian British                       |  2381  | 2.8%                |                    2342  | 2.8%                     |
| Black / African / Caribbean / Black British |  1048  | 1.2%                |                    1045  | 1.2%                     |
| Other ethnic group                          |   858  | 1.0%                |                     998  | 1.2%                     |
| Not known                                   |  5115  | 6.1%                |                    5200  | 6.1%                     |

 Due to low numbers in some categories, the ethnicity data is reported on an annual cohort. The high proportion of not known responses indicates difficulties in collecting this data. Furthermore the low completion rate makes the results difficult to interpret. 

 

## Introduction: Getting To Hospital Fast

It is important for patients to get to hospital as soon as possible following a stroke to ensure they receive the specialist care needed to reduce the impact of stroke and ensure the patient has the best possible chance of making a recovery. SSNAP reports timings from onset of stroke to arrival at hospital as well as timings for receiving key interventions such as scanning and thrombolysis. Since SSNAP started collecting data in April 2013, onset to arrival times at hospital have increased year on year at national level which is a cause for concern and will need to be continuously monitored. 

Median onset to arrival time for 2016/2017 was 2 hours and 50 minutes, an increase of 25 minutes from data reported in 2013/2014. It should be noted that the percentage of patients arriving on the same day as stroke has reduced year on year. The tables below provide latest periodic results.  

## 3.1 Timings From Onset

Aug-Nov 2016 
Dec 2016-Mar 
2017 
Apr-Jul 2017 
Aug-Nov 2017 
Ref 
Timings from onset (precise and best estimate times) (Q1.11.1 and 1.11.2) 
H3.1 H3.2 
Time from onset to  arrival †  
Median (h:mm) 
2:54 
2:50 
2:58 
3:01 
 (IQR)  
(1:30-8:52) 
(1:28-8:37) 
(1:29-9:20) 
(1:33-9:21) 
H3.3 H3.4 H3.5 
Time from onset to stroke unit admission* Median (h:mm) 
7:33 
7:56 
7:30 
7:40 
 (IQR)   
(4:18-20:04) 
(4:20-21:01) 
(4:10-20:17) 
(4:18-20:00) 
H3.6 H3.7 H3.8 
Time from onset to scan* Median (h:mm) 
4:02 
3:55 
4:05 
4:03 
(IQR)   
(2:00-11:56) 
(1:57-11:23) 
(1:59-12:03) 
(2:03-11:54) 
H3.9 
H3.10 
H3.11 
Time from onset to thrombolysis* 
Median  (h:mm) 
2:25 
2:25 
2:24 
2:25 
 (IQR) 
(1:50-3:09) 
(1:51-3:09) 
(1:50-3:08) 
(1:51-3:10) 
H3.12 

†excluding in hospital stroke onset 
*including in hospital stroke onset 
 

Comment: There are clearly major improvements to be made in terms of reducing the time from 
symptom onset to arrival in the hospital. This will require further campaigns such as the FAST campaign 
to improve the understanding of the public and also work with the ambulance services to reduce the 
time from call to hospital arrival. 

 

## 3.2 Arrival By Ambulance

Over 80% of patients newly arriving at hospital following their stroke arrival by ambulance. This percentage has been approximately 82% consistently over the four years of SSNAP reporting. Exact percentages on changes over time are provided in the appendix of this report.  
Comment: As in previous audits, most patients arrive at hospital by ambulance, highlighting the importance of ensuring that paramedics are seen as an integral part of the stroke team and are included in training education and quality improvement. We aspire to link ambulance data to SSNAP so that we can report an accurate account of the whole acute care pathway. 

## 3.3 Timings From Clock Start

Clock start is defined as the time of arrival for newly arrived patients, and the symptom onset time 
(precise and best estimate) for patients who have a stroke while in hospital. There have been continuous improvements in clock start to thrombolysis times and even more substantial improvements in clock start to scan times in the past four years as reported by SSNAP. Time to stroke unit admission has been more varied however and may reflect delays in A&E and as well as lack of available stroke unit beds. Most recent results are provided in the table below. 

| Timings from clock start       | Aug-Nov 2016    |
|--------------------------------|-----------------|
| Dec 2016-Mar                   |                 |
| 2017                           |                 |
| Apr-Jul 2017                   | Aug-Nov 2017    |
| H7.4                           |                 |
| H7.5                           |                 |
| Time from clock start to first |                 |
| arrival on a stroke unit       |                 |
| Median (h:mm)                  | 3:38            |
| (IQR)                          | (2:07-6:48)     |
| H6.4                           |                 |
| H6.5                           |                 |
| Time from clock start to scan  |                 |
| Median (h:mm)                  |                 |
| 0:59                           | 0:55            |
| (IQR)                          | (0:23-2:33)     |
| (0:22-2:23)                    |                 |
| H6.6                           |                 |
| H16.42                         |                 |
| H16.43                         |                 |
| Time from clock start to       |                 |
| thrombolysis                   |                 |
| Median (h:mm)                  | 0:51            |
| (IQR)                          | (0:36-1:15)     |
|                                |                 |

## 3.4 Period Of Arrival Arriving In Hours V Out Of Hours

Arrival times have remained fairly consistent in recent years with slightly more patients arriving at hospital 'out of hours', approximately half of all patients, with about 45% arriving during 'normal hours. Between 5-6% of patients had their onset of stroke whilst already an inpatient. More details are available in the appendix. 

## 3.5 Brain Scanning (Domain 1)

Contextualising information regarding brain scanning of stroke patients is provided in the 'executive summary' section of this report. 

Virtually all patients are brain scanned during their hospital stay. The new RCP National Clinical Guideline for Stroke (fifth edition, 2016) recommends that all patients are scanned within 1 hour, and this is now being achieved for more than half of stroke admissions. It is appreciated that this change will take time to implement. The National Clinical Guideline for Stroke 2012 recommended that all patients are scanned within 12 hours of clock start; this standard has been achieved for more than 90% of all patients.  
Comment: Improved access to scanning has been one of the main successes in stroke care over recent years, with over 90% of patients in the cohort for this report being scanned within 12 hours. Many services appear to be adopting the logical policy of scanning patients immediately on arrival at hospital. However SSNAP data has shown that there is a lower chance of patients being scanned at weekends than during the week and there are still relatively few patients scanned at night time. 

 

## 3.6 Stroke Unit Admission (Domain 2)

Over 95% of applicable stroke patients now spend at least some of their time on a stroke unit. More information on the importance of stroke units is provided in the executive summary. Timings for onset and arrival to stroke unit admission are provided in the previous section. The graph below demonstrates domain 2, stroke unit scores over time for routinely admitting teams. It is important to analayse routinely admitting teams and non-routinely admitting teams separately in the stroke unit domain, this is because non-routinely admitting teams are only measured on the 
90% of stay on a stroke unit measure and not the speed at which a patient is directly admitted to their stroke unit. 

## 3.7 First Ward Of Admission

It is acknowledged that for a small proportion of patients direct admission to a stroke unit is not appropriate and the audit captures and differentiates between those who go to an acceptable other location (e.g. intensive care) compared to a 'non acceptable' location (e.g. generic admissions unit). 

It is encouraging that since 2013 a lower proportion of patients are being admitted to a general medical ward, 21% in 2013/2014 to fewer than 15% in 2016/2017, and that nearly 80% of patients are now admitted directly to a specialist stroke unit. Most recent results are provided in the table below. Despite these improvements there is wide hospital level variation in direct stroke unit admissions as reported in the SSNAP full results portfolio. More work is required to address this. 

First ward of admission (at first admitting team) (Q1.14) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Stroke Unit 
78.9% 
77.8% 
79.1% 
79.4% 
H7.11 
14.3% 
14.8% 
14.2% 
13.7% 
H7.9 
Medical Assessment Unit / Acute Admissions Unit / Clinical Decisions Unit (unacceptable) 
2.2% 
2.3% 
2.1% 
2.2% 
H7.13 
Intensive Therapy Unit / Coronary Care Unit / High Dependency Unit (acceptable) Other (unacceptable) 
4.6% 
5.1% 
4.6% 
4.8% 
H7.15 
 

Comment: Almost all of this group of patients were treated at some time during their stay on a stroke unit although it is still of great concern that such a large percentage of patients are admitted initially to a general ward such as a medical admission unit. Direct admission to a stroke unit remains the most important intervention we have for acute stroke and so it is concerning that a significant number of patients are failed in this way. Correcting this part of the pathway should be a top priority for all hospitals operating such systems. In some cases this will be understandable if the patient has their stroke post-surgery or while on an intensive care unit, but we know that in-hospital stroke patients do tend to be identified and managed more slowly. 

 

## 3.8 Thrombolysis (Domain 3)

Thrombolysis is a clot busting drug which can be a very effective way of treating ischaemic strokes 
(caused by blood clot). The eligibility criteria for thrombolysis are based on age, type of stroke and time lapse since stroke onset. Based on these criteria, it is expected that between 15 and 20% of patients would be eligible for thrombolysis. More details on thrombolysis are provided in the executive summary. 

Was the patient given 
thrombolysis (Q2.6) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Yes 
11.5% 
11.6% 
12.0% 
11.2% 
H16.3 
No 
1.0% 
1.4% 
1.0% 
0.6% 
H16.5 
Thrombolysis not 
available at hospital 
0.6% 
0.4% 
0.3% 
0.4% 
H16.14 
Outside thrombolysis 
service hours 
0.2% 
0.5% 
0.1% 
0.0% 
H16.16 
Unable to scan quickly 
enough 
0.0% 
0.0% 
0.0% 
0.0% 
H16.18 
None 
0.2% 
0.5% 
0.5% 
0.2% 
H16.20 
No but* 
87.5% 
87.0% 
87.0% 
88.2% 
H16.11 

*Since a patient can have more than one "no but" reason, the breakdown is given in the above table. 

## Comment: It Is Encouraging To See That A Higher Level Of Thrombolysis Is Being Sustained Compared To Other High Income Countries.

'No but' is answered when there was a medical reason stated for not giving thrombolysis according to the hospital. The most common reasons are outlined below for April 2016 - March 2017 and year on year changes are available in the annual portfolio for 2016/2017.  

- 
32.4% Patient arrived outside the time window for thrombolysis 
- 
37.2% Wake up time unknown 
- 
13.7% Stroke too mild/severe 
- 
14.6% Haemorrhagic stroke 
Other reasons for not giving thrombolysis were that the patient's condition was improving, the patient had other co-morbidities and 'other medical reasons'. Other less common 'No but' reasons were the patient's age, medication, and patient refusal. 

Further details of less common "No but" reasons, can be found within the results portfolio.  
www.strokeaudit.org/results/national 

## 3.8.1 Thrombolysis Timings

For patients who are thrombolysed SSNAP data from 2013-2017 have shown that: 

- 
Onset to clock start has increased slightly from 1 hour 16 minutes to 1 hour 22 minutes 
- 
Clock start to scan has reduced a few minutes from 23 minutes to 19 minutes 
- 
Time from scan to thrombolysis has remained steady at approximately 30 minutes 
Comment: These data show there are still improvements to be made in door to needle time for patients receiving thrombolysis. There are big variations between units demonstrating that it is possible to set services up to operate more efficiently. 

 
Most recent data is available in the appendix. 

The heatmaps below demonstrate the variation across time of day and day of week. The first of which highlights varation in the administration of thrombolysis if the patient has an iscahemic stroke. The second map highlights the day and time variation for thrombolysis to be administered within 60 minutes. 

## 3.8.2 Thrombolysis Based On Eligibility

There are several reasons why thrombolysis might not be clinically appropriate for certain patients. This section presents results for eligible patients only. Eligibility is defined by the National Clinical Guideline for Stroke 2016 and includes: 
Patients with a final diagnosis of stroke (Q1.9 recorded as 'Stroke'), and one of: 

- 
newly arrived patients aged under 80 with an onset to arrival time of less than 3.5 hours 
- 
newly arrived patients aged 80 or over with an onset to arrival time of less than 2 hours 
- 
patients already in hospital at time of stroke 
except patients with at least one medical reason for not giving thrombolysis that is **consistent** with information provided in other sections of the audit. 

Minimum threshold for thrombolysis 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
11.6% 
12.0% 
12.0% 
11.1% 
H16.50 
Percentage of patients eligible for thrombolysis (according to the RCP guideline minimum threshold) 
88.1% 
85.5% 
87.4% 
88.3% 
H16.55 
Percentage of eligible patients (according to above threshold) who were given thrombolysis 

 See the 'Technical Information' section of the 'Full Results Portfolio' on the SSNAP reporting portal for more details about how eligibility is calculated. 

## 3.8.3 Complications Following Thrombolysis

Thrombolysis carries two main risks, brain haemorrhage (bleeding into the brain which can be fatal) 
and swelling of the mouth and face. Swelling (AO) is more common in people taking one type of blood pressure lowering medicine (ACE inhibitor), it needs prompt recognition and treatment and resolves quite rapidly. Complication rates and type are provided in the tables below. 

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Thrombolysis complications (Q2.8) if patient received thrombolysis 
Patient had complications 
7.7% 
7.5% 
8.8% 
8.1% 
H17.3 
(243/3137) 
(249/3309) 
(297/3389) 
(261/3210) 
H17.1 H17.2 
(Patients with complications/total number thrombolysed) 

 

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Type of complication (as 
reported) (Q2.8.1)* 
N=3137 
N=3309 
N=3389 
N=3210 
Symptomatic  intracranial haemorrhage (SIH) 
3.8% 
3.5% 
3.6% 
4.2% 
H17.6 
Angio oedema (AO) 
0.8% 
0.5% 
0.8% 
0.5% 
H17.8 
Extracranial bleed (EB) 
0.5% 
0.4% 
0.8% 
0.4% 
H17.10 
Other 
2.8% 
3.2% 
3.7% 
3.2% 
H17.12 
*some patients had more than one type of complication 
 

## Comment: The Symptomatic Intracranial Haemorrhage Rate In Patients Treated With Thrombolysis Is In Line With Data From Randomised Controlled Trials.

 

## 3.8.4 Nihss 24 Hours After Thrombolysis (Measuring Stroke Severity/Recovery After Thrombolysis)

Cases that do not report NIHSS 24h after thrombolysis cannot be used in analyses into clinical outcomes after thrombolysis. SSNAP therefore requires high completion rates of NIHSS scores 24 
hours after thrombolysis. Teams with less than 90% completion rate of NIHSS score after 24 hours are excluded from the SSNAP Collaboration. The SSNAP collaboration is an acknowledgement for use in peer reviewed papers, more details of which can be found in the link below. 

https://www.strokeaudit.org/Research/SSNAP-Collaboration.aspx 

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
NIHSS 24h after thrombolysis, if patient received thrombolysis (Q2.9) 
N=3137 
N=3309 
N=3389 
N=3210 
Known 
94.1 
94.3 
93.3 
94.4 
H18.3 
Not known 
5.9 
5.7 
6.7 
5.6 
  


Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 


If NIHSS 24h after thrombolysis is known, severity groups: 
N=2951 
N=3121 
N=3163 
N=3031 
0 
15.1 
15.2 
15.7 
14.2 
H18.6 
1-4 (minor stroke) 
33.8 
33.4 
34.0 
34.9 
H18.8 
5-15 (moderate stroke) 
33.5 
33.2 
32.8 
31.5 
H18.10 
16-20 (moderate/severe stroke) 
9.1 
9.0 
8.3 
8.7 
H18.12 
21-42 (severe stroke) 
8.4 
9.2 
9.1 
10.7 
H18.14 
 

Comment: A higher percentage of stroke admissions are thrombolysed than nearly every other country. The majority of patients not being thrombolysed, when there were no medical contraindications, were the result of services not being available on site or at the hour the patient arrived. Reorganisation of services is urgently needed in those areas that are still not providing specialist 24 hour hyperacute stroke care. 

 

## 3.9 Emerging Treatment: Thrombectomy

Thrombectomy is an emerging treatment in ischaemic stroke. It involves insertion of a guidewire catheter tube into an artery in the groin, and feeding this up into the blocked artery in the brain. The clot is then removed using a mechanical device with the aim of restoring blood and oxygen flow to the brain. If technically successful and done in time thrombectomy can greatly improve the outcome of the brain injury due to stroke in selected patients. 

The evidence base for using thrombectomy in treating ischaemic stroke has expanded enormously over the past 2 years but the implications for implementation in routine clinical practice are still emerging. For any service providing thrombectomy, ensuring that treatment is provided safely and effectively is of the highest clinical importance. For this reason SSNAP added questions on intraarterial therapy to the mandatory core dataset on 1 October 2015. Between April 2016 and March 2017, it was reported that 220 patients out of 24,912 ischaemic stroke patients received intraarterial intervention and data on thrombectomy was submitted by 29 teams. The median number of thrombectomies per team was 5 (IQR 2-8) with one team carrying out 34 and three teams carrying out 19-29. According to the 2016 Acute Organisational Audit 107 out of 158 sites that treat patients in the first 72 hours (including two neurosurgical centres), are able to provide patients with intraarterial thrombectomy either on site (28/158) or by referral (51/158). Though it is not possible to make meaningful conclusions on thrombectomy provision based on such low numbers at this early stage of data collection, median thrombectomy timings are provided in the table below to give the reader some insight into proposed future reporting. As thrombectomy provision becomes more widely available to patients across the country, it is expected that the number of cases submitted to SSNAP will continue to increase making the data more robust. It will then be possible to provide more detailed results. Until the uptake of intra-arterial intervention increases and this is reflected in SSNAP data, national level results only will be reported on.  Teams performing thrombectomies can however access their thrombectomy results through bespoke thrombectomy tools, available within the team level results section of the webtool. 

 

Thrombectomy timings 
Aug-Nov 2016 
Dec 2016-Mar 
2017 
Apr-Jul 2017 
Aug-Nov 2017 
Ref 
Number of patients receiving thrombectomy 
155 
220 
222 
272 
H.20.1 
H20.4 
243 
240 
250 
242 
H20.5 
Onset to puncture  
Median (min) (IQR)  
(176-312) 
(185-308) 
(180-300) 
(183-310) 
H20.6 H20.7 
310.5 
298 
297.5 
297 
H20.8 
Onset to completion 
Median (min) 
(IQR)  
(248.5-374) 
(241-370) 
(241-369) 
(240-357) 
H20.9 
H20.10 
130 
142 
153 
139 
H20.11 
Clock start to puncture 
Median (min) 
(IQR)  
(90-204) 
(81.5-205) 
(82-207) 
(86-196) 
H20.12 
21.5 
20 
20 
20 
H20.13 H20.14 
Puncture to deployment* 
Median (min) 
(IQR)  
(11-34) 
(12-30) 
(12-34) 
(13-32) 
H20.15 H20.16 
53 
54.5 
50 
48 
H20.17 
Puncture to end of procedure* Median (min) (IQR)  
(34-81.5) 
(32-75) 
(30-79) 
(30-76.5) 
H20.18 

*For patients where the device was not deployed these  patients have been excluded from this timing Annual thrombectomy data for 2016/17 is available here: https://www.strokeaudit.org/Results3/Clinical/National.aspx 

## 3.10 Specialist Assessments (Domain 4)

Following admission, there are a number of assessments that are considered mandatory elements of high quality stroke care. Some assessments (e.g. being seen by a nurse or stroke consultant) are applicable for all stroke patients. There are other instances where certain assessments do not apply for valid reasons. In these cases, teams can answer 'No but' and the record is excluded from the analysis of that particular standard. For example some patients may not need a formal swallow assessment as they had already passed their initial swallow screen. The 'compliant' percentage in the tables below indicates the proportion of *applicable* patients receiving the assessment in question. 

## 3.10.1 Swallowing Screening And Assessments

Swallow screening within 4h (Q2.10)   
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
90.7% 
90.2% 
91.3% 
90.8% 
H14.17 
Percentage of patients applicable to have swallow screening within 4h* 
74.0% 
73.5% 
75.7% 
76.3% 
H14.20 
Percentage of applicable patients who had swallow screening in 4 hours 
1:21 
1:19 
1:17 
1:16 
H14.12 H14.13 
Median (IQR) time from clock start to  swallow screening within 4h (h:mm) 
(0:43-2:25) 
(0:42-2:22) 
(0:41-2:18) 
(0:40-2:19) 
H14.14 

*Applicable patients are those for whom Q2.10.1 is not answered "Patient refused" or "Patient medically unwell until time of screening" 
 

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Formal swallow assessment by a Speech and Language 
Therapist or another professional trained in dysphagia assessment within 72 hours (Q3.8) 
39.4% 
39.5% 
38.0% 
37.6% 
H15.21 
Percentage of patients applicable for a formal swallow assessment within 72 hours* Percentage 
of 
applicable 
87.2% 
86.9% 
87.6% 
88.4% 
H15.24 
patients who had formal swallow assessment within 72 hours 
19:54 
20:22 
19:40.5 
19:50 
H15.1 H15.2 
Median (IQR) time from clock start 
to 
formal 
swallow 
assessment  (h:mm) 
(7:24-30:39) 
(7:27-32:10) 
(6:25-30:03) 
(7:20-29:36) 
H15.3 

*Applicable patients are those for whom Q 3.8.1 is answered "patient refused", "patient medically unwell" or 
"Patient passed swallow screening" 
                                                  

Comment: Over 75% of applicable patients are screened for the safety of their swallowing within 4 hours of arrival. While this has improved since data collection began, it is disturbing that there are still so many cases not meeting this standard. This screening should be an essential component of the immediate evaluation of the patient. Swallow assessment within 72 hours of admission is achieved for almost 90% of applicable patients which is another area where results have improved. 

## 3.10.2 Assessment By Nurse

Assessed by a nurse trained in stroke management (Q3.2) 
Aug-Nov 
2016 
Assessed within 72h 
95.2% 
94.6% 
95.2% 
95.8% 
H8.6 
Within 12h 
84.6% 
84.0% 
85.7% 
85.9% 
H8.9 
12-24h 
5.4% 
5.3% 
4.7% 
5.0% 
H8.11 
24-72h 
5.1% 
5.3% 
4.7% 
4.9% 
H8.13 
1:16 
1:12 
1:07 
1:09 
H8.14 H8.15 
Median (IQR) time from clock start to  assessment by stroke nurse 
(0:06-4:13) 
(0:05-4:28) 
(0:05-3:58) 
(0:05-4:00) 
H8.16 

## 3.10.3 Assessment By Stroke Specialist Consultant

Aug-Nov 
2016 
Assessed by a stroke specialist consultant physician (Q3.3) Assessed within 72h 
94.6% 
94.2% 
94.9% 
95.4% 
H9.6 
Within 12h 
49.0% 
49.0% 
50.5% 
53.7% 
H9.9 
12-24h 
32.9% 
32.1% 
32.4% 
30.7% 
H9.11 
24-72h 
12.7% 
13.1% 
12.1% 
11.0% 
H9.13 
Median (IQR) time for assessment by stroke consultant physician 
11:09 
11:03 
10:29 
8:38 
H9.14 H9.15 H9.16 
(1:45-19:45) 
(1:43-19:54) 
(1:42-19:20) 
(1:44-18:28) 
Assessed within 14h 
54.1% 
53.7% 
55.7% 
58.9% 
H9.19 

Comment: Approximately a fifth of stroke admissions are not seen by a specialist stroke physician within 24 hours of admission.   

Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 

## 3.11 Therapy Assessments In First 72 Hours (Part Of Domain 8)

For physiotherapy, occupational therapy and speech and language therapy assessments, applicable patients are those that remain after patients who refused, were medically unwell or had no relevant deficit are excluded. According to the findings of the 2016 Acute Organisational Audit 31% of sites provided at least two types of therapy 7 days a week. 

The 'compliant' percentage in the tables below indicates the proportion of *applicable* patients receiving the assessment in question. 

NB The audit did not ask about applicability in relation to therapy assessments within 24 hours. 

Adherence is therefore calculated out of all patients but it is not aimed at 100% optimal level/value. Please refer to Section 4.1 'assessments by discharge' and Section 5 'therapy intensity' for further information about each of the therapy disciplines. 

## 3.11.1 Occupational Therapy Assessments In First 72 Hours

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Assessed by an Occupational Therapist within 72h of Clock 
Start (Q3.5) 
87.1% 
86.2% 
86.5% 
86.1% 
H10.21 
Percentage of patients applicable to be assessed by an OT within 72h* 
91.7% 
91.2% 
91.9% 
92.8% 
H10.24 
Percentage of applicable patients assessed by an OT within 72 hours 

*Applicable patients are those for whom Q3.5.1 is not answered as "Patient refused", "Patient medically unwell" or 
"Patient had no relevant deficit" 

## 3.11.2 Physiotherapy Assessments In First 72 Hours

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Assessed by a 
Physiotherapist within 72h of Clock Start (Q3.6) Applicable to be assessed by a PT within 72h* 
89.4% 
88.5% 
88.6% 
88.3% 
H11.21 
95.1% 
94.3% 
94.8% 
95.6% 
H11.24 
Percentage of applicable patients assessed by an PT within 72 hours 

*Applicable patients are those for whom Q3.6.1 is not answered as "Patient refused", "Patient medically unwell" or "Patient had no relevant deficit" 

## 3.11.3 Speech And Language Therapy In First 72 Hours

Aug-Nov 
2016 
Communication assessed by a Speech and Language therapist within 72h of Clock 
Start (Q3.7) Applicable* to be assessed by a SALT within 72h 
49.9% 
49.7% 
48.8% 
48.8% 
H12.21 
89.0% 
87.8% 
89.1% 
89.6% 
H12.24 
Percentage of applicable patients assessed by a SALT within 72 hours 
 
Aug-Nov 
2016 
Communication assessed by a Speech and Language therapist within 72h of Clock Start (Q3.7) Applicable* to be assessed by a SALT within 72h 
49.9% 
49.7% 
48.8% 
48.8% 
H12.21 
89.0% 
87.8% 
89.1% 
89.6% 
H12.24 
Percentage of applicable 
patients assessed by a SALT within 72 hours 

*Applicable patients are those for whom Q3.7.1 is not answered as "Patient refused", "Patient medically unwell" or 
"Patient had no relevant deficit" 
Comment: Assessment by SALT, OT or PT within 72 hours of admission is not a particularly stringent target and should be achievable in the vast majority of cases. It is likely that services with rapid access to therapists are working more efficiently and are more likely to get their patients home more quickly, as well as initiating treatment earlier with the probability of a better 

Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 

## 2016 Nice Qs Statement 2

 
Patients with stroke are offered a minimum of 45 minutes per day of each active therapy that is required, for a minimum of 5 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 The aim of the therapy measures reported on by SSNAP is to get an overall picture of the intensity of each therapy being provided to patients i.e. to look at national changes over time, for teams to benchmark themselves against national level results and to look at differences between teams in terms of percentage of patients being considered to require each therapy and the average time patients get across their entire length of stay as an inpatient. SSNAP allows teams to reflect when a patient no longer requires one type of therapy but still requires another. This way the intensity of each therapy provided can be compared against what was required. Note: SSNAP collects data on whether a patient was considered to require therapy at any point in the admission and does not reflect whether the patient required or was able to tolerate therapy on each day. We have calculated a proxy measure for the **NICE quality standard** by combining the percentage of patients considered to require therapy, the percentage of days on which each therapy was received, and the average number of therapy minutes received per day. 

Patients: The benchmark for levels of patients requiring therapy is 80% for occupational therapy, 85% for physiotherapy and 50% for speech and language therapy. This has been derived using data collected in previous rounds of stroke audit and has proved to be consistent at national level. Minutes: In line with the NICE quality standard, the benchmark is 45 minutes of therapy provided per day 5 days a week. If a patient receives therapy 7 days a week the benchmark is equivalent therefore to 32 minutes per day. 

Days: In line with the NICE quality standard, an adjustment is made to the total number of days on which therapy was received to approximate the number of *working* days by multiplying by 5 out of 7 (approximately 70%). To improve performance in the therapy domains, teams may need to improve one or more of the 3 elements. Taking annual national level results for occupational therapy as an example,  

- 
83.9%  of patients nationally were considered to require therapy 
- 
a median of 40.1 minutes of therapy was provided per day (based on 7 day week) 
- 
therapy was delivered on 66.7% of inpatient days. 
These figures show that the percentage of patients considered applicable is in line with the expected level of 80% and the number of therapy minutes *across 7 days* exceeds what would be recommended across this time period (target for 7 days = 32 minutes) if the NICE quality standard was extrapolated. However, the percentage of days on which therapy is provided is below the NICE 
quality standard of approximately 70%. 

With limited resources to achieve equilibrium between patients, days and minutes, the goal is to maximise the use of resources to benefit the highest number of patients throughout their stay. 

Therapy teams can chose to deliver this therapy as either one 45 minute session a day or through several shorter sessions throughout the day. 

In addition to this, SSNAP produces a therapy pack, a comprehensive guide to therapy data and reporting in SSNAP. The guide is published each reporting period and contains useful information on the submission of data, FAQs and an explanation of how data are presented. The guide is available to logged in users at:   
https://www.strokeaudit.org/Support/Resources/Therapy-Resources.aspx  

## 4.1 Occupational Therapy (Domain 5)

| Aug-Nov                              | Dec 2016-   | Key Indicators: Occupational    |
|--------------------------------------|-------------|---------------------------------|
| Therapy                              | 2016        | Mar 2017                        |
| Apr-Jul 2017                         |             |                                 |
| Aug-Nov                              |             |                                 |
| 2017                                 |             |                                 |
| Percentage of patients reported as   |             |                                 |
| requiring occupational therapy       |             |                                 |
| 83.6%                                | 84.4%       | 84.5%                           |
| 40.7 min                             | 40 min      | 40.1 min                        |
| Median number of minutes per day     |             |                                 |
| on which occupational therapy is     |             |                                 |
| received                             |             |                                 |
| 64.9%                                | 64.1%       | 65.0%                           |
| Median % of days as an inpatient on  |             |                                 |
| which occupational therapy is        |             |                                 |
| received                             |             |                                 |
| 85.9%                                | 84.2%       | 85.6%                           |
| Proxy for 2016 NICE Quality Standard |             |                                 |
| Statement 2: % of the minutes of     |             |                                 |
| occupational therapy required        |             |                                 |
| (according to 2016 NICE QS-S2)       |             |                                 |
| which were delivered                 |             |                                 |

## 4.2 Physiotherapy (Domain 6)

Key Indicators: Physiotherapy 
Aug-Nov 
2016 
Percentage of patients reported as requiring physiotherapy 
85.1% 
86.3% 
85.9% 
85.0% 
Median number of minutes per day on which physiotherapy is received  
35 min 
35 min 
35 min 
35 min 
Median % of days as an inpatient on which physiotherapy is received 
73.7% 
71.2% 
72.7% 
75.4% 
80.3% 
78.7% 
80.1% 
82.1% 
Proxy for 2016 NICE Quality Standard Statement 2: % of the minutes of physiotherapy required (according to 
2016 NICE QS-S2) which were delivered 

## 4.3 Speech And Language Therapy (Domain 7)

Key Indicators: Speech and Language Therapy  
Aug-Nov 2016 
50.7% 
51.4% 
51.2% 
50.1% 
Percentage of patients reported as requiring speech and language therapy 
31.5 min 
31.7 min 
31.7 min 
32.1 min 
Median number of minutes per day on which speech and language therapy is received  
48.1% 
47.9% 
49.6% 
51.2% 
Median % of days as an inpatient on which speech and language therapy 
is received 
47.8% 
48.6% 
50.1% 
51.3% 
Proxy for 2016 NICE Quality Standard Statement 2: % of the minutes of speech and language therapy required (according to 2016 NICE QS- S2) which were delivered 

Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Dec 2016- Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 

## 4.4 Psychology

Psychology (Q4.4 - 4.6) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Applicable for psychology 
5.3% 
5.6% 
5.7% 
5.6% 
J7.3 
9.9% 
10.8% 
10.3% 
10.7% 
J7.4 
Median % of the days in hospital on which psychology is received 
40 min 
40 min 
40 min 
40 min 
J7.5 J7.6 
Median number (IQR) of minutes per day on which therapy is received 
(30-54 min) 
(30-53 min) 
(30-50 min) 
(30-50 min) 
J7.7 
 

Comment: The finding that only about 6% of patients need psychology is not consistent with published literature on the prevalence of cognitive and mood difficulties, or the self-reported, long term, unmet needs of stroke survivors. It is important to clarify that teams should answer that the patient is applicable if the patient has any psychological difficulty even if the service does not have access to a psychologist or other mental health professional. 

 

The graph below demonstrates the high number of teams recording that none of their patient's are applicable for psychology. The finding from the acute organisational audit is that only 6% of hospitals have access to sufficient clinical psychologists and therefore it is important to reiterate that all patients requiring psychology input at any point during their stay should be recorded as requiring psychology, regardless of whether the psychology service is available at that team.  

## Section 5:  Care Before  Leaving Hospital 5.1 Multidisciplinary Working (Part Of Domain 8)

Rehabilitation goals agreed (Q4.7) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
82.8% 
83.2% 
82.8% 
82.8% 
J13.12 
Percentage of patients applicable for rehab goals within 5 days* 
91.9% 
92.3% 
92.3% 
92.3% 
J13.15 
Percentage of applicable patients who have rehab goals set within 5 days 

*Patients are applicable unless they have no deficits, refuse rehabilitation goals, or are on palliative care and have no rehabilitation potential 
 

Bundle of care 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
61.8% 
60.4% 
62.9% 
64.0% 
J14.3 
If applicable, assessed by stroke nurse within 24h, at least one therapist within 24h, all applicable therapists within 72h and rehab goals agreed within 4 days 

## 5.2 Standards By Discharge (Domain 9) 5.2.1 Nutritional Screening, Risk Of Malnutrition And Dietitian

Nutritional screening (Q6.6) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Percentage of ALL patients screened 
96.8% 
96.5% 
96.5% 
96.0% 
J16.3 
If screened for nutrition: 
  
  
  
  
  
Identified as being at high risk of malnutrition 
19.6% 
20.1% 
18.9% 
19.7% 
J16.6 
  
  
  
  
  
If identified as being at high risk of malnutrition following nutritional screening: Seen by a dietitian 
92.4% 
92.7% 
93.1% 
93.5% 
J16.9 
 
Comment: Over 6% of patients identified as being at high risk of malnutrition on screening do not get to see a dietitian. 
 
Aug-Nov 
2016 
Combination of nutritional screening, risk of malnutrition, and seen by dietitian: 
15.5% 
16.1% 
15.6% 
16.5% 
J16.12.1 
Percentage of patients applicable for nutritional screening/being seen by a dietitian * 
83.3% 
82.7% 
82.5% 
80.7% 
J16.15.1 
Percentage of applicable patients screened for nutrition and seen by a dietitian by discharge**  

*Patients are applicable if screened for nutrition AND identified as high risk, or not screened for nutrition. ** Patients who are indicated as being for palliative care (either within 72 hours or by discharge) are excluded from this measurement  
 
5.2.2 Urinary continence plan 
 

Aug-Nov 
2016 
Urinary continence plan by discharge from inpatient care (Q6.5) 
40.4% 
41.7% 
40.5% 
40.8% 
J15.3 
Percentage of ALL patients for whom urinary continence plan drawn up 
0 days 
0 days 
0 days 
0 days 
J15.12 J15.13 
Median (IQR) time from clock start to continence plan drawn up (in days) 
(0 - 1) 
(0 - 1) 
(0 - 1) 
(0 - 1) 
J15.14 
43.2% 
44.7% 
42.9% 
42.6% 
J15.17 
Percentage of patients applicable for urinary continence plan by 
discharge* 
93.5% 
93.3% 
94.4% 
95.7% 
J15.20 
Percentage of applicable patients for whom urinary continence plan drawn up by discharge 

*Applicable patients are those for whom Q6.5.1 has not been answered "Patient refused" or "Patient continent" 
Comment: Over 95% of patients with incontinence are having an assessment performed while an in-patient. It is encouraging to see sustained improvements in results each reporting period but given the profound impact of incontinence on a person's life, the fact that around 4% of patients are not being adequately assessed is unacceptable. Becoming incontinent as an adult is embarrassing and demoralising. It should be treated with the utmost sensitivity and skill. To ignore it and not even bother to establish the cause and treatment is unacceptable practice.         

Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 

 

## 5.2.3 Mood And Cognition Screening

Mood screening (Q6.7) 
Aug-Nov 
2016 
85.2% 
84.7% 
86.1% 
86.4% 
J17.14 
Percentage of patients applicable for mood screening by discharge* Percentage 
of 
applicable 
89.9% 
88.6% 
88.6% 
89.1% 
J17.17 
patients who received mood screening by discharge 

*Patients that are not applicable are those who refused either or both screens, patients who were medically unwell for entire admission and patients who were discharged from inpatient care within 7 days of clock start without receiving both screens are excluded from this indicator.  
 

| Comment:                                                                                                 | There remains a significant issue in terms of screening patients for mood disturbance.    |
|----------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|
| Over 50% of patients are likely to have a significant depression or anxiety state at some time           |                                                                                           |
| after their stroke. This is frequently seen early after the stroke and it is vital that the diagnosis is |                                                                                           |
| made early and patients helped to deal with the problem. While there have been continued                 |                                                                                           |
| improvements in mood screening many patients who should be screened are not.                             |                                                                                           |
|                                                                                                          |                                                                                           |
| Cognition screening                                                                                      |                                                                                           |
| Aug-Nov                                                                                                  |                                                                                           |
| 2016                                                                                                     |                                                                                           |
| 82.9%                                                                                                    | 82.9%                                                                                     |
| J18.14                                                                                                   |                                                                                           |
| Percentage of patients                                                                                   |                                                                                           |
| applicable for cognition                                                                                 |                                                                                           |
| screening by discharge*                                                                                  |                                                                                           |
| Percentage                                                                                               | of                                                                                        |
| patients                                                                                                 | who                                                                                       |
| 93.5%                                                                                                    | 93.9%                                                                                     |
| cognition                                                                                                | screening                                                                                 |
| discharge                                                                                                |                                                                                           |

*Applicable patients are those for whom Q6.7.1 or Q6.8.1 has not been answered "Patient refused" or "Patient medically unwell for entire admission" and whose total length of stay is 7 days or longer. 

 

| Comment:                                                      | There are similar issues with screening for cognitive impairment where about 6% of    |
|---------------------------------------------------------------|---------------------------------------------------------------------------------------|
| patients are not being evaluated in the way that they should. |                                                                                       |
|                                                               |                                                                                       |
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
 

## 5.3.1 Worst Level Of Consciousness In First 7 Days

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Patient's worst level of 
consciousness (LOC) in the first 7 days (Q5.1) 
0: Alert keenly responsive 
79.9% 
79.1% 
81.0% 
80.8% 
J24.3 
1: Not alert but arousable by minor stimulation 
8.3% 
9.0% 
8.2% 
8.4% 
J24.5 
4.7% 
4.8% 
4.6% 
4.4% 
J24.7 
2: Not alert but require repeated stimulation to attend 
7.1% 
7.0% 
6.2% 
6.4% 
J24.9 
3: Respond only with reflex motor or autonomic effects /totally unresponsive 

## 5.3.2 Urinary Tract Infection In First 7 Days

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Did the patient develop a urinary tract infection in the first 7 days? (Q5.2) 
Yes 
4.7% 
4.5% 
4.4% 
4.4% 
J25.3 
No 
94.6% 
94.6% 
95.0% 
95.0% 
J25.5 
Not known 
0.6% 
0.9% 
0.6% 
0.6% 
J25.7 

## 5.3.3 Pneumonia In First 7 Days

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Did the patient receive antibiotics for a newly acquired pneumonia in the first 7 days? (Q5.3) 
Yes 
8.7% 
9.2% 
8.1% 
8.3% 
J26.3 
No 
90.7% 
90.0% 
91.4% 
91.1% 
J26.5 
Not known 
0.6% 
0.9% 
0.6% 
0.6% 
J26.7 

 
The following paper authored by Prof Craig J. Smith and Dr Benjamin D. Bray and published in the 
Journal of the American Heart Association, uses SSNAP data to derive a clinical risk score for 
predicting stroke-associated pneumonia. 
https://www.strokeaudit.org/SupportFiles/Documents/Research/J-Am-Heart-Assoc-2015-Smith.aspx 

## 5.3.4 Modified Rankin Scale Score At Discharge

Modified Rankin Scale (mRS) score at discharge (Q7.4) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
0 (no symptoms) 
12.2% 
12.2% 
12.5% 
11.6% 
J28.3 
1 (no significant disability) 
18.2% 
17.8% 
19.4% 
18.9% 
J28.5 
2 (slight disability) 
16.3% 
15.3% 
15.6% 
15.9% 
J28.7 
3 (moderate disability) 
17.3% 
17.6% 
17.1% 
17.4% 
J28.9 
4 (moderately severe disability) 
14.6% 
14.7% 
14.5% 
15.2% 
J28.11 
5 (severe disability) 
7.0% 
7.0% 
7.3% 
7.2% 
J28.13 
6 (Dead) 
14.3% 
15.4% 
13.5% 
13.8% 
J28.15 


Modified Rankin Scale (mRS) score Median (IQR) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
mRS score before stroke 
0 (0-2) 
0 (0-2) 
0 (0-2) 
0 (0-2) 
J28.16 J28.17  
J28.18 
mRS score at discharge 
3 (1-4) 
3 (1-4) 
3 (1-4) 
3 (1-4) 
J28.19 J28.20  
J28.21 
Change in mRS score 
1 (0-3) 
1 (0-3) 
1 (0-3) 
1 (0-3) 
J28.22 J28.23  
J28.24 

## 5.3.5 Palliative Care

Patients for palliative care 
after 72 hrs* (Q6.9) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Yes 
12.1% 
12.8% 
11.4% 
11.9% 
J29.3 
*Palliative care decision between 72h and discharge from inpatient care. 
 
Comment: One of the areas of care that we need to improve is care of the patients when they are unlikely to survive. The evidence suggests that patients prefer to die at home. We appear to be 
achieving this for only a small minority of patients. 
 

5.3.6 Intermittent Pneumatic Compression (IPC) 
Intermittent Pneumatic Compression (IPC) reduces the risk of a person admitted to hospital with a stroke developing a deep vein thrombosis (DVT). The CLOTS 3 trial results showed a 3.6% decrease in absolute risk reduction in the incidence of DVT and that IPC improves the six month survival rate of stroke patients. 

In August 2013 NHS England and NHS Improving Quality (NHS IQ) put forward a bid to supply approximately six months' worth of IPC sleeves to all stroke units in an effort to realise the benefits in every day practice. To ascertain the level of implementation of IPC sleeves following the findings of the trial, the questions related to IPC were added to the revised SSNAP dataset and are mandatory for patients admitted on or after 1 April2014.  
The graph below shows that whilst the percentage of teams treating at least some patients with IPC 
has increased substantially over time there are still very few teams treating more than 40% of their patients with IPC. 

Aug-Nov 
2016 
Patients who have intermittent pneumatic compression applied at any 
point 
N=26658 
N=28072 
N=27681 
N=28122 
Yes 
20.6% 
22.7% 
25.5% 
28.1% 
J35.3 
No 
77.7% 
75.8% 
73.1% 
70.7% 
J35.5 
Not Known 
1.7% 
1.5% 
1.4% 
1.2% 
J35.7 
If yes: 
N=5491 
N=6364 
N=7065 
N=7908 
J35.2 
6 days 
6 days 
6 days 
6 days 
J35.8 J35.9 
Median length of time  IPC is applied for 
(2 - 15) 
(2 - 15) 
(2 - 15) 
(2 - 15) 
J35.10 
Mean length of time IPC is applied for 
12 days 
12 days 
13 days 
12 days 
J35.11 

Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 

Comment: Since 2012 there is new RCT evidence to support intermittent pneumatic compression device use in selected stroke patients. We will look to monitor the implementation of this at a patient level in SSNAP. 

 
5.3.7 Mortality Data on SSNAP 
Based on data collected on SSNAP from April 2016 - March 2017, it is reported that 13.7% of stroke patients admitted to hospitals in England and Wales died (either in hospital or after being discharged from inpatient care) within 30 days of clock start. Annual mortality results including those for 
2013/14, 2014/15, 2015/16 and 2016/17 at provider level are publicly available on the SSNAP 
webtool. Provider level mortality results are adjusted for case mix including stroke severity and presented as a standardised mortality ratio. Data for 2017/18 will be available later in the year.  
https://www.strokeaudit.org/results/Clinical/National-Results 

## 5.4 Discharge Processes (Domain 10) 5.4.1 Discharge Destination

Aug-Nov 
2016 
Discharge destination (Q7.1) 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
N=26659 
N=28072 
N=27681 
N=28125 
Discharged alive from inpatient care 
85.7% 
84.6% 
86.5% 
86.2% 
J9.14 
Discharged to a care home 
9.3% 
9.4% 
8.8% 
8.5% 
J9.5 
Discharged home 
35.4% 
33.7% 
34.9% 
33.6% 
J9.7 
Discharged somewhere 
else 
2.1% 
2.0% 
1.9% 
1.8% 
J9.9 
Transferred to an 
ESD/community team 
32.3% 
32.7% 
34.2% 
35.1% 
J9.10.2 
Transferred to a nonparticipating inpatient team 
3.6% 
3.8% 
3.8% 
4.2% 
J9.11.2 
3.0% 
2.9% 
2.9% 
3.0% 
J9.11.4 
Transferred to a nonparticipating ESD/community team 


Aug-Nov 
2016 
If discharged home (Q7.6) 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
N=9431 
N=9450 
N=9666 
N=9436 
Living Alone 
25.2% 
25.4% 
25.0% 
24.8% 
J9.21 
Not living alone 
73.1% 
72.3% 
73.1% 
73.4% 
J9.23 
Not known 
1.7% 
2.2% 
2.0% 
1.9% 
J9.25 

## 5.4.2 Care Home Discharge

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
If discharged to a care home (Q7.5) 
N=2466 
N=2641 
N=2438 
N=2385 
Previously a resident 
34.8% 
36.5% 
36.7% 
37.7% 
J9.28 
Not previously a resident 
65.2% 
63.5% 
63.3% 
62.3% 
J9.30 


Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
If discharged alive from inpatient care: 
N=22834 
N=23749 
N=23951 
N=24232 
7.0% 
7.1% 
6.4% 
6.1% 
J9.33 
Newly institutionalised 
(discharged to a care home where not previously a resident) 


Aug-Nov 
2016 
If newly institutionalised: 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
N=1610 
N=1676 
N=1543 
N=1486 
Temporary 
20.9% 
20.6% 
18.9% 
22.2% 
J9.36 
Permanent 
79.1% 
79.4% 
81.1% 
77.8% 
J9.38 

Comment: About 85% of patients leave hospital alive after a stroke, with over a third of those returning home. Close to 10% are discharged to a care home, with approximately 65% of these being sent to a home for the first time. Approximately 80% of these were expected to become permanent residents. The new institutionalisation rate is an important measure of outcome, which at 7% is lower than we have previously seen in the Sentinel audits where there were rates of about 10-15%. 

 
5.4.3 Activities of Daily Living 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
If discharged alive, required help with activities of daily living (ADL)? (Q7.9) 
N=22834 
N=23749 
N=23951 
N=24232 
Yes 
40.4% 
40.5% 
39.9% 
40.8% 
J30.3 
No 
59.6% 
59.5% 
60.1% 
59.2% 
  
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 


If patient required help with ADL, what help did they receive (Q7.9.1) Paid carers 
68.2% 
67.8% 
67.0% 
67.8% 
J30.6 
Informal carers 
17.9% 
19.2% 
19.5% 
19.6% 
J30.8 
| Paid and informal carers       | 12.9%    | 11.8%    | 12.4%    | 11.3%    |
|--------------------------------|----------|----------|----------|----------|
| J30.10                         |          |          |          |          |
| Paid care services unavailable | 0.1%     | 0.1%     | 0.1%     | 0.1%     |
| Patient refused                | 0.9%     | 1.1%     | 1.1%     | 1.2%     |
| Applicable for receiving help  |          |          |          |          |
| for ADL (not refused)          |          |          |          |          |
| 99.1%                          | 98.9%    | 98.9%    | 98.8%    |          |
| J30.17                         |          |          |          |          |
| Compliant (any type of paid    |          |          |          |          |
| services)                      |          |          |          |          |
| 81.8%                          | 80.5%    | 80.2%    | 80.1%    |          |
| J30.20                         |          |          |          |          |
| Aug-Nov                        |          |          |          |          |
| 2016                           |          |          |          |          |
| Dec 2016-                      |          |          |          |          |
| Mar 2017                       |          |          |          |          |
| Apr-Jul 2017                   |          |          |          |          |
| Aug-Nov                        |          |          |          |          |
| 2017                           |          |          |          |          |
| Ref                            |          |          |          |          |
|                                |          |          |          |          |
|                                |          |          |          |          |
| If patient required help with  |          |          |          |          |
| ADL, number of social service  |          |          |          |          |
| visits per week (Q7.9.2)       |          |          |          |          |
| 0 visits                       | 34.4%    | 36.3%    | 35.1%    | 36.2%    |
| At least one visit per week    | 33.0%    | 32.8%    | 33.7%    | 35.3%    |
| 1-6 visits                     | 0.9%     | 0.8%     | 0.8%     | 1.1%     |
| 7-13 visits                    | 5.7%     | 5.1%     | 4.3%     | 5.1%     |
| 14-20 visits                   | 6.4%     | 6.1%     | 7.1%     | 6.7%     |
| 21-27 visits                   | 5.6%     | 6.0%     | 6.0%     | 5.8%     |
| 28+ visits                     | 14.4%    | 14.8%    | 15.5%    | 16.6%    |
| Not known                      | 32.6%    | 30.9%    | 31.2%    | 28.4%    |
|                                |          |          |          |          |

Comment: Approximately 40% of patients are discharged needing help with activities of daily living. 

Nearly a fifth receive this solely from unpaid carers and about two thirds from only paid carers. The remainder receive help from both paid and unpaid carers. Approximately 20% of patients requiring help with ADL receive three or more visits a day from social services. 

 

## 5.4.4 Joint Care Planning

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
If discharged alive, did the patient receive a joint health 
and social care plan at discharge (Q7.11) 
Yes 
49.4% 
49.1% 
47.7% 
48.9% 
J33.3 
No 
5.2% 
5.4% 
4.7% 
3.1% 
J33.5 
Not applicable 
45.4% 
45.5% 
47.6% 
48.0% 
J33.7 
Applicable for receiving a joint care plan 
46.8% 
46.1% 
45.4% 
44.8% 
J33.10 
Compliant 
90.6% 
90.1% 
91.0% 
94.1% 
J33.13 

The graph below deomstrates the wide range of reported applicability for joint health and social care plan. 

## 5.4.5  Named Contact At Discharge

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
If discharged alive, was there a named person for the 
patient and/or carer to contact after discharge? 
(Q7.12) Yes 
96.6% 
96.9% 
96.8% 
97.2% 
J34.3 
No 
3.4% 
3.1% 
3.2% 
2.8% 
  

## 5.5 Length Of Stay

Participation of post-acute teams has continued to increase, and therefore an increased number of records have been fully completed and locked to discharge which will more accurately reflect length of stay across the entire pathway. 

(See section 3.6 for additional stroke unit key indicators). 

## 5.5.1 Length Of Stay In An Inpatient Setting

| Length of stay (days)    |            |
|--------------------------|------------|
| Aug-Nov                  |            |
| 2016                     |            |
| Dec 2016-                |            |
| Mar 2017                 |            |
| Apr-Jul 2017             |            |
| Aug-Nov                  |            |
| 2017                     |            |
| Ref                      |            |
| (IQR)                    | (2.8-23.6) |
| Mean                     | 19.2       |
| Length of stay from      |            |
| Clock Start to final     |            |
| inpatient discharge      |            |
| including death          |            |
| Median                   | 7.2        |
| J8.1                     |            |
| J8.2                     |            |
| J8.3                     |            |
| J8.4                     |            |

Comment: The median length of stay in this cohort for all patients (including deaths in hospital) is between 7-8 days which is shorter than we would have expected. 

## 5.5.2 Length Of Stay On Stroke Unit

Length of stay on stroke unit (days) 
  
Aug-Nov 
2016 
(IQR) 
(2.1-21.6) 
(2.1-21.2) 
(2.1-21.0) 
(2.1-20.7) 
Mean 
17.7 
17.1 
17.2 
16.9 
Median  
6.2 
6.4 
6.1 
6.0 
J8.5 J8.6 J8.7 J8.8 
Length of stay on an SU across inpatient pathway (based on component parts of provider level) 
 (excludes patients who go straight to ITU/CCU/HDU at any provider during their inpatient stay) 

## 5.5.3 90% Of Stay On Stroke Unit (Part Of Domain 2)

Aug-Nov 
2016 
Is over 90% of a patient's stay in hospital spent on a stroke unit? 
Yes 
84.8% 
82.7% 
84.7% 
84.7% 
J8.11 

 (excludes patients who go straight to ITU/CCU/HDU at any provider during their inpatient stay) 
Comment: While we are managing to treat most patients at some stage on a stroke unit, approximately 15% are not spending at least 90% of their stay on the unit. 

## 5.5.4 Delays In Discharging Patients Who No Longer Require Inpatient Rehabilitation

Aug-Nov 
2016 
Date patient considered by 
the multidisciplinary team to no longer require inpatient rehabilitation (Q7.3.1) 
0.9 
0.7 
0.7 
0.6 
K20.7 
Number of days from patient no longer requiring inpatient rehabilitation to stroke unit discharge (Mean) 
1.1 
1.0 
1.1 
1.1 
K20.8 
Number of days from patient 
no longer requiring inpatient rehabilitation to hospital discharge (Mean) 

 
Comment: It is important that where there are delays in arranging discharge, for whatever reason, these are documented and data submitted to SSNAP. 

 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 

 

## 6.1 Introduction

Although national stroke audits have routinely collected data for acute stroke care and services since 1998, up until recently, there has been limited opportunity to audit and benchmark post-acute stroke services in the same way. With the arrival of SSNAP in early 2013, and the expansion of stroke clinical audit up to 6 months post-stroke, this changed and there are now 129 domiciliary services submitting data and receiving reports on the care they provide their stroke patients. 

## 6.1.1 Domiciliary Teams And Ssnap

There is no single model of stroke care organisation or commissioning and consequently pathways of stroke care beyond the acute setting are complex. The 2015 post-acute audit reported on the availability and structure of stroke services in community settings, we can now estimate that there are 160 teams providing ESD and approximately 200 community rehabilitation  services in England and Wales. More information on this pioneering audit can be found here: 
http://www.strokeaudit.org/results/PostAcute.aspx   
There are currently 323 teams working in the community registered on SSNAP,  a total of 202 
domiciliary teams have submitted at least one record to this report and 129 of these teams submitted enough records to receive named team results. We congratulate these teams for leading the way in SSNAP data collection. A full list of the domiciliary teams which submitted sufficient data to receive results can be found in the results portfolio. 

https://www.strokeaudit.org/results/Clinical-audit/National-Results.aspx  
It is clear that certain areas of the country are performing significantly better than others in terms of submitting domiciliary data to the audit. It is therefore important that all post-acute inpatient teams and community teams are encouraged to register for SSNAP and fully complete the information collected at this stage on all records transferred to them to give an accurate picture of the whole of the patient pathway.  

## 6.1.2 Early Supported Discharge And Community Rehabilitation

A key element of the National Stroke Strategy is the implementation of early supported discharge (ESD). ESD is a system in which rehabilitation is provided to stroke patients at home instead of at hospital by a multi-disciplinary team at the same intensity as inpatient care. ESD should be stroke specific and delivered by teams with specialist stroke skills. According to literature, approximately 
34% of stroke patients are considered eligible for ESD 1. 

ESD can result in better outcomes for patients including reduction of long-term mortality and institutionalisation rates, increased independence six months after a stroke and increased capacity to undertake activities of daily living and greater patient satisfaction (Langhorne et al 2005). Benefits have also been identified for acute hospital providers with reduced lengths of stays for stroke patients. 

Community stroke rehabilitation services cater for those stroke survivors who are able to return home following inpatient rehabilitation or ESD. Access to a specialist stroke multi-disciplinary community rehabilitation team should be available to all those for whom it is clinically appropriate. 

The needs of patients being treated by these teams will differ case by case. For example, some will need only one therapy while others will need several. Domiciliary stroke services should be designed around the needs of the stroke survivor and their family and be appropriate for all ages. For example, patients with aphasia and other communication-related impairments will have specific needs while working age adults will have different recovery goals such as returning to work or parenting. From research literature, it is known that there is a wide variation in the availability of rehabilitation and community services. Some areas have ESD, responsive community stroke rehabilitation teams and vocational rehabilitation services which demonstrate good outcomes and value for money. 

Other areas have no dedicated community stroke service and are without access to even generic rehabilitation teams. This inequality of access to services results in variation in patient experience and outcomes. The Care Quality Commission (CQC, 2011) reported across a number of aspects of ESD and community rehabilitation services and concluded: 'the overall picture is one of inconsistency, waits between transfer home and commencing community rehabilitation and lack of specialist access.' 

## 6.1.3 Interpreting The Ssnap Results

SSNAP publicly reports results for domiciliary teams at national and provider level. SSNAP now reports domiciliary results over a four month reporting period, in the same way that results for inpatient teams are reported. In the past, SSNAP combined 2 quarters worth of domiciliary data due to the slower rate of recruitment of these teams but now SSNAP has been collecting data for years it is expected that all domiciliary teams should be participating and entering all their data to SSNAP.  
National figures have been calculated based on the combined data input by ESD teams, CRT teams and a small number of teams which provide both of these functions. In the text that follows the term used will be 'domiciliary team' as there is insufficient data to report on the different types of team separately. However, it should be noted that ESD and CRT teams have distinct functions and, in the future, results for each type of team will be presented separately to better reflect this. 

The mechanics of collecting information at this stage of the pathway require the inpatient team to collect data on SSNAP about the processes of care as an inpatient and to send the data electronically to the next team to continue the electronic data capture. The domiciliary team has to be registered to have permission to complete the electronic record. Between August - November 2017: 
12,195 patients were reported in SSNAP as being discharged with a stroke specific domiciliary service (ESD or CRT team). This is approximately 50.3% of all patients discharged alive from inpatient care. 

- 
However, only 9,873 patient records were electronically transferred to domiciliary teams for 
further information to be collected on SSNAP.  
- 
In this time period, 7419 electronic records were **fully** completed by the domiciliary team for 
7239 patients. 
It is planned to report on case ascertainment for domiciliary teams using data from the post-acute organisational audit in the future. Provider level results for teams submitting at least 20 records are publicly available. Please see Tab L of the 'Full Results Portfolio' on the SSNAP Reporting Portal for these results. 

http://www.strokeaudit.org/results/National-Results.aspx  

## 6.2 **Results For Domiciliary Teams**

Rehabilitation Goals 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
N=6564 
N=6862 
N=7046 
N=7419 
91.5% 
90.7% 
89.9% 
90.1% 
L2.3 
Reported on SSNAP as applicable for rehabilitation 
goals while being treated by a domiciliary team If applicable, rehabilitation goals set by domiciliary team 
95.4% 
95.3% 
96.2% 
94.3% 
L2.6 
0 (0-1) 
0 (0-2) 
0 (0-1) 
0 (0-1) 
L2.7 L2.8 L2.9 
Median (IQR) days under the care of a domiciliary team until rehabilitation goals are set 


Modified Rankin Scale (mRS) score           
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
2 (1-3) 
2 (1-3) 
2 (1-3) 
2 (1-3) 
L3.1 L3.2 L3.3 
Median (IQR) mRS score at discharge from domiciliary teams 


Duration of treatment 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
37 (17-56) 
35 (16-53) 
37 (18-55) 
35 (16-52) 
Median (IQR) duration of treatment  with a domiciliary team  (days) 
L4.1 L4.2 L4.3 L4.4 
Mean 
49 
45 
48 
46 
1 (0-3) 
1 (0-3) 
1 (0-3) 
1 (1-3) 
L4.5 L4.6 L4.7 
Median (IQR) days between discharge from inpatient care to first direct contact with domiciliary team 

## 6.2.1 Therapy Results

This section presents results about the intensity of rehabilitation provided by domiciliary teams in the community. As described earlier in this report, intensity of therapy is collected separately for each part of the patient's pathway. 

The tables in this section present results for the 7,419 patient records for which data on therapy whilst under domiciliary care is available. The results cover 4 aspects: 

- 
the percentage of patients reported as being **applicable** for each therapy during their 
domiciliary rehabilitation 
- 
the percentage of **days** on which therapy was provided  
- 
the median number of **daily therapy minutes** received on **each day** therapy was provided 
- 
the median number of **daily therapy minutes** received across the **entire treatment period** 
under domiciliary team (i.e. regardless of whether or not therapy was provided every day). 
Note: SSNAP collects data on whether a patient was considered to require therapy at any point whilst under the care of a domiciliary team and does not reflect whether the patient required or was able to tolerate therapy on each day.  

Aug-Nov 2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Occupational Therapy whilst being treated by a domiciliary team 
N=6564 
N=6862 
N=7046 
N=7419 
80.2% 
80.4% 
80.0% 
77.8% 
L6.3 
Percentage of **patients** reported 
as **applicable** for OT at any point 
during treatment 
21.3% 
21.1% 
19.4% 
20.7% 
L6.4 
Median percentage of **days** on which OT is received by the patient 
50 (40-60) 
50 (42-60) 
50 (42-60) 
49 (41-60) 
Median (IQR) number of OT minutes received per day (on 
days when OT is provided) 
L6.5 L6.6 L6.7 
10 (5-19) 
10 (5-19) 
10 (5-18) 
10 (5-18) 
Median (IQR) number of OT 
minutes received per day 
(across entire treatment period) 
L6.12 
L6.13 L6.14 


Aug-Nov 2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Physiotherapy whilst being treated by a domiciliary  team 
N=6564 
N=6862 
N=7046 
N=7419 
72.4% 
73.7% 
72.0% 
71.4% 
L7.3 
Percentage of **patients** reported 
as **applicable** for PT at any point 
during treatment 
27.0% 
26.5% 
25.7% 
25.8% 
L7.4 
Median percentage  of **days** on 
which PT is received by the patient 
46 (38-57) 
47 (40-58) 
47 (40-58) 
46 (40-57) 
Median (IQR) number of PT minutes received per day (on 
days when PT is provided)  
L7.5 L7.6 L7.7 
| 12 (6-22)                        | 12 (6-21)            | 12 (6-21)         | 12 (6-21)    |
|----------------------------------|----------------------|-------------------|--------------|
| Median (IQR) number of PT        |                      |                   |              |
| minutes                          | received per day     |                   |              |
| (across entire treatment period) |                      |                   |              |
| L7.12                            |                      |                   |              |
| L7.13                            |                      |                   |              |
| L7.14                            |                      |                   |              |
|                                  |                      |                   |              |
| Aug-Nov 2016                     |                      |                   |              |
| Dec 2016-                        |                      |                   |              |
| Mar 2017                         |                      |                   |              |
| Apr-Jul 2017                     |                      |                   |              |
| Aug-Nov                          |                      |                   |              |
| 2017                             |                      |                   |              |
| Ref                              |                      |                   |              |
|                                  |                      |                   |              |
| Speech and language therapy      |                      |                   |              |
| whilst being treated by a        |                      |                   |              |
| domiciliary  team                |                      |                   |              |
| N=6564                           |                      |                   |              |
| N=6862                           | N=7046               | N=7419            |              |
| 33.4%                            | 32.8%                | 34.7%             | 34.2%        |
| L8.3                             |                      |                   |              |
| Percentage of                    | patients             | reported          |              |
| as                               | applicable           | for SALT at any   |              |
| point during treatment           |                      |                   |              |
| 16.1%                            | 15.8%                | 15.6%             | 16.3%        |
| L8.4                             |                      |                   |              |
| Median percentage of             | days                 | on                |              |
| which SALT is received by the    |                      |                   |              |
| patient                          |                      |                   |              |
| 48 (40-60)                       | 49 (40-60)           | 48 (40-60)        | 48 (40-60)   |
| Median (IQR) number of SALT      |                      |                   |              |
| minutes                          | received per day (on |                   |              |
| days when SALT is provided)      |                      |                   |              |
| L8.5                             |                      |                   |              |
| L8.6                             |                      |                   |              |
| L8.7                             |                      |                   |              |
| 7 (3-15)                         | 8 (3-15)             | 7 (3-15)          | 8 (3-15)     |
| Median (IQR) number of SALT      |                      |                   |              |
| minutes                          | received per day     |                   |              |
| (across entire treatment period) |                      |                   |              |
| L8.12                            |                      |                   |              |
| L8.13                            |                      |                   |              |
| L8.14                            |                      |                   |              |
|                                  |                      |                   |              |
|                                  |                      |                   |              |
| Aug-Nov 2016                     |                      |                   |              |
| Dec 2016-                        |                      |                   |              |
| Mar 2017                         |                      |                   |              |
| Apr-Jul 2017                     |                      |                   |              |
| Aug-Nov                          |                      |                   |              |
| 2017                             |                      |                   |              |
| Ref                              |                      |                   |              |
| Psychology                       | whilst being treated |                   |              |
| by a domiciliary  team           |                      |                   |              |
| N=6564                           | N=6862               | N=7046            | N=7419       |
| 8.0%                             | 7.6%                 | 8.0%              | 8.4%         |
| L10.3                            |                      |                   |              |
| Percentage of                    | patients             | reported          |              |
| as                               | applicable           | for psychology at |              |
| any point during treatment       |                      |                   |              |
| 6.1%                             | 6.5%                 | 6.5%              | 4.9%         |
| L10.4                            |                      |                   |              |
| Median Percentage  of            | days                 | on                |              |
| which psychology is received by  |                      |                   |              |
| the patient                      |                      |                   |              |
| 56 (45-60)                       | 55 (43-60)           | 60 (45-60)        | 57 (45-60)   |
| L10.5                            |                      |                   |              |
| L10.6                            |                      |                   |              |
| L10.7                            |                      |                   |              |
| Median (IQR) number of           |                      |                   |              |
| psychology                       | minutes              | received          |              |
| per day (on days when            |                      |                   |              |
| psychology  is provided)         |                      |                   |              |
| 5                                | 6                    | 6                 | 5            |
| L10.8                            |                      |                   |              |
| Mean number of psychology        |                      |                   |              |
| minutes                          | received per day     |                   |              |
| (across entire treatment period) |                      |                   |              |

Comment: The figure reported for patients applicable for psychology from an ESD/CRT team is unlikely to be an accurate reflection of the care needs for patients post-stroke. It is expected that at least 50% of stroke patients will suffer from depression or cognitive impairments in the weeks following their stroke and will therefore require psychological support. We urge all teams to indicate when a patient is applicable for psychology, even if the team is not in a position to provide this service to their patients. 

## Section 7: Six Month Follow Up Assessments

Collection of six month outcome data is key to assessing the outcomes of stroke care. It notably forms part of the CCG Outcomes Indicator Set that was reported in December 2014 ,December 2015 
and December 2016 in England. 

203 teams have submitted data for at least one patient who received a six month assessment. 101 teams have provided a six month assessment for at least 20 patients and the breakdown is shown in table below. These include acute hospitals, domiciliary teams, and voluntary organisations e.g. the Stroke Association. As this is a relatively small number, the results may not be representative of six month follow-up provision nationally. A full list of six month assessment provider teams which submitted at least 20 records to SSNAP can be found in the results portfolio. Named team results for teams providing six month follow ups are publicly available. Please see the 'Full Results Portfolio' on the SSNAP Results Portal for individual team results: www.strokeaudit.org/results/national  

Region 
Number of teams 
providing at least 
20 six month 
Number of teams 
providing at least 
20 six month 
assessments 
Aug-Nov 2016 
Dec 2016-Mar 2017 
Apr-Jul 2017 
Aug-Nov 2017 
East Midlands 
2 
2 
3 
2 
East of England  
10 
9 
10 
9 
7 
7 
8 
6 
Greater Manchester and 
Eastern Cheshire (formerly 
Manchester, Lancashire and South Cumbria) Islands 
0 
1 
0 
0 
London  
5 
9 
9 
7 
North West Coast (formerly Cheshire and Mersey) 
12 
10 
10 
9 
North of England 
12 
11 
11 
11 
Northern Ireland 
5 
6 
7 
9 
South East  
3 
4 
3 
3 
South West  
6 
9 
6 
6 
Thames Valley  
4 
4 
3 
4 
Wales 
9 
7 
6 
9 
Wessex  
5 
6 
5 
5 
West Midlands 
8 
7 
7 
9 
Yorkshire and The Humber  
14 
14 
14 
12 
Total 
102 
106 
102 
101 
Number of teams 
providing at least 
20 six month 
Number of teams 
providing at least 
20 six month 
assessments  
assessments 
assessments 

## 7.1 Interpreting The Results

The results which follow are based on six month assessments which were due in this reporting period. The record completion analysis below concerns whether the question about six month assessment has been answered at all, and the analyses covering the percentage of patients applicable to receive this assessment and the percentage of those who actually received it are based on all patients who were alive at the relevant time point. 

Breakdown of six month assessment analysis 

## Record Completion

Information on record completion for the six month assessment question is provided to give an indication of how widely this section of the audit is being answered, rather than indicating the numbers of patients who had a six month assessment completed. If this question is not answered, it is interpreted as an assessment did not take place. 

- 
24,527 patient records should have had an answer recorded on the webtool 
- 
Of these, 11,194 patient records (45.6%) did have an answer. 
Comment: It is extremely important that data regarding a patient's six month follow up is recorded on SSNAP. This is regardless of whether or not the assessment was provided. These data have the potential to reveal variations in access to six month assessments across the country.  In cases where six month assessments are being provided but are not recorded on SSNAP, valuable information about patient outcomes post stroke is being missed. 

 

## Applicability For Six Month Assessment

Patients are considered to be applicable to receive a six month assessment unless they are known to have died before six months after admission, or if they have a 'no but' reason recorded for the six month assessment question. Therefore any patients alive six months after admission who do not have an answer recorded in the audit are deemed applicable. 

- 
20,188 patients were considered to be applicable to receive a six month assessment (excludes died in care, died within six months of admission* and 'no but') 
*either as recorded on SSNAP or from the national register of deaths, the Office for National Statistics 
 
Note: SSNAP records are linked with mortality information from the Office for National Statistics (ONS). Usually, SSNAP data are securely sent for linkage following each reporting deadline, enabling SSNAP to track mortality other than as reported on SSNAP (i.e. after patients have left care). We use this in determining eligibility for receiving a six month assessment and for other purposes, such as providing casemix adjusted mortality rates for providers. (Following lengthy delays, SSNAP was able to perform linkage with ONS to obtain information for patients that died up to mid-2017. Casemixadjusted mortality results were publicly reported earlier in the year. It has therefore been possible to  exclude these patients from the denominator for 6 month assessments). 

## Patients Assessed At Six Months

Out of 20,188 patients considered to be applicable to receive a six month assessment: 

- 
6,233 patients (30.9%) received a six month assessment 
- 
The inpatient teams which had the highest percentage of patients going on to receive a six 
month assessment are: 
o Arrowe Park Hospital, Chesterfield Royal, Hexham General Hospital, Airedale General 
Hospital, Singleton Hospital, Nevill Hall Hospital, Kendray Hospital 
- 
N.B. This does not necessarily indicate that these were the teams who carried out the six 
month assessments, only that their patients went on to have them. 
Comment: While the vast majority of patients alive at this time after stroke are applicable to receive a six month review this is currently happening in a minority of cases. Clinical teams and commissioners need to work closely together to see this improve to get the most value from the audit for service improvement. 

## 7.2 Preliminary Result

Six month review timings 
Median (IQR) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
6.5 (5.9-7.5) 
6.5 (5.9-7.5) 
6.4 (5.7-7.3) 
6.4 (5.8-7.2) 
M5.1 M5.2 M5.3 
months 
months 
months 
months 
Time from admission to hospital (or stroke in hospital) to six month review assessment 
5.6 (4.4-6.4) 
5.6 (4.4-6.4) 
5.3 (4.1-6.3) 
5.4 (4.2-6.2) 
M5.4 M5.5 M5.6 
months 
months 
months 
months 
Time from discharge from all care (In patient and domiciliary) to six month 
assessment 

 SSNAP is collecting the mode of administration of the review as it provides context. 

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Method of assessment (Q8.1.2)  
% (n) 
N=6555 
N=6182 
N=6194 
N=6233 
 In person 
83.1% (5445) 
80.8% (4996) 
81.7% (5058) 
82.7% (5154) 
M6.2 M6.3 
 By telephone 
16.6% (1085) 
18.7% (1158) 
17.8% (1105) 
16.6% (1037) 
M6.6 M6.7 
 By post 
0.3% (22) 
0.4% (26) 
0.5% (28) 
0.6% (37) 
M6.8 M6.9 
 Online 
<0.1% (3) 
<0.1% (2) 
<0.1% (3) 
0.1% (5) 
M6.4 M6.5 
 

SSNAP offers six categories to identify the person who contacted the patient for a review. 

Unfortunately, this question was not well recorded throughout this reporting period and "*other*" was recorded for approximtely 30% of cases.  

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Discipline providing the six 
month follow up? (Q8.1.3) %(n) 
N=6555 
N=6182 
N=6194 
N=6233 
Stroke coordinator 
33.7% (2209) 
33.1% (2049) 
32.2% (1996) 
32.8% (2044) 
M6.13 M6.14 
Secondary care clinician 
7.4% (483) 
8.0% (496) 
8.0% (494) 
9.0% (563) 
M6.21 M6.22 
Therapist 
13.1% (858) 
12.3% (763) 
11.9% (739) 
11.8% (737) 
M6.15 M6.16 
Voluntary services employee 
6.5% (425) 
6.6% (406) 
6.9% (429) 
6.6% (413) 
M6.19 M6.20 
District/community nurse 
7.7% (507) 
8.0% (495) 
11.6% (716) 
10.1% (631) 
M6.17 M6.18 
GP 
0.1% (8) 
<0.1% (2) 
0.1% (7) 
0.1% (5) 
M6.11 M6.12 
Other 
31.5% (2065) 
31.9% (1971) 
29.3% (1813) 
29.5% (1840) 
M6.23 M6.24 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Was the patient screened for mood, behaviour or cognition (Q8.2) %(n) 
N=6555 
N=6182 
N=6194 
N=6233 
Yes 
74.2% (4861) 
74.1% (4583) 
74.1% (4592) 
75.1% (4678) 
M7.2 M7.3 
No 
19.4% (1273) 
19.5% (1207) 
19.9% (1235) 
17.7% (1104) 
M7.4 M7.5 
'No but'*  
6.4% (421) 
6.3% (392) 
5.9% (367) 
7.2% (451) 
M7.6 
M7.7 

*'No but' is an appropriate response if a problem has already been detected and there is an action plan in place 

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
N=4861 
N=4583 
N=4592 
N=4678 
Patient identified as needing support (if screened) 
(Q8.2.1)   
% (n) Yes 
19.1% (928) 
18.7% (859) 
22.0% (1008) 
21.9% (1026) 
M7.8 
M7.10 
Of those identified as needing 
support, support given (Q8.2.2) 
N=928 
N=859 
N=1008 
N=1026 
M7.8 
Yes 
60.8% (564) 
62.9% (540) 
62.8% (633) 
67.3% (691) 
M7.12 M7.13 
No 
28.0% (260) 
26.8% (230) 
24.2% (244) 
21.7% (223) 
M7.14 M7.15 
No but 
11.2% (104) 
10.4% (89) 
13.0% (131) 
10.9% (112) 
M7.16 M7.17 

Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 2017 
Aug-Nov 
2017 
Ref 
Patient location  at the time of the review (Q8.3)     
% (n) 
N=6555 
N=6182 
N=6194 
N=6233 
Home 
89.5% (5867) 
90.7% (5607) 
90.3% (5596) 
90.6% (5645) 
M8.2 M8.3 
Care Home 
9.4% (618) 
8.2% (506) 
8.4% (521) 
8.5% (527) 
M8.4 M8.5 
 Other 
1.1% (70) 
1.1% (69) 
1.2% (77) 
1.0% (61) 
M8.6 M8.7 
 

## Changes In Rankin Score Between Time Periods

Information about the function of stroke patients six months after admission to hospital is also collected. During this period it is available for 6,103 out of 20,188  patients applicable for a review during this reporting period and cannot be interpreted as representative until the data have been collected for a longer time period. The data on this cohort shows that patients who are receiving a review include all severity levels.  
 
Comment: Though the percentage of patients with follow up data recorded on SSNAP is improving each reporting period, it may not be entirely representative of the national picture. As recruitment of six month providers continues to increase, data will become more meaningful and robust.  The results below reinforce how invaluable these data could be.  


Pre stroke 
At discharge from 
all care 
At six months 
Modified Rankin Score at 3 time 
points for the 6103 patients for whom data was available* 
  
N 
% 
N 
% 
N 
% 
0 (no symptoms) 
3853 
63.1 
957 
15.7 
1119 
18.3 
1 (no significant disability) 
979 
16.0 
1777 
29.1 
1622 
26.6 
2 (slight disability) 
564 
9.2 
1340 
22.0 
1274 
20.9 
3 (moderate disability) 
462 
7.6 
1071 
17.5 
1175 
19.3 
4 (moderately severe disability) 
201 
3.3 
721 
11.8 
660 
10.8 
5 (severe disability) 
44 
0.7 
237 
3.9 
253 
4.1 
 
Change in mRS from before 
stroke to six months after stroke 
Number of patients 
Percentage of patients 
-4 
5 
<0.1% 
-3 
37 
0.6 
-2 
98 
1.6 
-1 
338 
5.5 
0 
1600 
26.2 
1 
1800 
29.5 
2 
1145 
18.8 
3 
741 
12.1 
4 
260 
4.3 
5 
79 
1.3 
Total 
6103 
100.0 
 

The graph below demonstrates the change in mRS from pre-stroke to 6 months post-stroke. 

Section 8: SSNAP Performance Tables (by named team) 
This section aims to provide a summary of performance for named teams based on **10 domains** of care. Both patient-centred domain scores (whereby scores are attributed to every team which treated the patient at any point in their care) and team-centred domain scores (whereby scores are attributed to the team considered to be most appropriate to assign the responsibility for the measure to) are calculated. Each domain is given a performance level (level A to E) and a key indicator score is calculated based on the average of the 10 domain levels for both patient-centred and team centred domains. The **overall performance** section of the table consists of: 
 

- 
A **Combined Key Indicator (KI) Score** derived from the average of the patient- and teamcentred total KI score. 
- 
Case ascertainment and **audit compliance** levels 
- 
SSNAP level which is the combined total key indicator score adjusted for case ascertainment and audit compliance. 
The results in this table should be read in combination with the SSNAP 'Summary Report' which includes named team results for the 44 key indicators which comprise the 10 domains: 
www.strokeaudit.org/results/National-Results  
 To be included in the SSNAP scoring, teams had to achieve a minimum case ascertainment requirement. Teams which did not meet this requirement (i.e. with insufficient records to be included in the named team results) are shown by an X. Some teams did not receive results due to them treating small number of patients during the time period. These teams are shown by 'TFP' (too few patients to report on). 

Across the SSNAP domain results a consistent colour code is used to represent each team's performance for specific domains and overall. 

 
Changes over time Teams are being encouraged to review their results (which are provided every 4 months) and plan to implement change. In some aspects it may be possible to make change rapidly, in other areas of care this may take longer. We are providing information on how the current results compare with the previous reporting period for an indication of where changes may be starting to be made. These need to be interpreted with caution at this stage as a number of factors may be influential at this time. Changes between the August 2017 - November 2017 results and the previous reporting period are illustrated within the table by arrows.  Upward pointing arrows indicate that the team has achieved a higher level this reporting period than in the previous reporting period; downward pointing arrows that the team has achieved a lower level this reporting period than previously. The number of arrows represents the extent of the change. 

For example, an *increase of 2 levels* from D to B would be shown by the symbol     

## Six Month Follow Up Results

SSNAP report upon the numbers and percentage of patients going on to receive a six month assessment; these results are patient-centred (attributed to all teams who treated the patient). Therefore, the named-team results do not necessarily indicate that these were the teams who carried out the six month assessments, just that their patients went on to have them. Please refer to results in the 'Full Results Portfolio' for details about the clinical information related to these reviews reported on SSNAP, for example, whether patients are taking appropriate medication at six months. 

## Interpreting The Results

The colour-coded tables are structured as follows: 

1. Patient-centred results 
A. 
Routinely admitting teams 
i. 
Geographical Region  
 
Hospital (ordered alphabetically) 
B. 
Non-routinely admitting teams *(as above)* 
C. 
Non-acute teams (as above) 
2. Team-centred results  
Same structure as above 
The column headings in the performance tables have been abbreviated for reasons of space. Please use the following key as a guide when using the results.  

Abbreviated heading 
Full Description 
SSNAP Level 
SSNAP Level 
CA 
Case ascertainment 
AC 
Audit compliance 
Combined KI level 
Combined Total Key Indicator Level 
D1 Scan D2 SU D3 Throm D4 Spec asst 
D5 OT D6 PT D7 SALT 
D8 MDT 
D9 Std disch 
D10 Disch proc 
Domain 1: Scanning Domain 2: Stroke unit  
Domain 3: Thrombolysis 
Domain 4: Specialist assessments Domain 5: Occupational therapy  
Domain 6: Physiotherapy 
Domain 7: Speech and language therapy  
Domain 8: Multi-disciplinary team working  
Domain 9: Standards by discharge 
Domain 10: Discharge processes 

44 teams in England have achieved the top overall performance level this reporting period. Considering the extremely high standards SSNAP has set, an 'A' score is a fantastic achievement for these teams. Though nowhere else in the world has set such stringent standards, it does show that this top score is achievable. It is expected that the number of teams achieving top scores will increase as further improvements to stroke services are made nationally in future reporting periods.  

| Number of patients                              | Overall Performance                     |
|-------------------------------------------------|-----------------------------------------|
| Routinely Admitting Teams                       |                                         |
| D1                                              | D2                                      |
| Trust                                           | Team Name                               |
| SSNAP                                           |                                         |
| Level                                           |                                         |
| %                                               |                                         |
| Assessed                                        |                                         |
| CA                                              | AC                                      |
| Combined                                        |                                         |
| KI Level                                        |                                         |
| TC KI Level                                     |                                         |
| Number                                          |                                         |
| Applicable                                      |                                         |
| Scan                                            | SU                                      |
| London - London SCN                             |                                         |
| Barking, Havering and Redbridge University      |                                         |
| Hospitals NHS Trust                             |                                         |
| Queens Hospital Romford HASU                    |                                         |
|                                                 |                                         |
| 408                                             | 393                                     |
| Barts Health NHS Trust                          | Royal London Hospital HASU              |
|                                                 |                                         |
| 302                                             | 303                                     |
| Imperial College Healthcare NHS Trust           | Charing Cross Hospital HASU             |
|                                                 |                                         |
| 386                                             | 344                                     |
| King's College Hospital NHS Foundation Trust    | King's College Hospital HASU            |
|                                                 |                                         |
| 300                                             | 281                                     |
| King's College Hospital NHS Foundation Trust    | Princess Royal University Hospital HASU |
|                                                 |                                         |
| 268                                             | 261                                     |
| London North West Healthcare NHS Trust          | Northwick Park Hospital HASU            |
|                                                 |                                         |
| 447                                             | 406                                     |
| St George's University Hospitals NHS Foundation |                                         |
| Trust                                           |                                         |
| St George's Hospital HASU                       |                                         |
|                                                 |                                         |
| 397                                             | 369                                     |
| University College London Hospitals NHS         |                                         |
| Foundation Trust                                |                                         |
| University College Hospital HASU                |                                         |
|                                                 |                                         |
| 409                                             | 365                                     |

## Midlands & East - East Midlands Scn

| Derby Teaching Hospitals NHS Foundation Trust   | Royal Derby Hospital         |
|-------------------------------------------------|------------------------------|
|                                                 |                              |
| 248                                             | 270                          |
| Northampton General Hospital NHS Trust          | Northampton General Hospital |
|                                                 |                              |
| 273                                             | 259                          |
| Nottingham University Hospitals NHS Trust       | Nottingham City Hospital     |
|                                                 |                              |
| 417                                             | 415                          |
| Sherwood Forest Hospitals NHS Foundation Trust  | Kings Mill Hospital          |
|                                                 |                              |
| 149                                             | 138                          |
| United Lincolnshire Hospitals NHS Trust         | Lincoln County Hospital      |
|                                                 |                              |
| 202                                             | 201                          |
| United Lincolnshire Hospitals NHS Trust         | Pilgrim Hospital             |
|                                                 |                              |
| 173                                             | 171                          |
| University Hospitals of Leicester NHS Trust     | Leicester Royal Infirmary    |
|                                                 |                              |
| 445                                             | 409                          |

## Midlands & East - East Of England Scn

Basildon and Thurrock University Hospitals NHS 
Foundation Trust
Basildon University Hospital
  
174
161
  
B↓
A
A
B↓
  
A
C
B↓
B
B↓
B
C
B
B↓
A
B↓
  
83
74%
32
39%
Cambridge University Hospitals NHS Foundation 
Trust
Addenbrooke's Hospital
  
226
233
  
B
A
B
B
  
B↓
D
B
B
B↓
A
C
C
A↑
C
B
  
184
98%
0
0%
Colchester Hospital University NHS Foundation 
Trust
Colchester General Hospital
  
219
218
  
A
A
A
A
  
A↑
C
A↑
B
A
A
C
A
B
A
A
  
94
77%
69
73%

East and North Hertfordshire NHS Trust Lister Hospital

  
284
280
  
A
A
B↓
A
  
A
C
C
A
A
A
A
B
B
B↓
A
  
118
56%
48
41%

Ipswich Hospital NHS Trust Ipswich Hospital

  
193
189
  
B
A
A
B
  
B
B
B
C
A
A
E
C↑
A
A
B
  
110
62%
94
85%
James Paget University Hospitals NHS Foundation 
Trust
James Paget Hospital
  
130
150
  
B↑
A
B
B↑
  
A↑
C
B↑↑
B
A↑
B
D
D
B↓
A↑
B↑
  
104
100%
1
1%

Luton and Dunstable University Hospital NHS 
Foundation Trust Luton and Dunstable Hospital

  
225
211
  
B
A
A
B
  
A
D
B
B
A
B
C↑
D↓
B
B
B
  
203
94%
4
2%

Mid Essex Hospital Services NHS Trust Broomfield Hospital

  
143
142
  
A
A
A
A
  
A
B
A
A
A
B
C
B
A
A
A
  
124
100%
43
35%
Norfolk and Norwich University Hospitals NHS 

Foundation Trust Norfolk and Norwich University Hospital

  
387
389
  
B↑
A
A↑
B↑
  
B↑
D
B↑
A↑
C
B
C↑
B↑
B↓
A
B↑
  
220
100%
78
35%
North West Anglia NHS Foundation Trust
Peterborough City Hospital
  
237
227
  
D↓
A
A
D↓
  
C
E↓↓
D
B
C
D↓
E
D
B↓
C
D
  
150
100%
0
0%

Queen Elizabeth Hospital King's Lynn NHS 
Foundation Trust Queen Elizabeth Hospital Kings Lynn

  
211
212
  
A↑
A
B↑
A↑
  
A↑
B↑
A↑
A↑↑
A
A
A↑↑
C↓
A
C
A↑
  
101
87%
0
0%

Southend University Hospital NHS Foundation Trust Southend Hospital

  
222
217
  
B↓
A
A↑
B↓
  
B↓
C
B
B
B
B
C↓↓
B
B
B↓
B↓
  
128
83%
105
82%
West Hertfordshire Hospitals NHS Trust
Watford General Hospital
  
209
205
  
A
A
A
A
  
A↑
C
C↓
B
A
A
A
B↑
A
B↓
A
  
87
64%
33
38%
West Suffolk NHS Foundation Trust
West Suffolk Hospital
  
163
167
  
A
A
A
A
  
A
C
C
B↓
A
A
A
B
C↑
B↓
A
  
119
84%
72
61%
| Patient Centred Data   |
|------------------------|
| %                      |
| Applicable             |
| Number                 |
| assessed               |
Number of patients
Overall Performance
Routinely Admitting Teams
D1
D2
D3
D4
D5
D6
D7
D8
D9
D10
Trust
Team Name
Admit
Disch
SSNAP 
Level
% 
Assessed
CA
AC
Combined 
KI Level
TC KI Level
Number 
Applicable
Scan
SU
Throm
Spec Asst
OT
PT
SALT
MDT
Std Disch
Disch Proc

## Midlands & East - West Midlands Scn

| Burton Hospitals NHS Foundation Trust            | Queens Hospital Burton upon Trent   |
|--------------------------------------------------|-------------------------------------|
|                                                  |                                     |
| 123                                              | 117                                 |
| George Eliot Hospital NHS Trust                  | George Eliot Hospital               |
|                                                  |                                     |
| 89                                               | 82                                  |
| Heart of England NHS Foundation Trust            | Birmingham Heartlands Hospital      |
|                                                  |                                     |
| 255                                              | 274                                 |
| Royal Wolverhampton NHS Trust                    | New Cross Hospital                  |
|                                                  |                                     |
| 171                                              | 171                                 |
| Sandwell and West Birmingham Hospitals NHS       |                                     |
| Trust                                            |                                     |
| Sandwell District Hospital                       |                                     |
|                                                  |                                     |
| 197                                              | 191                                 |
| Shrewsbury and Telford Hospital NHS Trust        | Princess Royal Hospital Telford     |
|                                                  |                                     |
| 309                                              | 313                                 |
| South Warwickshire NHS Foundation Trust          | Warwick Hospital                    |
|                                                  |                                     |
| 105                                              | 108                                 |
| The Dudley Group NHS Foundation Trust            | Russells Hall Hospital              |
|                                                  |                                     |
| 164                                              | 150                                 |
| University Hospitals Birmingham NHS Foundation   |                                     |
| Trust                                            |                                     |
| Queen Elizabeth Hospital Edgbaston               |                                     |
|                                                  |                                     |
| 200                                              | 171                                 |
| University Hospitals Coventry and Warwickshire   |                                     |
| NHS Trust                                        |                                     |
| University Hospital Coventry                     |                                     |
|                                                  |                                     |
| 306                                              | 317                                 |
| University Hospitals of North Midlands NHS Trust | Royal Stoke University Hospital     |
|                                                  |                                     |
| 412                                              | 397                                 |
| Walsall Healthcare NHS Trust                     | Manor Hospital                      |
|                                                  |                                     |
| 121                                              | 101                                 |
| Worcestershire Acute Hospitals NHS Trust         | Worcestershire Royal Hospital       |
|                                                  |                                     |
| 323                                              | 297                                 |
| Wye Valley NHS Trust                             | Hereford County Hospital            |
|                                                  |                                     |
| 173                                              | 171                                 |

## North Of England - Greater Manchester & Eastern Cheshire Scn

| Manchester University NHS Foundation Trust   | Wythenshawe Hospital       |
|----------------------------------------------|----------------------------|
|                                              |                            |
| 114                                          | 116                        |
| Pennine Acute Hospitals NHS Trust            | Fairfield General Hospital |
|                                              |                            |
| 358                                          | 348                        |
| Salford Royal NHS Foundation Trust           | Salford Royal Hospital     |
|                                              |                            |
| 703                                          | 694                        |
| Stockport NHS Foundation Trust               | Stepping Hill Hospital     |
|                                              |                            |
| 401                                          | 418                        |

## North Of England - North West Coast Scn

| Aintree University Hospitals NHS Foundation Trust   | University Hospital Aintree           |
|-----------------------------------------------------|---------------------------------------|
|                                                     |                                       |
| 148                                                 | 143                                   |
| Blackpool Teaching Hospitals NHS Foundation         |                                       |
| Trust                                               |                                       |
| Blackpool Victoria Hospital                         |                                       |
|                                                     |                                       |
| 182                                                 | 179                                   |
| Countess of Chester Hospital NHS Foundation         |                                       |
| Trust                                               |                                       |
| Countess of Chester Hospital                        |                                       |
|                                                     |                                       |
| 104                                                 | 111                                   |
| East Lancashire Hospitals NHS Trust                 | Royal Blackburn Hospital              |
|                                                     |                                       |
| 239                                                 | 233                                   |
| Lancashire Teaching Hospitals NHS Foundation        |                                       |
| Trust                                               |                                       |
| Royal Preston Hospital                              |                                       |
|                                                     |                                       |
| 213                                                 | 193                                   |
| Mid Cheshire Hospitals NHS Foundation Trust         | Leighton Hospital                     |
|                                                     |                                       |
| 189                                                 | 173                                   |
| Royal Liverpool and Broadgreen University           |                                       |
| Hospitals NHS Trust                                 |                                       |
| Royal Liverpool University Hospital                 |                                       |
|                                                     |                                       |
| 213                                                 | 213                                   |
| Southport and Ormskirk Hospital NHS Trust           | Southport and Formby District General |
|                                                     |                                       |
| 108                                                 | 120                                   |
| St Helens and Knowsley Teaching Hospitals NHS       |                                       |
| Trust                                               |                                       |
| Whiston Hospital HASU                               |                                       |
|                                                     |                                       |
| 242                                                 | 253                                   |
| University Hospitals of Morecambe Bay NHS           |                                       |
| Foundation Trust                                    |                                       |
| Furness General Hospital                            |                                       |
|                                                     |                                       |
| 86                                                  | 88                                    |
| University Hospitals of Morecambe Bay NHS           |                                       |
| Foundation Trust                                    |                                       |
| Royal Lancaster Infirmary                           |                                       |
|                                                     |                                       |
| 107                                                 | 98                                    |
| Warrington and Halton Hospitals NHS Foundation      |                                       |
| Trust                                               |                                       |
| Warrington Hospital                                 |                                       |
|                                                     |                                       |
| 90                                                  | 85                                    |
| Wirral University Teaching Hospital NHS             |                                       |
| Foundation Trust                                    |                                       |
| Arrowe Park Hospital                                |                                       |
|                                                     |                                       |
| 211                                                 | 222                                   |

## North Of England - North Of England Scn

| City Hospitals Sunderland NHS Foundation Trust   | Sunderland Royal Hospital                         |
|--------------------------------------------------|---------------------------------------------------|
|                                                  |                                                   |
| 245                                              | 257                                               |
| County Durham and Darlington NHS Foundation      |                                                   |
| Trust                                            |                                                   |
| University Hospital of North Durham              |                                                   |
|                                                  |                                                   |
| 307                                              | 305                                               |
| Newcastle upon Tyne Hospitals NHS Foundation     |                                                   |
| Trust                                            |                                                   |
| Royal Victoria Infirmary                         |                                                   |
|                                                  |                                                   |
| 350                                              | 357                                               |
| North Cumbria University Hospitals NHS Trust     | Cumberland Infirmary                              |
|                                                  |                                                   |
| 136                                              | 134                                               |
| North Cumbria University Hospitals NHS Trust     | West Cumberland Hospital                          |
|                                                  |                                                   |
| 94                                               | 85                                                |
| North Tees and Hartlepool NHS Foundation Trust   | University Hospitals of North Tees and Hartlepool |
|                                                  |                                                   |
| 224                                              | 225                                               |
| Northumbria Healthcare NHS Foundation Trust      |                                                   |
| Northumbria Specialist Emergency Care Hospital   |                                                   |
| HASU                                             |                                                   |
|                                                  |                                                   |
| 312                                              | 312                                               |
| South Tees Hospitals NHS Foundation Trust        | James Cook University Hospital                    |
|                                                  |                                                   |
| 232                                              | 241                                               |
| Patient Centred Data   |
|------------------------|
| %                      |
| Applicable             |
| Number                 |
| assessed               |
Number of patients
Overall Performance
Routinely Admitting Teams
D1
D2
D3
D4
D5
D6
D7
D8
D9
D10
Trust
Team Name
Admit
Disch
SSNAP 
Level
% 
Assessed
CA
AC
Combined 
KI Level
TC KI Level
Number 
Applicable
Scan
SU
Throm
Spec Asst
OT
PT
SALT
MDT
Std Disch
Disch Proc

## North Of England - Yorkshire And The Humber Scn

| Barnsley Hospital NHS Foundation Trust           | Barnsley Hospital           |
|--------------------------------------------------|-----------------------------|
|                                                  |                             |
| 186                                              | 178                         |
| Bradford Teaching Hospitals NHS Foundation Trust | Bradford Royal Infirmary    |
|                                                  |                             |
| 241                                              | 232                         |
| Calderdale and Huddersfield NHS Foundation Trust | Calderdale Royal Hospital   |
|                                                  |                             |
| 185                                              | 211                         |
| Chesterfield Royal Hospital NHS Foundation Trust | Chesterfield Royal          |
|                                                  |                             |
| 163                                              | 161                         |
| Doncaster and Bassetlaw Hospitals NHS            |                             |
| Foundation Trust                                 |                             |
| Doncaster Royal Infirmary                        |                             |
|                                                  |                             |
| 224                                              | 224                         |
| Harrogate and District NHS Foundation Trust      | Harrogate District Hospital |
|                                                  |                             |
| 68                                               | 70                          |
| Hull and East Yorkshire Hospitals NHS Trust      | Hull Royal Infirmary        |
|                                                  |                             |
| 285                                              | 286                         |
| Leeds Teaching Hospitals NHS Trust               | Leeds General Infirmary     |
|                                                  |                             |
| 301                                              | 298                         |
| Mid Yorkshire Hospitals NHS Trust                | Pinderfields Hospital       |
|                                                  |                             |
| 270                                              | 278                         |
| Northern Lincolnshire and Goole Hospitals NHS    |                             |
| Foundation Trust                                 |                             |
| Scunthorpe General Hospital                      |                             |
|                                                  |                             |
| 232                                              | 228                         |
| Rotherham NHS Foundation Trust                   | Rotherham Hospital          |
|                                                  |                             |
| 152                                              | 146                         |
| Sheffield Teaching Hospitals NHS Foundation      |                             |
| Trust                                            |                             |
| Royal Hallamshire Hospital                       |                             |
|                                                  |                             |
| 297                                              | 324                         |
| York Teaching Hospital NHS Foundation Trust      | York Hospital               |
|                                                  |                             |
| 299                                              | 299                         |

## South England - South East Scn

Ashford and St Peter's Hospitals NHS Foundation 
Trust
St Peter's Hospital
  
164
166
  
B↓
A
A
B↓
  
A
C
C
B
C↓
A
C↓
B
A
A↑
B↓
  
121
99%
0
0%
Brighton and Sussex University Hospitals NHS 
Trust
Royal Sussex County Hospital
  
210
180
  
A↑
A
A
A↑
  
A
C↓
B
A
A↑
A↑
B↑
B↑↑
B↓
B
A↑
  
104
98%
2
2%
Dartford and Gravesham NHS Trust
Darent Valley Hospital
  
132
93
  
D
A
B
D
  
A
E
D↓↓
D
C↑
C
E
D
D↓↓
D↓
D
  
95
100%
0
0%
East Kent Hospitals University NHS Foundation 
Trust
Queen Elizabeth the Queen Mother Hospital
  
118
119
  
D↓
A
A
D↓
  
B↓
D↓
C↓
B↓
B
B↑
E
D
B
E↓
D↓
  
82
100%
10
12%
East Kent Hospitals University NHS Foundation 
Trust
William Harvey Hospital
  
201
178
  
B
A
A
B
  
B↓
E↓↓
D↓
B↓
A
A
C↑
C↑
B
A↑
B
  
97
94%
37
38%
East Sussex Healthcare NHS Trust
Eastbourne District General Hospital
  
146
188
  
B↑
A
A
B↑
  
A
B
C
A↑
C
B↑
E
D
A
C↓
B↑
  
126
100%
13
10%
Epsom and St Helier University Hospitals NHS 
Trust
Epsom Hospital
  
103
97
  
C↑
A
A↑
C↑
  
A
E
D↑
B↑
B↑
B
E
C↑
B
B↑
C↑
  
38
76%
19
50%
Frimley Health NHS Foundation Trust
Frimley Park Hospital
  
226
204
  
B↓
A
B
A
  
A
C↓
A↑
A
C↓↓
A
B
B
B
B
A
  
163
99%
0
0%
Maidstone and Tunbridge Wells NHS Trust
Maidstone District General Hospital
  
122
111
  
B↓
A
A
B↓
  
A
C
C
B
A
A
A
B
D↓
B
B↓
  
75
100%
0
0%
Maidstone and Tunbridge Wells NHS Trust
Tunbridge Wells Hospital
  
148
132
  
C
A
A
C
  
A
E↓
D
C
C↓
A
B
B↑
D
C↓
C
  
88
100%
0
0%
Medway NHS Foundation Trust
Medway Maritime Hospital
  
100
96
  
D
A
B↑
D
  
B↑
E
D
D
D↑
D
C
D
B↓
A↑
D
  
74
97%
5
7%
Surrey and Sussex Healthcare NHS Trust
East Surrey Hospital
  
193
177
  
C
A
C
B
  
A
D
B
B
A↑
B↑
C
B
A↑
D
B
  
158
98%
0
0%
Western Sussex Hospitals NHS Foundation Trust
St Richards Hospital
  
148
145
  
C
A
A
C
  
B
C
A↑
C
C
C
C↓
C
A↑
D↓
C
  
114
100%
0
0%
Western Sussex Hospitals NHS Foundation Trust
Worthing Hospital
  
164
159
  
A↑
A
A
A↑
  
B↓
B↑
B
A
A
B
C
B
A
C↑
A↑
  
124
100%
0
0%

## South England - South West Scn

| Gloucestershire Hospitals NHS Foundation Trust    | Gloucestershire Royal Hospital   |
|---------------------------------------------------|----------------------------------|
|                                                   |                                  |
| 288                                               | 276                              |
| Great Western Hospitals NHS Foundation Trust      | Great Western Hospital Swindon   |
|                                                   |                                  |
| 127                                               | 133                              |
| North Bristol NHS Trust                           | North Bristol Hospitals          |
|                                                   |                                  |
| 274                                               | 259                              |
| Northern Devon Healthcare NHS Trust               | North Devon District Hospital    |
|                                                   |                                  |
| 141                                               | 144                              |
| Plymouth Hospitals NHS Trust                      | Derriford Hospital               |
|                                                   |                                  |
| 311                                               | 319                              |
| Royal Cornwall Hospitals NHS Trust                | Royal Cornwall Hospital          |
|                                                   |                                  |
| 281                                               | 279                              |
| Royal Devon and Exeter NHS Foundation Trust       | Royal Devon and Exeter Hospital  |
|                                                   |                                  |
| 250                                               | 250                              |
| Royal United Hospital Bath NHS Foundation Trust   | Royal United Hospital Bath       |
|                                                   |                                  |
| 184                                               | 172                              |
| Salisbury NHS Foundation Trust                    | Salisbury District Hospital      |
|                                                   |                                  |
| 121                                               | 124                              |
| Taunton and Somerset NHS Foundation Trust         | Musgrove Park Hospital           |
|                                                   |                                  |
| 210                                               | 185                              |
| Torbay and South Devon NHS Foundation Trust       | Torbay Hospital                  |
|                                                   |                                  |
| 201                                               | 203                              |
| University Hospitals Bristol NHS Foundation Trust | Bristol Royal Infirmary          |
|                                                   |                                  |
| 136                                               | 157                              |
| Weston Area Health NHS Trust                      | Weston General Hospital          |
|                                                   |                                  |
| 82                                                | 84                               |
| Yeovil District Hospital NHS Foundation Trust     | Yeovil District Hospital         |
|                                                   |                                  |
| 141                                               | 156                              |
| Patient Centred Data   |
|------------------------|
| %                      |
| Applicable             |
| Number                 |
| assessed               |
Number of patients
Overall Performance
Routinely Admitting Teams
D1
D2
D3
D4
D5
D6
D7
D8
D9
D10
Trust
Team Name
Admit
Disch
SSNAP 
Level
% 
Assessed
CA
AC
Combined 
KI Level
TC KI Level
Number 
Applicable
Scan
SU
Throm
Spec Asst
OT
PT
SALT
MDT
Std Disch
Disch Proc

South England - Thames Valley SCN
Buckinghamshire Healthcare NHS Trust
Wycombe General Hospital
  
238
232
  
B↓
A
B↓
A
  
A
C↓
B↓
B↓
A
B
B
B
B↑
C↓
B↓
  
145
85%
43
30%
Milton Keynes University Hospital NHS Foundation 
Trust
Milton Keynes General Hospital
  
87
84
  
B
A
B
B
  
A
C
B
B↑
A
A
C
C↓
B
C
B
  
42
82%
11
26%
Oxford University Hospitals NHS Foundation Trust
Horton General Hospital
  
TFP
23
  
TFP
A
TFP
TFP
  
NA
C↑↑
NA
NA
C
B↑↑
B↑
E↓
D↑
D↑
TFP
  
20
100%
0
0%
Oxford University Hospitals NHS Foundation Trust
John Radcliffe Hospital
  
214
208
  
A↑
A
A
A↑
  
A
C
B
B↑↑
A
B
A↑
B
B
D↓
B
  
164
99%
4
2%
Royal Berkshire NHS Foundation Trust
Royal Berkshire Hospital
  
227
215
  
A
B↓
A
A
  
A
C
A
B
A
A
C↓
B
A
B
A
  
124
85%
70
56%
South England - Wessex SCN
Dorset County Hospital NHS Foundation Trust
Dorset County Hospital
  
130
117
  
B↓
A
A
B↓
  
C
C↓
C↓
C↓
A
B
B↓
B
B↓
B↑
B↓
  
56
84%
49
88%
Hampshire Hospitals NHS Foundation Trust
Royal Hampshire County Hospital
  
192
187
  
B↓
A
A
B↓
  
B↑
C↓
C↓
B
A
A↑
C↓
B
B
A
B↓
  
129
98%
4
3%
Isle of Wight NHS Trust
St Mary's Hospital Newport
  
99
105
  
B↑
A
B
B↑
  
A
D↑
D↑
B
A↑↑
A↑
B↑
C
B↓
A
B↑
  
65
98%
39
60%
Poole Hospital NHS Foundation Trust
Poole Hospital
  
162
165
  
C↓
C↓↓
A
B
  
B↑
C
D↓
D
A
A
A
A
B↑
A
B
  
73
90%
43
59%
Portsmouth Hospitals NHS Trust
Queen Alexandra Hospital Portsmouth
  
343
319
  
C↑
A
B↓
C↑
  
C↑
D↑
B↑
C↑
A↑
A↑
E↓
D
B
A
C↑
  
219
89%
36
16%

Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Royal Bournemouth General Hospital

  
272
275
  
A
A
A
A
  
B
C
C
B
A
A
A
A
B
A
A
  
133
88%
56
42%

University Hospital Southampton NHS Foundation Trust Southampton General Hospital

  
278
276
  
A↑
A
A↑
A↑
  
B
C↓
A↑
B
A
A
C↑
C
B
A
A↑
  
208
98%
98
47%

## Northern Ireland

| Belfast Health and Social Care Trust       | Royal Victoria Hospital Belfast   |
|--------------------------------------------|-----------------------------------|
|                                            |                                   |
| 194                                        | 180                               |
| Northern Health and Social Care Trust      | Antrim Area Hospital              |
|                                            |                                   |
| 172                                        | 182                               |
| Northern Health and Social Care Trust      | Causeway Hospital                 |
|                                            |                                   |
| 76                                         | 72                                |
| South Eastern Health and Social Care Trust | Downe General Hospital            |
|                                            |                                   |
| X                                          | X                                 |
| South Eastern Health and Social Care Trust | Ulster Hospital                   |
|                                            |                                   |
| 158                                        | 155                               |
| Southern Health and Social Care Trust      | Craigavon Area Hospital           |
|                                            |                                   |
| 124                                        | 111                               |
| Southern Health and Social Care Trust      | Daisy Hill Hospital               |
|                                            |                                   |
| 46                                         | 54                                |
| Western Health and Social Care Trust       | Altnagelvin Hospital              |
|                                            |                                   |
| 103                                        | 91                                |
| Western Health and Social Care Trust       | South West Acute Hospital         |
|                                            |                                   |
| 94                                         | 87                                |

## Wales

| Abertawe Bro Morgannwg University Health Board   | Morriston Hospital                   |
|--------------------------------------------------|--------------------------------------|
|                                                  |                                      |
| 245                                              | 215                                  |
| Abertawe Bro Morgannwg University Health Board   | Princess Of Wales Hospital           |
|                                                  |                                      |
| 122                                              | 115                                  |
| Aneurin Bevan University Health Board            | Royal Gwent Hospital                 |
|                                                  |                                      |
| 266                                              | 253                                  |
| Betsi Cadwaladr University Health Board          | Glan Clwyd District General Hospital |
|                                                  |                                      |
| 171                                              | 173                                  |
| Betsi Cadwaladr University Health Board          | Maelor Hospital                      |
|                                                  |                                      |
| 117                                              | 97                                   |
| Betsi Cadwaladr University Health Board          | Ysbyty Gwynedd                       |
|                                                  |                                      |
| 104                                              | 88                                   |
| Cardiff and Vale University Health Board         | University Hospital of Wales         |
|                                                  |                                      |
| 210                                              | 202                                  |
| Cwm Taf University Health Board                  | Prince Charles Hospital              |
|                                                  |                                      |
| 166                                              | 156                                  |
| Hywel Dda Health Board                           | Bronglais Hospital                   |
|                                                  |                                      |
| 41                                               | 34                                   |
| Hywel Dda Health Board                           | Prince Philip Hospital               |
|                                                  |                                      |
| 73                                               | 39                                   |
| Hywel Dda Health Board                           | West Wales General                   |
|                                                  |                                      |
| 81                                               | 73                                   |
| Hywel Dda Health Board                           | Withybush General Hospital           |
|                                                  |                                      |
| 90                                               | 82                                   |
| Patient Centred Data   |
|------------------------|
| %                      |
| Applicable             |
| Number                 |
| assessed               |
| Overall Performance                                          | Patient Centred Data                        | Number of patients   |
|--------------------------------------------------------------|---------------------------------------------|----------------------|
| Non-Routinely Admitting Acute Teams                          |                                             |                      |
| D1                                                           | D2                                          | D3                   |
| Trust                                                        | Team Name                                   | Admit                |
| SSNAP                                                        |                                             |                      |
| Level                                                        |                                             |                      |
| CA                                                           | AC                                          |                      |
| Combined                                                     |                                             |                      |
| KI Level                                                     |                                             |                      |
| Scan                                                         | SU                                          | Throm                |
| London - London SCN                                          |                                             |                      |
| Barking, Havering and Redbridge University                   |                                             |                      |
| Hospitals NHS Trust                                          |                                             |                      |
| Queens Hospital Romford SU                                   |                                             |                      |
|                                                              |                                             |                      |
| 242                                                          | 234                                         |                      |
| Barts Health NHS Trust                                       | Newham General Hospital                     |                      |
|                                                              |                                             |                      |
| 55                                                           | 56                                          |                      |
| Barts Health NHS Trust                                       | Royal London Hospital SU                    |                      |
|                                                              |                                             |                      |
| 109                                                          | 95                                          |                      |
| Barts Health NHS Trust                                       | Whipps Cross University Hospital            |                      |
|                                                              |                                             |                      |
| 54                                                           | 53                                          |                      |
| Chelsea and Westminster Hospital NHS                         |                                             |                      |
| Foundation Trust                                             |                                             |                      |
| Chelsea and Westminster Hospital                             |                                             |                      |
|                                                              |                                             |                      |
| 36                                                           | 31                                          |                      |
| Chelsea and Westminster Hospital NHS                         |                                             |                      |
| Foundation Trust                                             |                                             |                      |
| West Middlesex University Hospital                           |                                             |                      |
|                                                              |                                             |                      |
| 54                                                           | 44                                          |                      |
| Croydon Health Services NHS Trust                            | Croydon University Hospital                 |                      |
|                                                              |                                             |                      |
| 74                                                           | 80                                          |                      |
| Epsom and St Helier University Hospitals NHS                 |                                             |                      |
| Trust                                                        |                                             |                      |
| St Helier Hospital                                           |                                             |                      |
|                                                              |                                             |                      |
| 60                                                           | 45                                          |                      |
| Guy's and St Thomas' NHS Foundation Trust                    | St Thomas Hospital                          |                      |
|                                                              |                                             |                      |
| 74                                                           | 68                                          |                      |
| Hillingdon Hospitals NHS Foundation Trust                    | Hillingdon Hospital                         |                      |
|                                                              |                                             |                      |
| 50                                                           | 43                                          |                      |
| Homerton University Hospital NHS Foundation                  |                                             |                      |
| Trust                                                        |                                             |                      |
| Homerton University Hospital                                 |                                             |                      |
|                                                              |                                             |                      |
| 38                                                           | 51                                          |                      |
| Imperial College Healthcare NHS Trust                        | Charing Cross Hospital SU - Nine South Ward |                      |
|                                                              |                                             |                      |
| 115                                                          | 84                                          |                      |
| King's College Hospital NHS Foundation Trust                 | King's College Hospital SU                  |                      |
|                                                              |                                             |                      |
| 43                                                           | 32                                          |                      |
| King's College Hospital NHS Foundation Trust                 | Princess Royal University Hospital SU       |                      |
|                                                              |                                             |                      |
| 92                                                           | 107                                         |                      |
| Kingston Hospital NHS Foundation Trust                       | Kingston Hospital                           |                      |
|                                                              |                                             |                      |
| 59                                                           | 55                                          |                      |
| Lewisham and Greenwich NHS Trust                             | University Hospital Lewisham                |                      |
|                                                              |                                             |                      |
| 109                                                          | 95                                          |                      |
| London North West Healthcare NHS Trust                       | Northwick Park Hospital SU                  |                      |
|                                                              |                                             |                      |
| 231                                                          | 202                                         |                      |
| North Middlesex University Hospital NHS Trust                | North Middlesex Hospital                    |                      |
|                                                              |                                             |                      |
| 65                                                           | 64                                          |                      |
| Royal Free London NHS Foundation Trust                       | Barnet General Hospital                     |                      |
|                                                              |                                             |                      |
| 48                                                           | 36                                          |                      |
| Royal Free London NHS Foundation Trust                       | Royal Free Hospital                         |                      |
|                                                              |                                             |                      |
| 66                                                           | 53                                          |                      |
| St George's University Hospitals NHS Foundation              |                                             |                      |
| Trust                                                        |                                             |                      |
| St George's Hospital SU                                      |                                             |                      |
|                                                              |                                             |                      |
| 57                                                           | 54                                          |                      |
| University College London Hospitals NHS                      |                                             |                      |
| Foundation Trust                                             |                                             |                      |
| University College Hospital SU                               |                                             |                      |
|                                                              |                                             |                      |
| 59                                                           | 49                                          |                      |
| Midlands & East - East Midlands SCN                          |                                             |                      |
| Kettering General Hospital NHS Foundation Trust              | Kettering General Hospital                  |                      |
|                                                              |                                             |                      |
| 33                                                           | 45                                          |                      |
| Midlands & East - East of England SCN                        |                                             |                      |
| Bedford Hospital NHS Trust                                   | Bedford Hospital                            |                      |
|                                                              |                                             |                      |
| 34                                                           | 38                                          |                      |
| North West Anglia NHS Foundation Trust                       | Hinchingbrooke Hospital                     |                      |
|                                                              |                                             |                      |
| 30                                                           | 22                                          |                      |
| PAPWORTH HOSPITAL NHS FOUNDATION                             |                                             |                      |
| TRUST                                                        |                                             |                      |
| Papworth Hospital                                            |                                             |                      |
|                                                              |                                             |                      |
| TFP                                                          | TFP                                         |                      |
| Midlands & East - West Midlands SCN                          |                                             |                      |
| Heart of England NHS Foundation Trust                        | Good Hope General Hospital                  |                      |
|                                                              |                                             |                      |
| 72                                                           | 77                                          |                      |
| Heart of England NHS Foundation Trust                        | Solihull Hospital                           |                      |
|                                                              |                                             |                      |
| 49                                                           | 51                                          |                      |
| Shrewsbury and Telford Hospital NHS Trust                    | Royal Shrewsbury Hospital                   |                      |
|                                                              |                                             |                      |
| TFP                                                          | TFP                                         |                      |
| University Hospitals of North Midlands NHS Trust             | County Hospital                             |                      |
|                                                              |                                             |                      |
| TFP                                                          | TFP                                         |                      |
| North of England - Greater Manchester & Eastern Cheshire SCN |                                             |                      |
| Bolton NHS Foundation Trust                                  | Royal Bolton Hospital                       |                      |
|                                                              |                                             |                      |
| 89                                                           | 81                                          |                      |
| Manchester University NHS Foundation Trust                   | Manchester Royal Infirmary                  |                      |
|                                                              |                                             |                      |
| 57                                                           | 58                                          |                      |
| Manchester University NHS Foundation Trust                   | Trafford General Hospital                   |                      |
|                                                              |                                             |                      |
| 43                                                           | 41                                          |                      |

Tameside and Glossop Integrated Care NHS 
Foundation Trust Tameside General Hospital

  
82
85
  
C↑
A↑
B↓
B↑
  
A↑
D
D↓
D
A
B
D↑
B↑
B
A↑
B↑
  
47
100%
0
0%

Wrightington, Wigan and Leigh NHS Foundation Trust Royal Albert Edward Infirmary

  
134
134
  
C↓
A
D↓
B↓
  
B↑
D
D↓↓
C
A
B
D↓
C↓
B↓
A
C↓
  
65
97%
27
42%
Six Month Assessment
TC KI Level
Number 
Applicable
% 
Applicable
Number 
assessed
% 
Assessed
| Overall Performance                             | Patient Centred Data               | Number of patients   |
|-------------------------------------------------|------------------------------------|----------------------|
| Non-Routinely Admitting Acute Teams             |                                    |                      |
| D1                                              | D2                                 | D3                   |
| Trust                                           | Team Name                          | Admit                |
| SSNAP                                           |                                    |                      |
| Level                                           |                                    |                      |
| CA                                              | AC                                 |                      |
| Combined                                        |                                    |                      |
| KI Level                                        |                                    |                      |
| Scan                                            | SU                                 | Throm                |
|                                                 |                                    |                      |
| North of England - North of England SCN         |                                    |                      |
| Gateshead Health NHS Foundation Trust           | Queen Elizabeth Hospital Gateshead |                      |
|                                                 |                                    |                      |
| 96                                              | 99                                 |                      |
| Northumbria Healthcare NHS Foundation Trust     | Hexham General Hospital            |                      |
|                                                 |                                    |                      |
| 31                                              | 33                                 |                      |
| Northumbria Healthcare NHS Foundation Trust     | North Tyneside General Hospital    |                      |
|                                                 |                                    |                      |
| 69                                              | 74                                 |                      |
| Northumbria Healthcare NHS Foundation Trust     | Wansbeck General Hospital          |                      |
|                                                 |                                    |                      |
| 71                                              | 71                                 |                      |
| North of England - Yorkshire and The Humber SCN |                                    |                      |
| Airedale NHS Foundation Trust                   | Airedale General Hospital          |                      |
|                                                 |                                    |                      |
| 67                                              | 67                                 |                      |
| Northern Lincolnshire and Goole Hospitals NHS   |                                    |                      |
| Foundation Trust                                |                                    |                      |
| Diana Princess of Wales Hospital Grimsby        |                                    |                      |
|                                                 |                                    |                      |
| 57                                              | 54                                 |                      |
| Northern Lincolnshire and Goole Hospitals NHS   |                                    |                      |
| Foundation Trust                                |                                    |                      |
| Goole District Hospital                         |                                    |                      |
|                                                 |                                    |                      |
| TFP                                             | TFP                                |                      |
| York Teaching Hospital NHS Foundation Trust     | Scarborough General Hospital       |                      |
|                                                 |                                    |                      |
| 63                                              | 58                                 |                      |
| South England - South East SCN                  |                                    |                      |
| East Kent Hospitals University NHS Foundation   |                                    |                      |
| Trust                                           |                                    |                      |
| East Kent Neuro Rehab Unit                      |                                    |                      |
|                                                 |                                    |                      |
| TFP                                             | TFP                                |                      |
| East Kent Hospitals University NHS Foundation   |                                    |                      |
| Trust                                           |                                    |                      |
| Kent and Canterbury Hospital                    |                                    |                      |
|                                                 |                                    |                      |
| 53                                              | 45                                 |                      |
| Royal Surrey County Hospital NHS Foundation     |                                    |                      |
| Trust                                           |                                    |                      |
| Royal Surrey County Hospital                    |                                    |                      |
|                                                 |                                    |                      |
| 31                                              | 23                                 |                      |
| Wales                                           |                                    |                      |
| Abertawe Bro Morgannwg University Health Board  | Singleton Hospital                 |                      |
|                                                 |                                    |                      |
| 32                                              | 31                                 |                      |
| Aneurin Bevan University Health Board           | Nevill Hall Hospital               |                      |
|                                                 |                                    |                      |
| 62                                              | 60                                 |                      |
| Aneurin Bevan University Health Board           | Ysbyty Ystrad Fawr                 |                      |
|                                                 |                                    |                      |
| X                                               | X                                  |                      |
| Cardiff and Vale University Health Board        | Llandough Hospital                 |                      |
|                                                 |                                    |                      |
| 86                                              | 78                                 |                      |
Six Month Assessment
TC KI Level
Number 
Applicable
% 
Applicable
Number 
assessed
% 
Assessed
|                                              |                                           |       |           |     |    | Non-Acute Inpatient Teams   | Number of patients   | Overall Performance   | Patient Centred Data   |
|----------------------------------------------|-------------------------------------------|-------|-----------|-----|----|-----------------------------|----------------------|-----------------------|------------------------|
| D1                                           | D2                                        | D3    | D4        | D5  | D6 | D7                          | D8                   | D9                    | D10                    |
| Trust                                        | Admit                                     | Disch |           |     |    |                             |                      |                       |                        |
| AC                                           |                                           |       |           |     |    |                             |                      |                       |                        |
| Combined                                     |                                           |       |           |     |    |                             |                      |                       |                        |
| KI Level                                     |                                           |       |           |     |    |                             |                      |                       |                        |
| TC KI Level                                  |                                           |       |           |     |    |                             |                      |                       |                        |
| Team Name                                    |                                           |       |           |     |    |                             |                      |                       |                        |
| SSNAP                                        |                                           |       |           |     |    |                             |                      |                       |                        |
| Level                                        |                                           |       |           |     |    |                             |                      |                       |                        |
| CA                                           |                                           |       |           |     |    |                             |                      |                       |                        |
| Scan                                         | SU                                        | Throm | Spec Asst | OT  | PT | SALT                        | MDT                  | Std Disch             | Disch Proc             |
| London - London SCN                          |                                           |       |           |     |    |                             |                      |                       |                        |
| Barking, Havering and Redbridge University   |                                           |       |           |     |    |                             |                      |                       |                        |
| Hospitals NHS Trust                          |                                           |       |           |     |    |                             |                      |                       |                        |
| King George Hospital Inpatient Rehab Team    |                                           |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 43                                        | B     | A         | A   | B  | NA                          | B↓                   | NA                    | NA                     |
| Central and North West London NHS Foundation |                                           |       |           |     |    |                             |                      |                       |                        |
| Trust                                        |                                           |       |           |     |    |                             |                      |                       |                        |
| St Pancras Hospital                          |                                           |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 20                                        | D↓↓   | D↓↓↓      | C↓↓ | B  | NA                          | E                    | NA                    | NA                     |
| Midlands & East - East Midlands SCN          |                                           |       |           |     |    |                             |                      |                       |                        |
| Leicestershire Partnership NHS Trust         | Coalville Community Hospital              |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 42                                        | B↑↑   | A↑↑↑      | E↓↓ | A  | NA                          | A                    | NA                    | NA                     |
| Leicestershire Partnership NHS Trust         |                                           |       |           |     |    |                             |                      |                       |                        |
| St Lukes Stroke Rehabilitation Team - Market |                                           |       |           |     |    |                             |                      |                       |                        |
| Harborough Hospital                          |                                           |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 40                                        | B↑↑   | B↓        | C↑↑ | A↑ | NA                          | A↑                   | NA                    | NA                     |
| University Hospitals of Leicester NHS Trust  | Leicester City Stroke Rehabilitation Unit |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 51                                        | B     | B↓        | B↑  | A  | NA                          | A                    | NA                    | NA                     |
| Midlands & East - East of England SCN        |                                           |       |           |     |    |                             |                      |                       |                        |
| Anglian Community Enterprise CIC             | Clacton Hospital                          |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 29                                        | B↓    | A         | D↓↓ | A  | NA                          | B↓                   | NA                    | NA                     |
| Essex Partnership University NHS Foundation  |                                           |       |           |     |    |                             |                      |                       |                        |
| Trust                                        |                                           |       |           |     |    |                             |                      |                       |                        |
| St Margaret's Hospital Essex                 |                                           |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 20                                        | D     | B↓        | D   | C  | NA                          | A                    | NA                    | NA                     |
| Hertfordshire Community NHS Trust            | Danesbury Neurological Centre             |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 27                                        | A     | A↑        | B↓  | A  | NA                          | B↓                   | NA                    | NA                     |
| Hertfordshire Community NHS Trust            | Holywell Rehabilitation Unit              |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 20                                        | A↑    | A         | B   | A  | NA                          | A                    | NA                    | NA                     |
| Norfolk Community Health and Care NHS Trust  | Norwich Community Hospital - Beech Ward   |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 48                                        | C     | B↓        | A↑  | B  | NA                          | A                    | NA                    | NA                     |
| Provide                                      | St Peter's Community Hospital Rehab Unit  |       |           |     |    |                             |                      |                       |                        |
| TFP                                          | 31                                        | A     | A↑        | B↓  | A  | NA                          | A                    | NA                    | NA                     |

## Midlands & East - West Midlands Scn

Birmingham Community Healthcare NHS 
Foundation Trust
Moseley Hall Stroke Rehabilitation Unit
TFP
39
B↑
A
C
A↑
NA
A
NA
NA
B
B
A
D↑
B↑
B
B
36
95%
9
25%
South Warwickshire NHS Foundation Trust
Feldon Stroke Rehabilitation Unit SWFT
TFP
47
A
A
B
A
NA
A
NA
NA
A
A
A
A
A
D↓
A
41
100%
0
0%
Staffordshire and Stoke-on-Trent Partnership NHS 
Trust
Staffordshire Rehabilitation Team
TFP
40
B
B↓
C↓↓
A↑
NA
A↑
NA
NA
A
A
E
A↑
B↑
A
A↑
29
97%
23
79%
Worcestershire Health and Care NHS Trust
Worcestershire Stroke Rehabilitation Unit
TFP
66
D↑
D
D
C
NA
A
NA
NA
A
B
C↑↑
E
D↓
B
C
.
.
.
.
North of England - North West Coast SCN
East Lancashire Hospitals NHS Trust
Pendle Community Hospital - Marsden Stroke Unit
TFP
45
B↑↑
B↑
A
B↑
NA
A↑
NA
NA
C
C
B
B↑
A
C↑
B↑
52
98%
8
15%
Lancashire Teaching Hospitals NHS Foundation 
Trust
Chorley and South Ribble Hospital
TFP
49
B↑↑
A
B↑↑
B↑
NA
A↑
NA
NA
A↑
B
C
E
A
C↑
B↑
60
100%
0
0%

## North Of England - Yorkshire And The Humber Scn

Doncaster and Bassetlaw Hospitals NHS 
Foundation Trust
Bassetlaw District General Hospital
TFP
35
C↓↓
B↓
B↓
C↓↓
NA
B↓
NA
NA
A
A
B↓
A
C↓
D↓
B↓
17
100%
0
0%
Doncaster and Bassetlaw Hospitals NHS 
Foundation Trust
Montagu Hospital
TFP
35
B↓
A
A↑
B↓
NA
B↓
NA
NA
B↓
B
A
B
A
D↓
B↓
23
92%
0
0%
Humber NHS Foundation Trust
Rossmore Unit, Hull Integrated Stroke Service
TFP
22
D
A
D
C
NA
B
NA
NA
A
A
D
E
C
C
C
12
86%
10
83%
South West Yorkshire Partnership NHS Foundation 
Trust
Kendray Hospital
TFP
47
A↑
A
B↓
A↑
NA
A
NA
NA
A
B
B
B
B
C↑
A↑
85
80%
82
96%
South England - South East SCN
East Sussex Healthcare NHS Trust
Bexhill Hospital - Irvine Unit
TFP
28
C
A
D
B
NA
A
NA
NA
C
B
C↑
E
A
C↓
C
26
100%
1
4%
South England - South West SCN
CORNWALL PARTNERSHIP NHS 
FOUNDATION TRUST
Lanyon Stroke Rehabilitation Unit
TFP
67
C↓
B↓
D
B↓
NA
B↓
NA
NA
B↓
B
C↓
C
B
A
B↓
55
100%
6
11%
CORNWALL PARTNERSHIP NHS 
FOUNDATION TRUST
Woodfield Stroke Rehabilitation Unit
TFP
39
B↓
A
C↓
A
NA
A
NA
NA
A
B
B↓
D↓
B
A
A
31
100%
6
19%
Great Western Hospitals NHS Foundation Trust
Forest Ward - Swindon Intermediate Care Centre
TFP
27
D
B
D
C↑
NA
A↑
NA
NA
C
D
C↑↑
E
A↑
D
C↑
14
93%
7
50%
Livewell Southwest
Mount Gould Hospital
TFP
49
A
A
A
A
NA
B
NA
NA
A
A
B
E
B
A
B
35
97%
2
6%
Royal Devon and Exeter NHS Foundation Trust
East Devon Community Stroke Rehab Unit
TFP
47
B
A↑
B↓
B
NA
A
NA
NA
B↓
A↑
C
C
B
B
B
39
100%
0
0%
Somerset Partnership NHS Foundation Trust
South Petherton Community Hospital
TFP
50
C↑
A
D
B↑
NA
A↑
NA
NA
B↑
B↑↑
C↑
C
A
B↑↑
B↑
34
94%
5
15%
Torbay and South Devon NHS Foundation Trust
Newton Abbot Hospital
TFP
80
A
A
B
A
NA
A
NA
NA
A
A
A
D
A
A
A
61
100%
0
0%
Wiltshire Health and Care
WHC Mulberry Stroke Rehabilitation Ward
TFP
35
D
A
D
C
NA
A↑
NA
NA
C
C↑
D
D↑
B
C
C↑
37
100%
1
3%
Six Month Assessment
Number 
Applicable
% 
Applicable
Number 
assessed
% 
Assessed
|                                       |                                   |       |           |    |     | Non-Acute Inpatient Teams   | Number of patients   | Overall Performance   | Patient Centred Data   |
|---------------------------------------|-----------------------------------|-------|-----------|----|-----|-----------------------------|----------------------|-----------------------|------------------------|
| D1                                    | D2                                | D3    | D4        | D5 | D6  | D7                          | D8                   | D9                    | D10                    |
| Trust                                 | Admit                             | Disch |           |    |     |                             |                      |                       |                        |
| AC                                    |                                   |       |           |    |     |                             |                      |                       |                        |
| Combined                              |                                   |       |           |    |     |                             |                      |                       |                        |
| KI Level                              |                                   |       |           |    |     |                             |                      |                       |                        |
| TC KI Level                           |                                   |       |           |    |     |                             |                      |                       |                        |
| Team Name                             |                                   |       |           |    |     |                             |                      |                       |                        |
| SSNAP                                 |                                   |       |           |    |     |                             |                      |                       |                        |
| Level                                 |                                   |       |           |    |     |                             |                      |                       |                        |
| CA                                    |                                   |       |           |    |     |                             |                      |                       |                        |
| Scan                                  | SU                                | Throm | Spec Asst | OT | PT  | SALT                        | MDT                  | Std Disch             | Disch Proc             |
|                                       |                                   |       |           |    |     |                             |                      |                       |                        |
| South England - Thames Valley SCN     |                                   |       |           |    |     |                             |                      |                       |                        |
| Frimley Health NHS Foundation Trust   | Wexham Park Hospital              |       |           |    |     |                             |                      |                       |                        |
|                                       |                                   |       |           |    |     |                             |                      |                       |                        |
| TFP                                   | 55                                |       | D         | A  | D   | C                           |                      | NA                    | E↓                     |
| Oxford Health NHS Foundation Trust    | Abingdon Community Hospital       |       |           |    |     |                             |                      |                       |                        |
|                                       |                                   |       |           |    |     |                             |                      |                       |                        |
| TFP                                   | 25                                |       | C↓        | A  | D↓↓ | B                           |                      | NA                    | A                      |
| Oxford Health NHS Foundation Trust    | Witney Community Hospital         |       |           |    |     |                             |                      |                       |                        |
|                                       |                                   |       |           |    |     |                             |                      |                       |                        |
| TFP                                   | 20                                |       | C         | A  | D   | B                           |                      | NA                    | A                      |
| Northern Ireland                      |                                   |       |           |    |     |                             |                      |                       |                        |
| Southern Health and Social Care Trust | South Tyrone and Lurgan Hospitals |       |           |    |     |                             |                      |                       |                        |
|                                       |                                   |       |           |    |     |                             |                      |                       |                        |
| TFP                                   | 37                                |       | C↑        | B↓ | A↑  | B↑↑                         |                      | NA                    | A                      |
| Wales                                 |                                   |       |           |    |     |                             |                      |                       |                        |
| Aneurin Bevan University Health Board | St Woolos Hospital                |       |           |    |     |                             |                      |                       |                        |
|                                       |                                   |       |           |    |     |                             |                      |                       |                        |
| TFP                                   | 51                                |       | C         | A  | B↑  | C↓                          |                      | NA                    | A                      |
| Cwm Taf University Health Board       | Ysbyty Cwm Rhondda                |       |           |    |     |                             |                      |                       |                        |
|                                       |                                   |       |           |    |     |                             |                      |                       |                        |
| TFP                                   | TFP                               |       | TFP       | NA | B↑↑ | TFP                         |                      | NA                    | NA                     |
Six Month Assessment
Number 
Applicable
% 
Applicable
Number 
assessed
% 
Assessed
|                                                 |                                         |       |           |    |    | Routinely Admitting Teams   | Number of patients   | Overall Performance   | Team Centred Data   |
|-------------------------------------------------|-----------------------------------------|-------|-----------|----|----|-----------------------------|----------------------|-----------------------|---------------------|
| D1                                              | D2                                      | D3    | D4        | D5 | D6 | D7                          | D8                   | D9                    | D10                 |
| Trust                                           | Team Name                               | Admit | Disch     |    |    |                             |                      |                       |                     |
| SSNAP                                           |                                         |       |           |    |    |                             |                      |                       |                     |
| Level                                           |                                         |       |           |    |    |                             |                      |                       |                     |
| CA                                              | AC                                      |       |           |    |    |                             |                      |                       |                     |
| Combined                                        |                                         |       |           |    |    |                             |                      |                       |                     |
| KI Level                                        |                                         |       |           |    |    |                             |                      |                       |                     |
| TC KI Level                                     |                                         |       |           |    |    |                             |                      |                       |                     |
| Scan                                            | SU                                      | Throm | Spec Asst | OT | PT | SALT                        | MDT                  | Std Disch             | Disch Proc          |
| London - London SCN                             |                                         |       |           |    |    |                             |                      |                       |                     |
| Barking, Havering and Redbridge University      |                                         |       |           |    |    |                             |                      |                       |                     |
| Hospitals NHS Trust                             |                                         |       |           |    |    |                             |                      |                       |                     |
| Queens Hospital Romford HASU                    |                                         |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 400                                             | 405                                     |       | B↑↑       | A  | A↑ | B↑                          |                      | A                     | C↑↑                 |
| Barts Health NHS Trust                          | Royal London Hospital HASU              |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 294                                             | 303                                     |       | B         | A↑ | C↓ | A                           |                      | A                     | C                   |
| Imperial College Healthcare NHS Trust           | Charing Cross Hospital HASU             |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 367                                             | 403                                     |       | B         | A  | A↑ | B                           |                      | A                     | C                   |
| King's College Hospital NHS Foundation Trust    | King's College Hospital HASU            |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 287                                             | 299                                     |       | B↓        | A  | B  | B↓                          |                      | A                     | E↓↓                 |
| King's College Hospital NHS Foundation Trust    | Princess Royal University Hospital HASU |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 264                                             | 271                                     |       | B         | A↑ | C  | B↓                          |                      | A                     | D                   |
| London North West Healthcare NHS Trust          | Northwick Park Hospital HASU            |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 446                                             | 439                                     |       | A         | A  | A  | A                           |                      | A                     | B                   |
| St George's University Hospitals NHS Foundation |                                         |       |           |    |    |                             |                      |                       |                     |
| Trust                                           |                                         |       |           |    |    |                             |                      |                       |                     |
| St George's Hospital HASU                       |                                         |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 386                                             | 397                                     |       | A         | A  | A  | A                           |                      | A                     | C                   |
| University College London Hospitals NHS         |                                         |       |           |    |    |                             |                      |                       |                     |
| Foundation Trust                                |                                         |       |           |    |    |                             |                      |                       |                     |
| University College Hospital HASU                |                                         |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 404                                             | 403                                     |       | A         | A  | A  | A                           |                      | B↓                    | B↑↑                 |
| Midlands & East - East Midlands SCN             |                                         |       |           |    |    |                             |                      |                       |                     |
| Derby Teaching Hospitals NHS Foundation Trust   | Royal Derby Hospital                    |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 241                                             | 269                                     |       | C         | A  | B  | C↓                          |                      | C                     | C                   |
| Northampton General Hospital NHS Trust          | Northampton General Hospital            |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 267                                             | 258                                     |       | A         | B↓ | A  | A                           |                      | A                     | C↓                  |
| Nottingham University Hospitals NHS Trust       | Nottingham City Hospital                |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 411                                             | 418                                     |       | C         | A  | A↑ | C↓                          |                      | D↓                    | C↓                  |
| Sherwood Forest Hospitals NHS Foundation Trust  | Kings Mill Hospital                     |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 142                                             | 139                                     |       | A         | B↓ | A  | A                           |                      | A↑                    | B                   |
| United Lincolnshire Hospitals NHS Trust         | Lincoln County Hospital                 |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 201                                             | 199                                     |       | B         | A  | A↑ | B                           |                      | A                     | C↑                  |
| United Lincolnshire Hospitals NHS Trust         | Pilgrim Hospital                        |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 172                                             | 173                                     |       | B↓        | A  | A  | B↓                          |                      | B↓                    | C↓                  |
| University Hospitals of Leicester NHS Trust     | Leicester Royal Infirmary               |       |           |    |    |                             |                      |                       |                     |
|                                                 |                                         |       |           |    |    |                             |                      |                       |                     |
| 429                                             | 426                                     |       | B↓        | A  | A  | B↓                          |                      | B                     | C                   |

## Midlands & East - East Of England Scn

Basildon and Thurrock University Hospitals NHS 
Foundation Trust
Basildon University Hospital
  
173
173
  
B↓
A
A
B↓
  
A
C
B
B
B↓
B
C
B
B↓
A
B↓
Cambridge University Hospitals NHS Foundation 
Trust
Addenbrooke's Hospital
  
220
239
  
B
A
B
B
  
B↓
D
C↓
B
A
A
C
C↓
A↑
C
B
Colchester Hospital University NHS Foundation 
Trust
Colchester General Hospital
  
217
214
  
A
A
A
A
  
A↑
C
B
B
A
A
B↑
A
B
A
A
East and North Hertfordshire NHS Trust
Lister Hospital
  
271
286
  
A
A
B↓
A
  
A
C
C
A↑
A
A
A
B
B
B↓
A
Ipswich Hospital NHS Trust
Ipswich Hospital
  
192
190
  
B
A
A
B
  
B
B
B
C
A
A
E
C↑
A
A
B
James Paget University Hospitals NHS Foundation 
Trust
James Paget Hospital
  
126
144
  
B↑
A
B
B↑
  
A↑
C
B↑↑
B
B
B
D
C↑
B↓
A↑
B↑
Luton and Dunstable University Hospital NHS 
Foundation Trust
Luton and Dunstable Hospital
  
221
220
  
B
A
A
B
  
A
D
B
B
A
B
C
C
B
A↑↑
B
Mid Essex Hospital Services NHS Trust
Broomfield Hospital
  
140
146
  
A
A
A
A
  
A
B
A↑
A
A
B
B↑
B
A
A
A
Norfolk and Norwich University Hospitals NHS 
Foundation Trust
Norfolk and Norwich University Hospital
  
386
396
  
B↑
A
A↑
B↑
  
B↑
D
B↑
A↑
C
B
C↑
B↑
A
A
B↑
North West Anglia NHS Foundation Trust
Peterborough City Hospital
  
234
227
  
D↓
A
A
D↓
  
C
E↓↓
D
B
C
D↓↓
E
C↓
B↓
C
D↓
Queen Elizabeth Hospital King's Lynn NHS 
Foundation Trust
Queen Elizabeth Hospital Kings Lynn
  
209
212
  
A↑
A
B↑
A↑
  
A↑
B↑
A↑
A↑↑
A
A
A↑↑
B
A
C
A↑
Southend University Hospital NHS Foundation 
Trust
Southend Hospital
  
219
218
  
B↓
A
A↑
B↓
  
B↓
C
B
B
B
B
C↓↓
A
A↑
B↓
B↓
West Hertfordshire Hospitals NHS Trust
Watford General Hospital
  
204
208
  
A
A
A
A
  
A↑
C
C↓
B
A
A
A
B↑
A
B↓
A
West Suffolk NHS Foundation Trust
West Suffolk Hospital
  
161
166
  
A
A
A
A
  
A
C
C
B↓
A
A
A
B
C↑
B↓
A
|             |           |       |           |    |    | Routinely Admitting Teams   | Number of patients   | Overall Performance   | Team Centred Data   |
|-------------|-----------|-------|-----------|----|----|-----------------------------|----------------------|-----------------------|---------------------|
| D1          | D2        | D3    | D4        | D5 | D6 | D7                          | D8                   | D9                    | D10                 |
| Trust       | Team Name | Admit | Disch     |    |    |                             |                      |                       |                     |
| SSNAP       |           |       |           |    |    |                             |                      |                       |                     |
| Level       |           |       |           |    |    |                             |                      |                       |                     |
| CA          | AC        |       |           |    |    |                             |                      |                       |                     |
| Combined    |           |       |           |    |    |                             |                      |                       |                     |
| KI Level    |           |       |           |    |    |                             |                      |                       |                     |
| TC KI Level |           |       |           |    |    |                             |                      |                       |                     |
| Scan        | SU        | Throm | Spec Asst | OT | PT | SALT                        | MDT                  | Std Disch             | Disch Proc          |

## Midlands & East - West Midlands Scn

| Burton Hospitals NHS Foundation Trust            | Queens Hospital Burton upon Trent   |
|--------------------------------------------------|-------------------------------------|
|                                                  |                                     |
| 119                                              | 118                                 |
| George Eliot Hospital NHS Trust                  | George Eliot Hospital               |
|                                                  |                                     |
| 70                                               | 82                                  |
| Heart of England NHS Foundation Trust            | Birmingham Heartlands Hospital      |
|                                                  |                                     |
| 252                                              | 265                                 |
| Royal Wolverhampton NHS Trust                    | New Cross Hospital                  |
|                                                  |                                     |
| 160                                              | 169                                 |
| Sandwell and West Birmingham Hospitals NHS       |                                     |
| Trust                                            |                                     |
| Sandwell District Hospital                       |                                     |
|                                                  |                                     |
| 190                                              | 187                                 |
| Shrewsbury and Telford Hospital NHS Trust        | Princess Royal Hospital Telford     |
|                                                  |                                     |
| 304                                              | 317                                 |
| South Warwickshire NHS Foundation Trust          | Warwick Hospital                    |
|                                                  |                                     |
| 92                                               | 105                                 |
| The Dudley Group NHS Foundation Trust            | Russells Hall Hospital              |
|                                                  |                                     |
| 163                                              | 170                                 |
| University Hospitals Birmingham NHS Foundation   |                                     |
| Trust                                            |                                     |
| Queen Elizabeth Hospital Edgbaston               |                                     |
|                                                  |                                     |
| 196                                              | 168                                 |
| University Hospitals Coventry and Warwickshire   |                                     |
| NHS Trust                                        |                                     |
| University Hospital Coventry                     |                                     |
|                                                  |                                     |
| 303                                              | 316                                 |
| University Hospitals of North Midlands NHS Trust | Royal Stoke University Hospital     |
|                                                  |                                     |
| 316                                              | 405                                 |
| Walsall Healthcare NHS Trust                     | Manor Hospital                      |
|                                                  |                                     |
| 120                                              | 103                                 |
| Worcestershire Acute Hospitals NHS Trust         | Worcestershire Royal Hospital       |
|                                                  |                                     |
| 313                                              | 325                                 |
| Wye Valley NHS Trust                             | Hereford County Hospital            |
|                                                  |                                     |
| 171                                              | 173                                 |

## North Of England - Greater Manchester & Eastern Cheshire Scn

| Manchester University NHS Foundation Trust   | Wythenshawe Hospital       |
|----------------------------------------------|----------------------------|
|                                              |                            |
| 73                                           | 118                        |
| Pennine Acute Hospitals NHS Trust            | Fairfield General Hospital |
|                                              |                            |
| 303                                          | 348                        |
| Salford Royal NHS Foundation Trust           | Salford Royal Hospital     |
|                                              |                            |
| 699                                          | 699                        |
| Stockport NHS Foundation Trust               | Stepping Hill Hospital     |
|                                              |                            |
| 385                                          | 415                        |

## North Of England - North West Coast Scn

| Aintree University Hospitals NHS Foundation Trust   | University Hospital Aintree           |
|-----------------------------------------------------|---------------------------------------|
|                                                     |                                       |
| 147                                                 | 144                                   |
| Blackpool Teaching Hospitals NHS Foundation         |                                       |
| Trust                                               |                                       |
| Blackpool Victoria Hospital                         |                                       |
|                                                     |                                       |
| 180                                                 | 179                                   |
| Countess of Chester Hospital NHS Foundation         |                                       |
| Trust                                               |                                       |
| Countess of Chester Hospital                        |                                       |
|                                                     |                                       |
| 101                                                 | 109                                   |
| East Lancashire Hospitals NHS Trust                 | Royal Blackburn Hospital              |
|                                                     |                                       |
| 233                                                 | 238                                   |
| Lancashire Teaching Hospitals NHS Foundation        |                                       |
| Trust                                               |                                       |
| Royal Preston Hospital                              |                                       |
|                                                     |                                       |
| 209                                                 | 200                                   |
| Mid Cheshire Hospitals NHS Foundation Trust         | Leighton Hospital                     |
|                                                     |                                       |
| 128                                                 | 176                                   |
| Royal Liverpool and Broadgreen University           |                                       |
| Hospitals NHS Trust                                 |                                       |
| Royal Liverpool University Hospital                 |                                       |
|                                                     |                                       |
| 211                                                 | 214                                   |
| Southport and Ormskirk Hospital NHS Trust           | Southport and Formby District General |
|                                                     |                                       |
| 105                                                 | 120                                   |
| St Helens and Knowsley Teaching Hospitals NHS       |                                       |
| Trust                                               |                                       |
| Whiston Hospital HASU                               |                                       |
|                                                     |                                       |
| 238                                                 | 245                                   |
| University Hospitals of Morecambe Bay NHS           |                                       |
| Foundation Trust                                    |                                       |
| Furness General Hospital                            |                                       |
|                                                     |                                       |
| 86                                                  | 89                                    |
| University Hospitals of Morecambe Bay NHS           |                                       |
| Foundation Trust                                    |                                       |
| Royal Lancaster Infirmary                           |                                       |
|                                                     |                                       |
| 106                                                 | 98                                    |
| Warrington and Halton Hospitals NHS Foundation      |                                       |
| Trust                                               |                                       |
| Warrington Hospital                                 |                                       |
|                                                     |                                       |
| 72                                                  | 85                                    |
  
|             |           |       |           |    |    | Routinely Admitting Teams   | Number of patients   | Overall Performance   | Team Centred Data   |
|-------------|-----------|-------|-----------|----|----|-----------------------------|----------------------|-----------------------|---------------------|
| D1          | D2        | D3    | D4        | D5 | D6 | D7                          | D8                   | D9                    | D10                 |
| Trust       | Team Name | Admit | Disch     |    |    |                             |                      |                       |                     |
| SSNAP       |           |       |           |    |    |                             |                      |                       |                     |
| Level       |           |       |           |    |    |                             |                      |                       |                     |
| CA          | AC        |       |           |    |    |                             |                      |                       |                     |
| Combined    |           |       |           |    |    |                             |                      |                       |                     |
| KI Level    |           |       |           |    |    |                             |                      |                       |                     |
| TC KI Level |           |       |           |    |    |                             |                      |                       |                     |
| Scan        | SU        | Throm | Spec Asst | OT | PT | SALT                        | MDT                  | Std Disch             | Disch Proc          |

## North Of England - North Of England Scn

| City Hospitals Sunderland NHS Foundation Trust   | Sunderland Royal Hospital                         |
|--------------------------------------------------|---------------------------------------------------|
|                                                  |                                                   |
| 243                                              | 255                                               |
| County Durham and Darlington NHS Foundation      |                                                   |
| Trust                                            |                                                   |
| University Hospital of North Durham              |                                                   |
|                                                  |                                                   |
| 299                                              | 304                                               |
| Newcastle upon Tyne Hospitals NHS Foundation     |                                                   |
| Trust                                            |                                                   |
| Royal Victoria Infirmary                         |                                                   |
|                                                  |                                                   |
| 340                                              | 358                                               |
| North Cumbria University Hospitals NHS Trust     | Cumberland Infirmary                              |
|                                                  |                                                   |
| 130                                              | 134                                               |
| North Cumbria University Hospitals NHS Trust     | West Cumberland Hospital                          |
|                                                  |                                                   |
| 87                                               | 88                                                |
| North Tees and Hartlepool NHS Foundation Trust   | University Hospitals of North Tees and Hartlepool |
|                                                  |                                                   |
| 221                                              | 225                                               |
| Northumbria Healthcare NHS Foundation Trust      |                                                   |
| Northumbria Specialist Emergency Care Hospital   |                                                   |
| HASU                                             |                                                   |
|                                                  |                                                   |
| 310                                              | 308                                               |
| South Tees Hospitals NHS Foundation Trust        | James Cook University Hospital                    |
|                                                  |                                                   |
| 230                                              | 238                                               |
| North of England - Yorkshire and The Humber SCN  |                                                   |
| Barnsley Hospital NHS Foundation Trust           | Barnsley Hospital                                 |
|                                                  |                                                   |
| 170                                              | 177                                               |
| Bradford Teaching Hospitals NHS Foundation       |                                                   |
| Trust                                            |                                                   |
| Bradford Royal Infirmary                         |                                                   |
|                                                  |                                                   |
| 238                                              | 237                                               |
| Calderdale and Huddersfield NHS Foundation       |                                                   |
| Trust                                            |                                                   |
| Calderdale Royal Hospital                        |                                                   |
|                                                  |                                                   |
| 181                                              | 208                                               |
| Chesterfield Royal Hospital NHS Foundation Trust | Chesterfield Royal                                |
|                                                  |                                                   |
| 159                                              | 161                                               |
| Doncaster and Bassetlaw Hospitals NHS            |                                                   |
| Foundation Trust                                 |                                                   |
| Doncaster Royal Infirmary                        |                                                   |
|                                                  |                                                   |
| 208                                              | 225                                               |
| Harrogate and District NHS Foundation Trust      | Harrogate District Hospital                       |
|                                                  |                                                   |
| 64                                               | 69                                                |
| Hull and East Yorkshire Hospitals NHS Trust      | Hull Royal Infirmary                              |
|                                                  |                                                   |
| 283                                              | 286                                               |
| Leeds Teaching Hospitals NHS Trust               | Leeds General Infirmary                           |
|                                                  |                                                   |
| 296                                              | 297                                               |
| Mid Yorkshire Hospitals NHS Trust                | Pinderfields Hospital                             |
|                                                  |                                                   |
| 267                                              | 275                                               |
| Northern Lincolnshire and Goole Hospitals NHS    |                                                   |
| Foundation Trust                                 |                                                   |
| Scunthorpe General Hospital                      |                                                   |
|                                                  |                                                   |
| 226                                              | 231                                               |
| Rotherham NHS Foundation Trust                   | Rotherham Hospital                                |
|                                                  |                                                   |
| 151                                              | 149                                               |
| Sheffield Teaching Hospitals NHS Foundation      |                                                   |
| Trust                                            |                                                   |
| Royal Hallamshire Hospital                       |                                                   |
|                                                  |                                                   |
| 288                                              | 320                                               |
| York Teaching Hospital NHS Foundation Trust      | York Hospital                                     |
|                                                  |                                                   |
| 294                                              | 304                                               |

## South England - South East Scn

Ashford and St Peter's Hospitals NHS Foundation 
Trust
St Peter's Hospital
  
153
169
  
B↓
A
A
B↓
  
A
C
D↓
B
C↓
A
B
B
A
A
B↓
Brighton and Sussex University Hospitals NHS 
Trust
Royal Sussex County Hospital
  
206
208
  
A↑
A
A
A↑
  
A
C↓
B
A
A↑↑
A↑
B↑
B↑
A
B
A↑
Dartford and Gravesham NHS Trust
Darent Valley Hospital
  
131
113
  
D
A
B
D
  
A↑
E
D↓
D
C↑
B↑
E
D
D↓↓
D↓
D
East Kent Hospitals University NHS Foundation 
Trust
Queen Elizabeth the Queen Mother Hospital
  
114
124
  
D↓
A
A
D↓
  
B↓
D↓
C
B↓
B
B↑
E
D
B
E
D↓
East Kent Hospitals University NHS Foundation 
Trust
William Harvey Hospital
  
198
183
  
B
A
A
B
  
B↓
E↓↓
D
B↓
A
A
C↑
C
B
A↑
B
East Sussex Healthcare NHS Trust
Eastbourne District General Hospital
  
144
174
  
B↑
A
A
B↑
  
A
B
C
A↑
B↑
B↑
E↓
D
A
C↓
B
Epsom and St Helier University Hospitals NHS 
Trust
Epsom Hospital
  
101
101
  
C↑
A
A↑
C↑
  
A
E
D↑
B↑
B↑
B↑
E
C↑
B
B↑
C↑
Frimley Health NHS Foundation Trust
Frimley Park Hospital
  
219
234
  
B↓
A
B
A
  
A
C↓
B
A
A
B
A
Maidstone and Tunbridge Wells NHS Trust
Maidstone District General Hospital
  
118
111
  
B↓
A
A
B↓
  
A
C
C
B
A
A
A
B
B
B↓
Maidstone and Tunbridge Wells NHS Trust
Tunbridge Wells Hospital
  
141
135
  
C
A
A
C
  
A
E
C↑
C
A↑
Medway NHS Foundation Trust
Medway Maritime Hospital
  
98
96
  
D
A
B↑
D
  
B↑
E
D
D
Surrey and Sussex Healthcare NHS Trust
East Surrey Hospital
  
183
205
  
C
A
C
B
  
A
D
C↓
B
A↑
B↑
C
B
A↑
Western Sussex Hospitals NHS Foundation Trust
St Richards Hospital
  
137
155
  
C
A
A
C
  
B
C
B
C↑
C
C
C
Western Sussex Hospitals NHS Foundation Trust
Worthing Hospital
  
160
167
  
A↑
A
A
A↑
  
A
B↑
B
A
A
B
C
B
A
A↑
|                                                   |                                     |       |           |     |     | Routinely Admitting Teams   | Number of patients   | Overall Performance   | Team Centred Data   |
|---------------------------------------------------|-------------------------------------|-------|-----------|-----|-----|-----------------------------|----------------------|-----------------------|---------------------|
| D1                                                | D2                                  | D3    | D4        | D5  | D6  | D7                          | D8                   | D9                    | D10                 |
| Trust                                             | Team Name                           | Admit | Disch     |     |     |                             |                      |                       |                     |
| SSNAP                                             |                                     |       |           |     |     |                             |                      |                       |                     |
| Level                                             |                                     |       |           |     |     |                             |                      |                       |                     |
| CA                                                | AC                                  |       |           |     |     |                             |                      |                       |                     |
| Combined                                          |                                     |       |           |     |     |                             |                      |                       |                     |
| KI Level                                          |                                     |       |           |     |     |                             |                      |                       |                     |
| TC KI Level                                       |                                     |       |           |     |     |                             |                      |                       |                     |
| Scan                                              | SU                                  | Throm | Spec Asst | OT  | PT  | SALT                        | MDT                  | Std Disch             | Disch Proc          |
| South England - South West SCN                    |                                     |       |           |     |     |                             |                      |                       |                     |
| Gloucestershire Hospitals NHS Foundation Trust    | Gloucestershire Royal Hospital      |       |           |     |     |                             |                      |                       |                     |
| 279                                               | 275                                 | D     | A         | A   | D   | C↑                          | C↑↑                  | B↑                    | D                   |
| Great Western Hospitals NHS Foundation Trust      | Great Western Hospital Swindon      |       |           |     |     |                             |                      |                       |                     |
| 125                                               | 131                                 | E     | C↓↓       | C↓  | D↑  | B                           | E                    | C↑                    | E                   |
| North Bristol NHS Trust                           | North Bristol Hospitals             |       |           |     |     |                             |                      |                       |                     |
| 263                                               | 262                                 | D     | A         | B   | D   | A                           | D                    | C↓                    | D                   |
| Northern Devon Healthcare NHS Trust               | North Devon District Hospital       |       |           |     |     |                             |                      |                       |                     |
| 137                                               | 146                                 | D↓    | A         | B   | C↓  | D↓                          | E↓                   | D                     | E                   |
| Plymouth Hospitals NHS Trust                      | Derriford Hospital                  |       |           |     |     |                             |                      |                       |                     |
| 308                                               | 317                                 | B↑    | A         | A   | B↑  | B↓                          | C↑                   | C↓                    | B                   |
| Royal Cornwall Hospitals NHS Trust                | Royal Cornwall Hospital             |       |           |     |     |                             |                      |                       |                     |
| 278                                               | 294                                 | C     | A         | A↑  | C↓  | A                           | C                    | D↓                    | B                   |
| Royal Devon and Exeter NHS Foundation Trust       | Royal Devon and Exeter Hospital     |       |           |     |     |                             |                      |                       |                     |
| 238                                               | 245                                 | B     | A         | A   | B   | C↓                          | C                    | C↓                    | C↓                  |
| Royal United Hospital Bath NHS Foundation Trust   | Royal United Hospital Bath          |       |           |     |     |                             |                      |                       |                     |
| 180                                               | 189                                 | B↓    | B↓        | A   | B↓  | A                           | C                    | B                     | A                   |
| Salisbury NHS Foundation Trust                    | Salisbury District Hospital         |       |           |     |     |                             |                      |                       |                     |
| 119                                               | 122                                 | D↓    | A         | B   | D↓  | A↑                          | D↓                   | D↓                    | B↑                  |
| Taunton and Somerset NHS Foundation Trust         | Musgrove Park Hospital              |       |           |     |     |                             |                      |                       |                     |
| 208                                               | 209                                 | B     | A         | A   | B   | A                           | C                    | C                     | B↑                  |
| Torbay and South Devon NHS Foundation Trust       | Torbay Hospital                     |       |           |     |     |                             |                      |                       |                     |
| 196                                               | 201                                 | B     | A         | A   | B   | C↓↓                         | D↓                   | D↓↓                   | D                   |
| University Hospitals Bristol NHS Foundation Trust | Bristol Royal Infirmary             |       |           |     |     |                             |                      |                       |                     |
| 130                                               | 151                                 | C↓    | B↓        | A   | C↓  | A                           | C                    | C↓                    | C↑                  |
| Weston Area Health NHS Trust                      | Weston General Hospital             |       |           |     |     |                             |                      |                       |                     |
| 70                                                | 84                                  | C↑    | A         | A   | C↑  | C                           | D↓                   | B↑                    | B                   |
| Yeovil District Hospital NHS Foundation Trust     | Yeovil District Hospital            |       |           |     |     |                             |                      |                       |                     |
| 138                                               | 152                                 | B↑    | A         | A   | B↑  | A↑↑                         | C                    | B                     | C↑                  |
| South England - Thames Valley SCN                 |                                     |       |           |     |     |                             |                      |                       |                     |
| Buckinghamshire Healthcare NHS Trust              | Wycombe General Hospital            |       |           |     |     |                             |                      |                       |                     |
| 218                                               | 245                                 | B↓    | A         | B↓  | A   | A                           | C↓                   | B↓                    | A                   |
| Milton Keynes University Hospital NHS Foundation  |                                     |       |           |     |     |                             |                      |                       |                     |
| Trust                                             |                                     |       |           |     |     |                             |                      |                       |                     |
| Milton Keynes General Hospital                    |                                     |       |           |     |     |                             |                      |                       |                     |
| 72                                                | 84                                  | B     | A         | B   | B   | A                           | C                    | C                     | B↑↑                 |
| Oxford University Hospitals NHS Foundation Trust  | Horton General Hospital             |       |           |     |     |                             |                      |                       |                     |
| TFP                                               | 21                                  | TFP   | A         | TFP | TFP | NA                          | B                    | NA                    | NA                  |
| Oxford University Hospitals NHS Foundation Trust  | John Radcliffe Hospital             |       |           |     |     |                             |                      |                       |                     |
| 200                                               | 205                                 | A↑    | A         | A   | A↑  | A                           | C                    | B                     | B↑↑                 |
| Royal Berkshire NHS Foundation Trust              | Royal Berkshire Hospital            |       |           |     |     |                             |                      |                       |                     |
| 224                                               | 219                                 | A     | B↓        | A   | A   | A                           | C                    | A                     | B                   |
| South England - Wessex SCN                        |                                     |       |           |     |     |                             |                      |                       |                     |
| Dorset County Hospital NHS Foundation Trust       | Dorset County Hospital              |       |           |     |     |                             |                      |                       |                     |
| 130                                               | 117                                 | B↓    | A         | A   | B↓  | C                           | C↓                   | C↓                    | C↓                  |
| Hampshire Hospitals NHS Foundation Trust          | Royal Hampshire County Hospital     |       |           |     |     |                             |                      |                       |                     |
| 186                                               | 186                                 | B↓    | A         | A   | B↓  | B↑                          | C↓                   | C↓                    | B                   |
| Isle of Wight NHS Trust                           | St Mary's Hospital Newport          |       |           |     |     |                             |                      |                       |                     |
| 99                                                | 105                                 | B↑    | A         | B   | B↑  | A                           | D↑                   | D↑                    | B                   |
| Poole Hospital NHS Foundation Trust               | Poole Hospital                      |       |           |     |     |                             |                      |                       |                     |
| 161                                               | 166                                 | C↓    | C↓↓       | A   | B   | B↑                          | C                    | D                     | D                   |
| Portsmouth Hospitals NHS Trust                    | Queen Alexandra Hospital Portsmouth |       |           |     |     |                             |                      |                       |                     |
| 335                                               | 324                                 | C↑    | A         | B↓  | C↑  | C                           | D↑                   | B↑                    | D                   |
| Royal Bournemouth and Christchurch Hospitals      |                                     |       |           |     |     |                             |                      |                       |                     |
| NHS Foundation Trust                              |                                     |       |           |     |     |                             |                      |                       |                     |
| Royal Bournemouth General Hospital                |                                     |       |           |     |     |                             |                      |                       |                     |
| 265                                               | 275                                 | A     | A         | A   | A   | B                           | C                    | C↓                    | B                   |
| University Hospital Southampton NHS Foundation    |                                     |       |           |     |     |                             |                      |                       |                     |
| Trust                                             |                                     |       |           |     |     |                             |                      |                       |                     |
| Southampton General Hospital                      |                                     |       |           |     |     |                             |                      |                       |                     |
| 272                                               | 282                                 | A↑    | A         | A↑  | A↑  | B                           | C↓                   | A↑                    | B                   |

## Northern Ireland

|                                            |                           |    |    |    |    |    |    |    |    |     |      |     |    |    | Belfast Health and Social Care Trust   | Royal Victoria Hospital Belfast   |
|--------------------------------------------|---------------------------|----|----|----|----|----|----|----|----|-----|------|-----|----|----|----------------------------------------|-----------------------------------|
| 192                                        | 187                       | B  | A  | A  | B  | A  | E↓ | B  | C↓ | C   | A↑   | A↑  | C  | B  | A                                      | B                                 |
| Northern Health and Social Care Trust      | Antrim Area Hospital      |    |    |    |    |    |    |    |    |     |      |     |    |    |                                        |                                   |
| 170                                        | 183                       | D  | A  | A↑ | D  | D↓ | E  | D↓ | C↑ | C   | B↑↑↑ | D↑  | D  | B  | D↓                                     | D                                 |
| Northern Health and Social Care Trust      | Causeway Hospital         |    |    |    |    |    |    |    |    |     |      |     |    |    |                                        |                                   |
| 76                                         | 72                        | D↑ | A  | A↑ | D↑ | D  | E  | D↑ | E  | C↑↑ | D↑   | D   | D  | B↑ | C                                      | D↑                                |
| South Eastern Health and Social Care Trust | Downe General Hospital    |    |    |    |    |    |    |    |    |     |      |     |    |    |                                        |                                   |
| X                                          | X                         | X  | X  | X  | X  | X  | X  | X  | X  | X   | X    | X   | X  | X  | X                                      | X                                 |
| South Eastern Health and Social Care Trust | Ulster Hospital           |    |    |    |    |    |    |    |    |     |      |     |    |    |                                        |                                   |
| 155                                        | 159                       | D↓ | A  | B↓ | C  | C↑ | E  | C↓ | E  | A   | B    | C   | E↓ | A  | A                                      | C                                 |
| Southern Health and Social Care Trust      | Craigavon Area Hospital   |    |    |    |    |    |    |    |    |     |      |     |    |    |                                        |                                   |
| 121                                        | 121                       | D  | A  | A  | D  | D↓ | D↑ | C↑ | C↑ | C↓↓ | A↑↑↑ | D↓  | D↑ | B↓ | A                                      | C↑                                |
| Southern Health and Social Care Trust      | Daisy Hill Hospital       |    |    |    |    |    |    |    |    |     |      |     |    |    |                                        |                                   |
| 45                                         | 54                        | C↑ | A↑ | A  | C↑ | C  | E  | C↑ | E  | A↑  | C↑   | C↑  | D  | B  | A                                      | C↑                                |
| Western Health and Social Care Trust       | Altnagelvin Hospital      |    |    |    |    |    |    |    |    |     |      |     |    |    |                                        |                                   |
| 102                                        | 95                        | D↑ | A  | B  | D  | C  | E  | B  | E  | E↓  | D    | B↑↑ | E  | D  | D↓                                     | D                                 |
| Western Health and Social Care Trust       | South West Acute Hospital |    |    |    |    |    |    |    |    |     |      |     |    |    |                                        |                                   |
| 93                                         | 92                        | B↓ | A  | A  | B↓ | A  | A  | A  | B↓ | B↓  | B    | E↓↓ | D↓ | B  | C                                      | B↓                                |
|             |           |       |           |    |    | Routinely Admitting Teams   | Number of patients   | Overall Performance   | Team Centred Data   |
|-------------|-----------|-------|-----------|----|----|-----------------------------|----------------------|-----------------------|---------------------|
| D1          | D2        | D3    | D4        | D5 | D6 | D7                          | D8                   | D9                    | D10                 |
| Trust       | Team Name | Admit | Disch     |    |    |                             |                      |                       |                     |
| SSNAP       |           |       |           |    |    |                             |                      |                       |                     |
| Level       |           |       |           |    |    |                             |                      |                       |                     |
| CA          | AC        |       |           |    |    |                             |                      |                       |                     |
| Combined    |           |       |           |    |    |                             |                      |                       |                     |
| KI Level    |           |       |           |    |    |                             |                      |                       |                     |
| TC KI Level |           |       |           |    |    |                             |                      |                       |                     |
| Scan        | SU        | Throm | Spec Asst | OT | PT | SALT                        | MDT                  | Std Disch             | Disch Proc          |

## Wales

| Abertawe Bro Morgannwg University Health Board   | Morriston Hospital                   |
|--------------------------------------------------|--------------------------------------|
|                                                  |                                      |
| 242                                              | 241                                  |
| Abertawe Bro Morgannwg University Health Board   | Princess Of Wales Hospital           |
|                                                  |                                      |
| 120                                              | 118                                  |
| Aneurin Bevan University Health Board            | Royal Gwent Hospital                 |
|                                                  |                                      |
| 262                                              | 273                                  |
| Betsi Cadwaladr University Health Board          | Glan Clwyd District General Hospital |
|                                                  |                                      |
| 169                                              | 174                                  |
| Betsi Cadwaladr University Health Board          | Maelor Hospital                      |
|                                                  |                                      |
| 116                                              | 109                                  |
| Betsi Cadwaladr University Health Board          | Ysbyty Gwynedd                       |
|                                                  |                                      |
| 103                                              | 101                                  |
| Cardiff and Vale University Health Board         | University Hospital of Wales         |
|                                                  |                                      |
| 206                                              | 208                                  |
| Cwm Taf University Health Board                  | Prince Charles Hospital              |
|                                                  |                                      |
| 165                                              | 176                                  |
| Hywel Dda Health Board                           | Bronglais Hospital                   |
|                                                  |                                      |
| 40                                               | 38                                   |
| Hywel Dda Health Board                           | Prince Philip Hospital               |
|                                                  |                                      |
| 68                                               | 40                                   |
| Hywel Dda Health Board                           | West Wales General                   |
|                                                  |                                      |
| 78                                               | 72                                   |
| Hywel Dda Health Board                           | Withybush General Hospital           |
|                                                  |                                      |
| 89                                               | 84                                   |
| Non-Routinely Admitting Acute Teams              | Number of patients                          | Overall Performance   | Team Centred Data   |
|--------------------------------------------------|---------------------------------------------|-----------------------|---------------------|
| Trust                                            | Team Name                                   | Admit                 | Disch               |
| SSNAP                                            |                                             |                       |                     |
| Level                                            |                                             |                       |                     |
| CA                                               | AC                                          |                       |                     |
| Combined                                         |                                             |                       |                     |
| KI Level                                         |                                             |                       |                     |
| TC KI Level                                      |                                             |                       |                     |
| London - London SCN                              |                                             |                       |                     |
| Barking, Havering and Redbridge University       |                                             |                       |                     |
| Hospitals NHS Trust                              |                                             |                       |                     |
| Queens Hospital Romford SU                       |                                             |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 250                                         |                       | D                   |
| Barts Health NHS Trust                           | Newham General Hospital                     |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 56                                          |                       | B↑                  |
| Barts Health NHS Trust                           | Royal London Hospital SU                    |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 97                                          |                       | C↓                  |
| Barts Health NHS Trust                           | Whipps Cross University Hospital            |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 53                                          |                       | B                   |
| Chelsea and Westminster Hospital NHS             |                                             |                       |                     |
| Foundation Trust                                 |                                             |                       |                     |
| Chelsea and Westminster Hospital                 |                                             |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 30                                          |                       | B                   |
| Chelsea and Westminster Hospital NHS             |                                             |                       |                     |
| Foundation Trust                                 |                                             |                       |                     |
| West Middlesex University Hospital               |                                             |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 52                                          |                       | C                   |
| Croydon Health Services NHS Trust                | Croydon University Hospital                 |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 84                                          |                       | C                   |
| Epsom and St Helier University Hospitals NHS     |                                             |                       |                     |
| Trust                                            |                                             |                       |                     |
| St Helier Hospital                               |                                             |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 41                                          |                       | D↓↓                 |
| Guy's and St Thomas' NHS Foundation Trust        | St Thomas Hospital                          |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 67                                          |                       | A↑                  |
| Hillingdon Hospitals NHS Foundation Trust        | Hillingdon Hospital                         |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 40                                          |                       | B                   |
| Homerton University Hospital NHS Foundation      |                                             |                       |                     |
| Trust                                            |                                             |                       |                     |
| Homerton University Hospital                     |                                             |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 51                                          |                       | B↑↑                 |
| Imperial College Healthcare NHS Trust            | Charing Cross Hospital SU - Nine South Ward |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 95                                          |                       | C↓                  |
| King's College Hospital NHS Foundation Trust     | King's College Hospital SU                  |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 37                                          |                       | B↓                  |
| King's College Hospital NHS Foundation Trust     | Princess Royal University Hospital SU       |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 101                                         |                       | C                   |
| Kingston Hospital NHS Foundation Trust           | Kingston Hospital                           |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 58                                          |                       | A↑                  |
| Lewisham and Greenwich NHS Trust                 | University Hospital Lewisham                |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 95                                          |                       | C                   |
| London North West Healthcare NHS Trust           | Northwick Park Hospital SU                  |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 215                                         |                       | A                   |
| North Middlesex University Hospital NHS Trust    | North Middlesex Hospital                    |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 73                                          |                       | B                   |
| Royal Free London NHS Foundation Trust           | Barnet General Hospital                     |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 42                                          |                       | A↑↑                 |
| Royal Free London NHS Foundation Trust           | Royal Free Hospital                         |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 61                                          |                       | B↓                  |
| St George's University Hospitals NHS Foundation  |                                             |                       |                     |
| Trust                                            |                                             |                       |                     |
| St George's Hospital SU                          |                                             |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 53                                          |                       | A                   |
| University College London Hospitals NHS          |                                             |                       |                     |
| Foundation Trust                                 |                                             |                       |                     |
| University College Hospital SU                   |                                             |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 66                                          |                       | B                   |
| Midlands & East - East Midlands SCN              |                                             |                       |                     |
| Kettering General Hospital NHS Foundation Trust  | Kettering General Hospital                  |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 46                                          |                       | E↓                  |
| Midlands & East - East of England SCN            |                                             |                       |                     |
| Bedford Hospital NHS Trust                       | Bedford Hospital                            |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 39                                          |                       | D↓                  |
| North West Anglia NHS Foundation Trust           | Hinchingbrooke Hospital                     |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 22                                          |                       | E                   |
| PAPWORTH HOSPITAL NHS FOUNDATION                 |                                             |                       |                     |
| TRUST                                            |                                             |                       |                     |
| Papworth Hospital                                |                                             |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | TFP                                         |                       | TFP                 |
| Midlands & East - West Midlands SCN              |                                             |                       |                     |
| Heart of England NHS Foundation Trust            | Good Hope General Hospital                  |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 76                                          |                       | C                   |
| Heart of England NHS Foundation Trust            | Solihull Hospital                           |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | 51                                          |                       | A                   |
| Shrewsbury and Telford Hospital NHS Trust        | Royal Shrewsbury Hospital                   |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | TFP                                         |                       | TFP                 |
| University Hospitals of North Midlands NHS Trust | County Hospital                             |                       |                     |
|                                                  |                                             |                       |                     |
| TFP                                              | TFP                                         |                       | TFP                 |
D1
D2
D3
D4
D5
D6
D7
D8
D9
D10
Scan
SU
Throm
Spec Asst
OT
PT
SALT
MDT
Std Disch
Disch Proc
| Non-Routinely Admitting Acute Teams                          | Number of patients                 | Overall Performance   | Team Centred Data   |
|--------------------------------------------------------------|------------------------------------|-----------------------|---------------------|
| Trust                                                        | Team Name                          | Admit                 | Disch               |
| SSNAP                                                        |                                    |                       |                     |
| Level                                                        |                                    |                       |                     |
| CA                                                           | AC                                 |                       |                     |
| Combined                                                     |                                    |                       |                     |
| KI Level                                                     |                                    |                       |                     |
| TC KI Level                                                  |                                    |                       |                     |
|                                                              |                                    |                       |                     |
| North of England - Greater Manchester & Eastern Cheshire SCN |                                    |                       |                     |
| Bolton NHS Foundation Trust                                  | Royal Bolton Hospital              |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 81                                 |                       | B                   |
| Manchester University NHS Foundation Trust                   | Manchester Royal Infirmary         |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 59                                 |                       | B                   |
| Manchester University NHS Foundation Trust                   | Trafford General Hospital          |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 38                                 |                       | A                   |
| Tameside and Glossop Integrated Care NHS                     |                                    |                       |                     |
| Foundation Trust                                             |                                    |                       |                     |
| Tameside General Hospital                                    |                                    |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 85                                 |                       | C↑                  |
| Wrightington, Wigan and Leigh NHS Foundation                 |                                    |                       |                     |
| Trust                                                        |                                    |                       |                     |
| Royal Albert Edward Infirmary                                |                                    |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 140                                |                       | C↓                  |
| North of England - North of England SCN                      |                                    |                       |                     |
| Gateshead Health NHS Foundation Trust                        | Queen Elizabeth Hospital Gateshead |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 99                                 |                       | B                   |
| Northumbria Healthcare NHS Foundation Trust                  | Hexham General Hospital            |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 33                                 |                       | D                   |
| Northumbria Healthcare NHS Foundation Trust                  | North Tyneside General Hospital    |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 72                                 |                       | B                   |
| Northumbria Healthcare NHS Foundation Trust                  | Wansbeck General Hospital          |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 71                                 |                       | A↑                  |
| North of England - Yorkshire and The Humber SCN              |                                    |                       |                     |
| Airedale NHS Foundation Trust                                | Airedale General Hospital          |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 67                                 |                       | D                   |
| Northern Lincolnshire and Goole Hospitals NHS                |                                    |                       |                     |
| Foundation Trust                                             |                                    |                       |                     |
| Diana Princess of Wales Hospital Grimsby                     |                                    |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 54                                 |                       | C↓                  |
| Northern Lincolnshire and Goole Hospitals NHS                |                                    |                       |                     |
| Foundation Trust                                             |                                    |                       |                     |
| Goole District Hospital                                      |                                    |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | TFP                                |                       | TFP                 |
| York Teaching Hospital NHS Foundation Trust                  | Scarborough General Hospital       |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 56                                 |                       | D↓                  |
| South England - South East SCN                               |                                    |                       |                     |
| East Kent Hospitals University NHS Foundation                |                                    |                       |                     |
| Trust                                                        |                                    |                       |                     |
| East Kent Neuro Rehab Unit                                   |                                    |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | TFP                                |                       | TFP                 |
| East Kent Hospitals University NHS Foundation                |                                    |                       |                     |
| Trust                                                        |                                    |                       |                     |
| Kent and Canterbury Hospital                                 |                                    |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 48                                 |                       | C↑                  |
| Royal Surrey County Hospital NHS Foundation                  |                                    |                       |                     |
| Trust                                                        |                                    |                       |                     |
| Royal Surrey County Hospital                                 |                                    |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 27                                 |                       | B                   |
| Wales                                                        |                                    |                       |                     |
| Abertawe Bro Morgannwg University Health Board               | Singleton Hospital                 |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 31                                 |                       | D                   |
| Aneurin Bevan University Health Board                        | Nevill Hall Hospital               |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | 62                                 |                       | D                   |
| Aneurin Bevan University Health Board                        | Ysbyty Ystrad Fawr                 |                       |                     |
|                                                              |                                    |                       |                     |
| TFP                                                          | X                                  |                       | X                   |
D1
D2
D3
D4
D5
D6
D7
D8
D9
D10
Scan
SU
Throm
Spec Asst
OT
PT
SALT
MDT
Std Disch
Disch Proc
|                                                  | Non-Acute Inpatient Teams                       | Number of patients   | Overall Performance   |
|--------------------------------------------------|-------------------------------------------------|----------------------|-----------------------|
| Trust                                            | Team Name                                       | Admit                | Disch                 |
| SSNAP                                            |                                                 |                      |                       |
| Level                                            |                                                 |                      |                       |
| CA                                               | AC                                              |                      |                       |
| Combined                                         |                                                 |                      |                       |
| KI Level                                         |                                                 |                      |                       |
| TC KI Level                                      |                                                 |                      |                       |
| London - London SCN                              |                                                 |                      |                       |
| Barking, Havering and Redbridge University       |                                                 |                      |                       |
| Hospitals NHS Trust                              |                                                 |                      |                       |
| King George Hospital Inpatient Rehab Team        |                                                 |                      |                       |
| TFP                                              | 45                                              | B                    | A                     |
| Central and North West London NHS Foundation     |                                                 |                      |                       |
| Trust                                            |                                                 |                      |                       |
| St Pancras Hospital                              |                                                 |                      |                       |
| TFP                                              | 20                                              | D↓↓                  | D↓↓↓                  |
| Midlands & East - East Midlands SCN              |                                                 |                      |                       |
| Leicestershire Partnership NHS Trust             | Coalville Community Hospital                    |                      |                       |
| TFP                                              | 53                                              | B↑↑                  | A↑↑↑                  |
| Leicestershire Partnership NHS Trust             |                                                 |                      |                       |
| St Lukes Stroke Rehabilitation Team - Market     |                                                 |                      |                       |
| Harborough Hospital                              |                                                 |                      |                       |
| TFP                                              | 43                                              | B↑↑                  | B↓                    |
| University Hospitals of Leicester NHS Trust      | Leicester City Stroke Rehabilitation Unit       |                      |                       |
| TFP                                              | 50                                              | B                    | B↓                    |
| Midlands & East - East of England SCN            |                                                 |                      |                       |
| Anglian Community Enterprise CIC                 | Clacton Hospital                                |                      |                       |
| TFP                                              | 29                                              | B↓                   | A                     |
| Essex Partnership University NHS Foundation      |                                                 |                      |                       |
| Trust                                            |                                                 |                      |                       |
| St Margaret's Hospital Essex                     |                                                 |                      |                       |
| TFP                                              | 20                                              | D                    | B↓                    |
| Hertfordshire Community NHS Trust                | Danesbury Neurological Centre                   |                      |                       |
| TFP                                              | 30                                              | A                    | A↑                    |
| Hertfordshire Community NHS Trust                | Holywell Rehabilitation Unit                    |                      |                       |
| TFP                                              | 21                                              | A↑                   | A                     |
| Norfolk Community Health and Care NHS Trust      | Norwich Community Hospital - Beech Ward         |                      |                       |
| TFP                                              | 48                                              | C                    | B↓                    |
| Provide                                          | St Peter's Community Hospital Rehab Unit        |                      |                       |
| TFP                                              | 32                                              | A                    | A↑                    |
| Midlands & East - West Midlands SCN              |                                                 |                      |                       |
| Birmingham Community Healthcare NHS              |                                                 |                      |                       |
| Foundation Trust                                 |                                                 |                      |                       |
| Moseley Hall Stroke Rehabilitation Unit          |                                                 |                      |                       |
| TFP                                              | 38                                              | B↑                   | A                     |
| South Warwickshire NHS Foundation Trust          | Feldon Stroke Rehabilitation Unit SWFT          |                      |                       |
| TFP                                              | 47                                              | A                    | A                     |
| Staffordshire and Stoke-on-Trent Partnership NHS |                                                 |                      |                       |
| Trust                                            |                                                 |                      |                       |
| Staffordshire Rehabilitation Team                |                                                 |                      |                       |
| TFP                                              | 41                                              | B                    | B↓                    |
| Worcestershire Health and Care NHS Trust         | Worcestershire Stroke Rehabilitation Unit       |                      |                       |
| TFP                                              | 66                                              | D↑                   | D                     |
| North of England - North West Coast SCN          |                                                 |                      |                       |
| East Lancashire Hospitals NHS Trust              | Pendle Community Hospital - Marsden Stroke Unit |                      |                       |
| TFP                                              | 44                                              | B↑↑                  | B↑                    |
| Lancashire Teaching Hospitals NHS Foundation     |                                                 |                      |                       |
| Trust                                            |                                                 |                      |                       |
| Chorley and South Ribble Hospital                |                                                 |                      |                       |
| TFP                                              | 49                                              | B↑↑                  | A                     |
| North of England - Yorkshire and The Humber SCN  |                                                 |                      |                       |
| Doncaster and Bassetlaw Hospitals NHS            |                                                 |                      |                       |
| Foundation Trust                                 |                                                 |                      |                       |
| Bassetlaw District General Hospital              |                                                 |                      |                       |
| TFP                                              | 34                                              | C↓↓                  | B↓                    |
| Doncaster and Bassetlaw Hospitals NHS            |                                                 |                      |                       |
| Foundation Trust                                 |                                                 |                      |                       |
| Montagu Hospital                                 |                                                 |                      |                       |
| TFP                                              | 35                                              | B↓                   | A                     |
| Humber NHS Foundation Trust                      | Rossmore Unit, Hull Integrated Stroke Service   |                      |                       |
| TFP                                              | 22                                              | D                    | A                     |
| South West Yorkshire Partnership NHS             |                                                 |                      |                       |
| Foundation Trust                                 |                                                 |                      |                       |
| Kendray Hospital                                 |                                                 |                      |                       |
| TFP                                              | 47                                              | A↑                   | A                     |
| South England - South East SCN                   |                                                 |                      |                       |
| East Sussex Healthcare NHS Trust                 | Bexhill Hospital - Irvine Unit                  |                      |                       |
| TFP                                              | 26                                              | C                    | A                     |
Team Centred Data
D1
D2
D3
D4
D5
D6
D7
D8
D9
D10
Scan
SU
Throm
Spec Asst
OT
PT
SALT
MDT
Std Disch
Disch Proc
|                                              | Non-Acute Inpatient Teams                      | Number of patients   | Overall Performance   |
|----------------------------------------------|------------------------------------------------|----------------------|-----------------------|
| Trust                                        | Team Name                                      | Admit                | Disch                 |
| SSNAP                                        |                                                |                      |                       |
| Level                                        |                                                |                      |                       |
| CA                                           | AC                                             |                      |                       |
| Combined                                     |                                                |                      |                       |
| KI Level                                     |                                                |                      |                       |
| TC KI Level                                  |                                                |                      |                       |
|                                              |                                                |                      |                       |
| South England - South West SCN               |                                                |                      |                       |
| CORNWALL PARTNERSHIP NHS                     |                                                |                      |                       |
| FOUNDATION TRUST                             |                                                |                      |                       |
| Lanyon Stroke Rehabilitation Unit            |                                                |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 64                                             |                      | C↓                    |
| CORNWALL PARTNERSHIP NHS                     |                                                |                      |                       |
| FOUNDATION TRUST                             |                                                |                      |                       |
| Woodfield Stroke Rehabilitation Unit         |                                                |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 40                                             |                      | B↓                    |
| Great Western Hospitals NHS Foundation Trust | Forest Ward - Swindon Intermediate Care Centre |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 26                                             |                      | D                     |
| Livewell Southwest                           | Mount Gould Hospital                           |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 48                                             |                      | A                     |
| Royal Devon and Exeter NHS Foundation Trust  | East Devon Community Stroke Rehab Unit         |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 47                                             |                      | B                     |
| Somerset Partnership NHS Foundation Trust    | South Petherton Community Hospital             |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 50                                             |                      | C↑                    |
| Torbay and South Devon NHS Foundation Trust  | Newton Abbot Hospital                          |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 79                                             |                      | A                     |
| Wiltshire Health and Care                    | WHC Mulberry Stroke Rehabilitation Ward        |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 34                                             |                      | D                     |
| South England - Thames Valley SCN            |                                                |                      |                       |
| Frimley Health NHS Foundation Trust          | Wexham Park Hospital                           |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 55                                             |                      | D                     |
| Oxford Health NHS Foundation Trust           | Abingdon Community Hospital                    |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 24                                             |                      | C↓                    |
| Oxford Health NHS Foundation Trust           | Witney Community Hospital                      |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 20                                             |                      | C                     |
| Northern Ireland                             |                                                |                      |                       |
| Southern Health and Social Care Trust        | South Tyrone and Lurgan Hospitals              |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 38                                             |                      | C↑                    |
| Wales                                        |                                                |                      |                       |
| Aneurin Bevan University Health Board        | St Woolos Hospital                             |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 48                                             |                      | C                     |
| Cwm Taf University Health Board              | Ysbyty Cwm Rhondda                             |                      |                       |
|                                              |                                                |                      |                       |
| TFP                                          | 21                                             |                      | TFP                   |
Team Centred Data
D1
D2
D3
D4
D5
D6
D7
D8
D9
D10
Scan
SU
Throm
Spec Asst
OT
PT
SALT
MDT
Std Disch
Disch Proc

## Conclusion

It is unprecedented to have collected such a high volume of cases with good data quality and a representative sample within three years of initiating a new national audit. Participation in the audit continues to be an unparalleled success. In the latest reporting period 28,698 patient records were submitted to SSNAP for analysis, demonstrating the efforts of all the teams and registered audit users.  
Without information and data about stroke services in England, Wales and Northern Ireland it would not be possible to persuade clinicians, commissioners or NHS England that there is still work to be done to ensure that high quality care is provided to patients regardless of where they live or when they have their stroke. 

Recent audit results have shown that improvements to stroke services are being made. In January to March 2016 only 25 services achieved an "A" score compared to 44 teams in this reporting period. 

The consistent decrease in the number of hospitals achieving the lowest scoring band is similarly reassuring.  This is demonstrated in the graph below that highlights changes over time in SSNAP 
scores. 

The latest audit results reinforce our belief that whilst the audit sets the bar high to attain the top grade, world class stroke care is achievable.  That clinicians are reviewing their results every reporting period and investigating where changes need to be made to improve the care they provide to patients should be celebrated. It is important that we allow teams the time to conduct a full diagnosis and time to draw up action plans to address issues. We are privileged to have honest selfreporting from providers. We are now increasingly in a position to report  what happens to patients after the early part of their recovery and we urge all stroke care providers working in a community setting to participate in SSNAP to make the post-acute data similar in quality to the years spent reporting acute data with resultant improvements to the quality of care and outcomes. This will remain one of our biggest challenges in the year ahead.  
Availability of SSNAP reports in the public domain SSNAP results are made public each reporting period by named team. This model provides clinicians, commissioners, patients and carers, and the general public with up to date information on the processes of stroke care across the entire pathway and is in line with the Department of Health in England's data transparency policy.  

## August 2017 - November 2017 Report

This report includes complete data for 28,698 stroke patients admitted to and 28,125 stroke patients discharged from inpatient care between 1st August 2017 and 30th November 2017. The volume of records collected allows robust conclusions to be drawn at national level. Similar levels of case ascertainment were achieved in previous reporting periods. 

## Definitions

•
'**Normal Hours'** refers to patients who arrived at hospital on a weekday between 8am and
6pm (excluding Bank Holidays).
•
'Out of Hours' refers to patients who arrived at hospital on a weekday before 8am or after 6pm or at any time on a weekend or Bank Holiday.
•
'Inpatient Onset' refers to patients who were already in hospital at the time of stroke.
•
'Clock Start' is used to signify the time at which the 'clock starts' for measuring key timings.
This is arrival in most instances (patients newly arriving in hospital) but will be the onset of
symptoms time for patients already in hospital at time of stroke.
•
'Team': SSNAP collects self-reported details of care at the level of individual clinical teams
across the stroke pathway e.g. acute teams, inpatient rehabilitation teams.
•
'Routinely Admitting Teams' are defined as teams who typically directly admit the majority
of their stroke patients.
•
'Non-Routinely Admitting Acute Teams' are teams who provide acute care but who are
typically transferred the majority of their stroke patients from other teams.
•
'Non-Acute Inpatient Teams': teams who provide only rehabilitation care in an inpatient
setting.
•
'Early Supported Discharge Teams': multi-disciplinary teams providing rehabilitation and
support to stroke patients in a community setting with the aim of reducing the duration of hospital care for stroke patients.
•
Community Rehabilitation Teams': teams working in the community delivering
rehabilitation services.
•
'Six Month Assessment Providers': teams who undertake six month reviews of stroke
patients. They may be acute teams, domiciliary teams or third sector providers.
•
'Team-Centred Results': results are attributed to the team considered to be most
appropriate to assign the responsibility for the measure to.
•
'Patient-Centred Results': results are attributed to every team which treated the patient at
any point in their care.
•
'Audit Compliance': measure of completeness of non-mandatory SSNAP data items.
•
'Case Ascertainment': percentage of all stroke cases entered onto SSNAP. High levels of case
ascertainment are essential to ensure representativeness.
•
'Key Indicator': an important measure of stroke care, e.g. in SSNAP there are 44 Key
Indicators which are considered representative of high quality care.
•
'Domain': an important area of care comprising several key indicators related to that topic
i.e. in SSNAP there are 10 domains e.g. scanning.
•
'Total Key Indicator Score': the average of the 10 domain levels (separately for patientcentred and team-centred results).
•
'Combined Total Key Indicator Score': the average of the patient-centred and team-centred Total Key Indicator Score.
•
'SSNAP Score': combined Total Key Indicator Score adjusted for Case Ascertainment and
Audit Compliance.
Denominators This report does not contain numerators and denominators for each standard. Please refer to the accompanying 'Full results portfolio' (www.strokeaudit.org/results/national) for this level of detail. 

The table below outlines the key denominators in the report. These vary throughout the report depending on the number of patients included in the analyses for each standard. 

| Key denominators                   | Aug-Nov 2016    |
|------------------------------------|-----------------|
| Dec 2016-Mar                       |                 |
| 2017                               |                 |
| Apr-Jul 2017                       | Aug-Nov 2017    |
| Cases Locked to 72 hours           | 27327           |
| Cases with known onset time        | 18695           |
| Cases with infarct                 | 23798           |
| Cases with intracerebral           |                 |
| haemorrhage                        |                 |
| 3419                               | 3529            |
| Cases with unknown type of stroke  | 110             |
| Inpatient strokes                  | 1530            |
| Arrive within 'normal hours'       | 12920           |
| Arrive 'out of hours'              | 12877           |
| Patients who went to a stroke unit | 26202           |
| Patient who had a brain scan       | 27217           |
| Patients who had thrombolysis      | 3137            |

Technical information on how the results were calculated can be found on the final tab of the 
'Full Results Portfolio' www.strokeaudit.org/results Wherever possible, the audit question numbers have been included in the tables of results to facilitate reference to the actual question wording. 

| Activities of daily living                                              | Refers to activities that people normally undertake (e.g. bathing, dressing,    |
|-------------------------------------------------------------------------|---------------------------------------------------------------------------------|
| self-feeding).                                                          |                                                                                 |
| Acute ischaemic stroke                                                  | A type of stroke that happens when a clot blocks an artery that carries         |
| blood to the brain, causing brain cells to die.                         |                                                                                 |
| Acute stroke unit                                                       | An acute stroke unit is one which treats patients usually in an intensive       |
| model of care with continuous monitoring and nurse staffing levels.     |                                                                                 |
| Anticoagulation                                                         | Treatment to reduce the likelihood of blood clotting.                           |
| Antihypertensive                                                        | A drug that reduces high blood pressure.                                        |
| Antiplatelet                                                            | A drug that helps prevent the formation of blood clots by affecting the         |
| function of certain blood cells; examples are aspirin and clopidogrel.  |                                                                                 |
| Aphasia                                                                 | A condition that affects the brain and leads to problems using language         |
| correctly.                                                              |                                                                                 |
| Audit                                                                   | An audit compares clinical process for individual patients and national         |
| guidelines.                                                             |                                                                                 |
| Atrial fibrillation (AF)                                                | This is an abnormal heart beat which can result in the formation of blood       |
| clots.  Warfarin is prescribed for people with AF to thin the blood and |                                                                                 |
| prevent clots forming.                                                  |                                                                                 |
| Cardiovascular Disease                                                  |                                                                                 |
| Outcomes Strategy                                                       |                                                                                 |
| Provides advice to local authority and NHS commissioners and providers  |                                                                                 |
| about actions to improve cardiovascular disease outcomes.               |                                                                                 |
| https://www.gov.uk/government/publications/improving-cardiovascular-    |                                                                                 |
| disease-outcomes-strategy                                               |                                                                                 |
| Care home                                                               | A residential setting where a number of older people live, usually in single    |
| rooms, and have access to on-site care services.                        |                                                                                 |
| Carer                                                                   | Someone (commonly the patient's spouse, a close relative or a friend) who       |
| provides on going, unpaid support and personal care at home.            |                                                                                 |
| Casemix                                                                 | A measure of the characteristics of people included in a study such as age,     |
| gender, ethnicity and co-existing illnesses.                            |                                                                                 |
CCG Outcome Indicator Set  
(CCG OIS) 
A set of measures by which commissioners of health services (Clinical 
Commissioning Groups) are held to account for the quality of services and the health outcomes achieved through commissioning. http://www.england.nhs.uk/ccg-ois  
CCU 
Coronary Care Unit. 
Cohort 
Group of patients included in analysis for report.  It comprises patients admitted and/or discharged to hospital during a defined date range.  
Co-morbidity 
The coexistence of two or more diseases. 
Community rehabilitation team Teams working in the community delivering rehabilitation services. 
Continence plan 
A plan to help a patient increase their control over urinary and faecal discharge. 
Congestive heart failure 
Poor heart function resulting in accumulation of fluid in the lungs and legs.  
Domiciliary Care 
The delivery of a range of personal care and support services to individuals in their own homes. 
Dysphagia 
Difficulty in swallowing. 
Early Supported Discharge 
A service providing rehabilitation and support to stroke patients in a community setting by a multi-disciplinary team with the aim of reducing the duration of hospital care for stroke patients. 
HDU 
High Dependency Unit. Bleeding caused by blood escaping into the tissues. 
Haemorrhage/ 
haemorrhagic stroke Hyperacute stroke unit 
Some stroke services designate the most intensive treatment as hyperacute. This would be where patients are initially treated and usually for a short period of time (i.e. up to three days). 
Hypertension 
High blood pressure. 
Incontinence 
Inability to control passing of urine and/or faeces. 
Infarct 
An area of cell death due to the result of a deprived blood supply. 
Interquartile range (IQR) 
 The IQR is the range between 25th and 75th centile which is equivalent to 
the middle half of all values. 
| A mechanical method of preventing deep vein thrombosis in the legs.        | Intermittent Pneumatic                                                     |
|----------------------------------------------------------------------------|----------------------------------------------------------------------------|
| Compression (IPC)                                                          |                                                                            |
| ITU                                                                        | Intensive Treatment/Therapy Unit.                                          |
| Joint care planning                                                        | A process in which a person and their healthcare professional work         |
| together to create a personalised package of care.                         |                                                                            |
| Level of Consciousness                                                     | A medical term used to describe a patient's awareness of his or her        |
| surroundings and arousal potential.                                        |                                                                            |
| Lipid Lowering                                                             | Reducing the concentration of lipid, such as cholesterol, in the blood.    |
| MAU                                                                        | Medical Assessment Unit.                                                   |
| Median                                                                     | The median is the middle point of a data set; half of the values are below |
| this point, and half are above this point.                                 |                                                                            |
| Mood screening                                                             | Identifying mood disturbance and cognitive impairment using a validated    |
| tool.                                                                      |                                                                            |
| Motor deficits                                                             | These include phenomena such as lack of coordination in movement, lack     |
| of selected movement, and lack of motor control.                           |                                                                            |
| Multidisciplinary Team                                                     | Refers to several types of health professionals working together,          |
| physiotherapists, occupational therapists, speech and language therapists, |                                                                            |
| nurses and doctors.                                                        |                                                                            |
| Myocardial Infarction                                                      | A heart attack.                                                            |
| National Clinical Guidelines For                                           |                                                                            |
| Stroke (2016)                                                              |                                                                            |
| National evidence based guidelines for stroke care published by the        |                                                                            |
| Intercollegiate Working Party for Stroke fifth edition 2016.               |                                                                            |
| www.strokeaudit.org/guideline                                              |                                                                            |
| National Institutes of Health                                              |                                                                            |
| Stroke Scale (NIHSS)                                                       |                                                                            |
| A validated international tool used by healthcare professionals to         |                                                                            |
| objectively quantify the impairment caused by a stroke.                    |                                                                            |
| National Sentinel Stroke  Audit                                            |                                                                            |
| (NSSA)                                                                     |                                                                            |
| A national audit conducted by The Royal College of Physicians monitors the |                                                                            |
| rate of progress in stroke care services in England, Wales and Northern    |                                                                            |
| Ireland in a two year cycle                                                | www.rcplondon.ac.uk/sentinel                                               |
| been replaced by the Sentinel Stroke National Audit Programme (SSNAP).     |                                                                            |
| National Stroke Strategy                                                   | Provides a quality framework to secure improvements to stroke services,    |
| offers guidance and support to commissioners and strategic health          |                                                                            |
| authorities.                                                               |                                                                            |
| http://clahrc-gm.nihr.ac.uk/cms/wp-content/uploads/DoH-                    |                                                                            |
| National-Stroke-Strategy-2007.pdf                                          |                                                                            |
|                                                                             | NICE Acute stroke guidelines                                                 | The NICE Clinical Guideline CG68 Stroke Diagnosis and initial management    |
|-----------------------------------------------------------------------------|------------------------------------------------------------------------------|-----------------------------------------------------------------------------|
| of acute stroke (NICE 2008).                                                | http://guidance.nice.org.uk/CG68                                             |                                                                             |
| NICE Rehabilitation stroke                                                  |                                                                              |                                                                             |
| guidelines                                                                  |                                                                              |                                                                             |
| Stroke rehabilitation: Long-term rehabilitation after stroke (NICE 2013):   |                                                                              |                                                                             |
| www.nice.org.uk/CG162                                                       |                                                                              |                                                                             |
| NICE Quality Standard for Stroke                                            | NICE quality standards define high standards of care within stroke. It       |                                                                             |
| provides specific, concise quality statements, measures and audience        |                                                                              |                                                                             |
| descriptors to provide definitions of high-quality care.                    |                                                                              |                                                                             |
| http://pathways.nice.org.uk/pathways/stroke                                 |                                                                              |                                                                             |
| Nutritional screening                                                       | A first-line process of identifying patients who are already malnourished or |                                                                             |
| at risk of becoming so.                                                     |                                                                              |                                                                             |
| Palliative care                                                             | Treating symptoms for end of life care.                                      |                                                                             |
| Rankin score                                                                | A scale used to measure the degree of disability of dependence in the daily  |                                                                             |
| activities of living.                                                       |                                                                              |                                                                             |
| Rehabilitation stroke unit                                                  | Stroke units generally accepting patients after 7 days or more and focussing |                                                                             |
| on rehabilitation.                                                          |                                                                              |                                                                             |
| Sentinel Stroke National Audit                                              |                                                                              |                                                                             |
| Programme (SSNAP)                                                           |                                                                              |                                                                             |
| SSNAP is a new continuous audit that collects data for every stroke patient |                                                                              |                                                                             |
| along the entire stroke care pathway up to six months:                      |                                                                              |                                                                             |
| www.strokeaudit.org                                                         |                                                                              |                                                                             |
| SINAP                                                                       | Stroke Improvement National Audit Programme. A continuous acute stroke       |                                                                             |
| audit which measured the process of stroke care in the first 72 hours       |                                                                              |                                                                             |
| between May 2010 and December 2012                                          | www.rcplondon.ac.uk/sinap                                                    | . The                                                                       |
| Sentinel Stroke National Audit Programme (SSNAP) has replaced SINAP.        |                                                                              |                                                                             |
| Specialist                                                                  |                                                                              |                                                                             |
| A clinician whose practice is limited to a particular branch of medicine    | o                                                                            | r                                                                           |
| surgery,                                                                    | especially                                                                   | one who is certified by a higher educational                                |
| Thrombolysis                                                                |                                                                              |                                                                             |
|                                                                             |                                                                              |                                                                             |
| Thrombectomy                                                                |                                                                              |                                                                             |
| The use of drugs to break up a blood clot.                                  |                                                                              |                                                                             |
|                                                                             |                                                                              |                                                                             |
| The surgical removal of a thrombus from a blood vessel.                     |                                                                              |                                                                             |
| TIA                                                                         | Transient ischaemic attack - a stroke which completely recovers within 24    |                                                                             |
| hours of onset of symptoms.                                                 |                                                                              |                                                                             |
| Urinary tract infection                                                     | An infection of the kidney, ureter, bladder, or urethra.                     |                                                                             |
|                                                                             |                                                                              |                                                                             |
Key indicators: Brain Scanning 
Aug-Nov 
Percentage of patients scanned within 1 hour of 
clock start* 
50.7 
52.5 
52.6 
52.8 
Percentage of patients scanned within 12 hours of clock start 
93.5 
94.0 
94.3 
94.5 
Median time between clock start and scan 
0:59 
0:55 
0:55 
0:55 
 
Key indicators: Stroke unit 
Aug-Nov 
Percentage of patients directly admitted to a stroke unit within 4 hours of clock start (CCG OIS) 
58.5 
54.8 
60.2 
58.7 
Median time between clock start and arrival on stroke unit  
3:38 
3:47 
3:31 
3:36 
Percentage of patients who spent at least 90% of their stay on stroke unit 
84.8 
82.7 
84.7 
84.7 
 
Key indicators: Thrombolysis 
Aug-Nov 
Percentage of all stroke patients given thrombolysis (all stroke types) (CCG OIS C3.6) 
11.5 
11.6 
12.0 
11.2 
Percentage of eligible patients given thrombolysis (according to the Royal College of Physicians (RCP) guideline minimum threshold) Percentage of patients who were thrombolysed within 1 hour of clock start, if thrombolysed 
63.0 
62.3 
64.2 
63.9 
Percentage of applicable patients directly admitted to a stroke unit within 4 hours of clock start AND who either receive thrombolysis or have a prespecified justifiable reason ('no but') for why it could not be given Median time between clock start and thrombolysis (minutes) 
0:51 
0:52 
0:50 
0:50 
|           | Dec 2016-   | Apr-Jul    |   Aug-Nov  |
|-----------|-------------|------------|------------|
| 2016      | Mar 2017    | 2017       |     2017   |
| Dec 2016- | Apr-Jul     | Aug-Nov    |            |
| 2016      | Mar 2017    | 2017       |     2017   |
| Dec 2016- | Apr-Jul     | Aug-Nov    |            |
| 2016      | Mar 2017    | 2017       |     2017   |
| 88.1      | 85.5        | 87.4       |       88.3 |
| 58.1      | 54.3        | 59.9       |       58.6 |
Key Indicators: Specialist Assessments 
Aug-Nov 
Percentage of patients who were assessed by a stroke specialist consultant physician within 24h of clock start 
Median time between clock start and being assessed by stroke consultant 
11:09 
11:03 
10:29 
8:38 
Percentage of patients who were assessed by a nurse trained in stroke management within 24h of clock start Median time between clock start and being assessed by stroke nurse (minutes) 
1:16 
1:12 
1:07 
1:09 
Percentage of applicable patients who were given a swallow screen within 4h of clock start 
74.0 
73.5 
75.7 
76.3 
Percentage of applicable patients who were given a formal swallow assessment within 72h of clock start 
 
Key Indicators: Occupational Therapy  
Aug-Nov 
Percentage of patients reported as requiring occupational therapy 
83.6 
84.4 
84.5 
83.9 
Median number of minutes per day on which occupational therapy is received  
40.7 
40 
40.1 
40.1 
Median % of days as an inpatient on which occupational therapy is received  
64.9 
64.1 
65.0 
66.7 
Proxy for 2016 NICE Quality Standard Statement 2: % of the minutes of occupational therapy required (according to 2016 NICE QS-S2) which were 
delivered 
 
Key Indicators: Physiotherapy 
Aug-Nov 
Percentage of patients reported as requiring physiotherapy  
85.1 
86.3 
85.9 
85.0 
Median number of minutes per day on which physiotherapy is received 
35 
35 
35 
35 
Median % of days as an inpatient on which physiotherapy is received 
73.7 
71.2 
72.7 
75.4 
Proxy for 2016 NICE Quality Standard Statement 2: % of the minutes of physiotherapy required (according to 2016 NICE QS‐S2) which were delivered 
|           | Dec 2016-   | Apr-Jul    |   Aug-Nov  |
|-----------|-------------|------------|------------|
| 2016      | Mar 2017    | 2017       |     2017   |
| 81.9      | 81.1        | 82.9       |       84.5 |
| 90.1      | 89.4        | 90.4       |       90.9 |
| 87.2      | 86.9        | 87.6       |       88.4 |
| Dec 2016- | Apr-Jul     | Aug-Nov    |            |
| 2016      | Mar 2017    | 2017       |     2017   |
| 85.9      | 84.2        | 85.6       |       87.3 |
| Dec 2016- | Apr-Jul     | Aug-Nov    |            |
| 2016      | Mar 2017    | 2017       |     2017   |
| 80.3      | 78.7        | 80.1       |       82.1 |
Key Indicators: Speech and Language Therapy  
Aug-Nov 
Percentage of patients reported as requiring 
speech and language therapy 
50.7 
51.4 
51.2 
50.1 
Median number of minutes per day on which speech and language therapy is received  
31.5 
31.7 
31.7 
32.1 
Median % of days as an inpatient on which speech and language therapy is received 
48.1 
47.9 
49.6 
51.2 
Proxy for 2016 NICE Quality Standard Statement 2: % of the minutes of speech and language therapy required (according to 2016 NICE QS-S2) which 
were delivered 
 
Key indicators: Multidisciplinary team working 
Aug-Nov 
Percentage of applicable patients who were assessed by an occupational therapist within 72h of clock start Median time between clock start and being assessed by occupational therapist  
21:44 
21:48 
21:21 
21:25 
Percentage of applicable patients who were assessed by a physiotherapist within 72h of clock start Median time between clock start and being assessed by physiotherapist  
20:52 
21:15 
20:44 
20:44 
Percentage of applicable patients who were assessed by a speech and language therapist within 
72h of clock start Median time between clock start and being assessed by speech and language therapist  
23:00 
23:25 
22:56 
22:49 
Percentage of applicable patients who have rehabilitation goals agreed within 5 days of clock start Percentage of applicable patients who are assessed by a nurse within 24h AND at least one therapist within 24h AND all relevant therapists within 72h AND have rehab goals agreed within 5 days 
|           | Dec 2016-   | Apr-Jul    |   Aug-Nov  |
|-----------|-------------|------------|------------|
| 2016      | Mar 2017    | 2017       |     2017   |
| 47.8      | 48.6        | 50.1       |       51.3 |
| Dec 2016- | Apr-Jul     | Aug-Nov    |            |
| 2016      | Mar 2017    | 2017       |     2017   |
| 91.7      | 91.2        | 91.9       |       92.8 |
| 95.1      | 94.3        | 94.8       |       95.6 |
| 89.0      | 87.8        | 89.1       |       89.6 |
| 91.9      | 92.3        | 92.3       |       92.3 |
| 61.8      | 60.4        | 62.9       |       64   |
| Dec 2016-                                           | Apr-Jul    | Aug-Nov    |
|-----------------------------------------------------|------------|------------|
| Key Indicators: Standards by Discharge              |            |            |
| Aug-Nov                                             |            |            |
| 2016                                                | Mar 2017   | 2017       |
| Percentage of applicable patients screened for      |            |            |
| nutrition and seen by a dietitian by discharge*     |            |            |
| 83.3                                                | 82.7       | 82.5       |
| 92.0                                                | 91.6       | 92.8       |
| Percentage of applicable patients who have a        |            |            |
| continence plan drawn up within 3 weeks of clock    |            |            |
| start                                               |            |            |
| Percentage of applicable patients who have mood     |            |            |
| and cognition screening by discharge                |            |            |
| 91.9                                                | 91.6       | 91.5       |
|                                                     |            |            |
| Dec 2016-                                           | Apr-Jul    | Aug-Nov    |
| Key Indicators: Discharge Processes                 |            |            |
| Aug-Nov                                             |            |            |
| 2016                                                | Mar 2017   | 2017       |
| Percentage of applicable patients receiving a joint |            |            |
| health and social care plan on discharge            |            |            |
| 90.6                                                | 90.1       | 91.0       |
| Percentage of patients treated by a stroke skilled  |            |            |
| Early Supported Discharge team*                     |            |            |
| 34.5                                                | 35.7       | 33.9       |
| 97.5                                                | 98.0       | 98.2       |
| Percentage of applicable patients in atrial         |            |            |
| fibrillation on discharge who are discharged on     |            |            |
| anticoagulants or with a plan to start              |            |            |
| anticoagulation                                     |            |            |
| 96.6                                                | 96.9       | 96.8       |
| Percentage of those patients who are discharged     |            |            |
| alive who are given a named person to contact       |            |            |
| after discharge                                     |            |            |
Number of stroke patients (Q1.9) included in report  
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
Number of stroke patients 
27327 
28575 
28156 
28698 
F1.1 
Patients already in hospital at 
time of stroke (Q1.10) 
5.6% 
5.7% 
5.3% 
5.6% 
F11.3 
 
Gender (Q1.6) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
Female patients 
49.0% 
49.1% 
48.2% 
48.7% 
F3.3 
Male patients 
51.0% 
50.9% 
51.8% 
51.3% 
F3.5 
 
Median age on clock start (Q1.5) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
Age (years) 
77 
77 
77 
77 
F4.1 
Male Patients 
73 
74 
74 
74 
F4.10 
Female Patients 
80 
81 
80 
80 
F4.7 
 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
% of patients aged >80 years  on clock start (Q1.5) Patients aged over 80 years 
38.6% 
39.6% 
37.8% 
39.1% 
F4.6 
Males aged over 80 years 
28.6% 
29.5% 
28.6% 
29.7% 
F4.18 
Females aged over 80 years 
49.1% 
50.0% 
47.8% 
49.0% 
F4.15 
 
Number of co-morbidities (Q2.1)  
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
0 
26.6% 
26.2% 
26.1% 
26.0% 
F5.3 
1 
35.7% 
36.1% 
35.9% 
36.1% 
F5.5 
2 
26.0% 
26.0% 
26.2% 
26.3% 
F5.7 
3 
9.8% 
9.8% 
9.7% 
9.7% 
F5.9 
4 
1.7% 
1.8% 
1.8% 
1.6% 
F5.11 
5 
0.2% 
0.2% 
0.2% 
0.2% 
F5.13 


Type of co-morbidity (Q2.1) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
Congestive Heart Failure 
5.5% 
5.1% 
5.3% 
5.0% 
F5.16 
Hypertension 
53.1% 
53.6% 
54.3% 
54.0% 
F5.19 
Diabetes 
20.8% 
20.9% 
21.4% 
21.5% 
F5.22 
Stroke/TIA 
26.3% 
25.7% 
26.1% 
25.9% 
F5.25 
Atrial Fibrillation 
19.4% 
20.1% 
18.9% 
19.0% 
F6.3 
 
Stroke Type (Q2.5) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
Infarction 
87.1% 
87.2% 
87.9% 
87.2% 
F7.3 
Intracerebral Haemorrhage 
12.5% 
12.3% 
11.5% 
12.3% 
F7.5 
Unknown (not scanned) 
0.4% 
0.5% 
0.5% 
0.4% 
F7.7 
 
Patient arrived by ambulance (Q1.12) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
Yes 
81.6% 
82.1% 
80.2% 
80.2% 
H4.3 
 
Arrival during (Q1.13) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
47.3% 
45.2% 
44.2% 
46.2% 
H5.3 
Patient arrived in 'Normal hours' (Monday to Friday 8am - 6pm, excluding bank holidays) Patient arrived 'Out of hours' 
47.1% 
49.1% 
50.5% 
48.2% 
H5.5 
The onset of stroke was when the 
patient was already in hospital 
5.6% 
5.7% 
5.3% 
5.6% 
H5.7 
 
Brain Imaging (Q2.4) 
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
Scanned 
99.6% 
99.5% 
99.5% 
99.6% 
H6.3 
 
Brain scan timings  
Aug-Nov 
2016 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
0:59 
0:55 
0:55 
0:55 
H6.4 H6.5 
Median time from clock start to scan (IQR) (h:mm)  
(0:23-2:33) 
(0:23-2:26) 
(0:22-2:24) 
(0:22-2:23) 
H6.6 
4:02 
3:55 
4:05 
4:03 
H3.7 H3.8 
Median time from onset to scan (IQR) (h:mm)* 
(2:00-11:56) 
(1:57-11:23) 
(1:59-12:03) 
(2:03-11:54) 
H3.9 
Aug-Nov 
2016 
Went to stroke unit (at first admitting team) (Q1.15) Yes 
95.9% 
95.6% 
96.2% 
96.2% 
H7.3 
 
Stroke unit timings 
Aug-Nov 
2016 
3:38 
3:47 
3:31 
3:36 
H7.4 H7.5 
Median time from clock start to first arrival on a stroke unit (IQR) (h:mm) 
(2:07-6:48) 
(2:11-7:57) 
(2:00-6:30) 
(2:01-6:45) 
H7.6 
7:33 
7:56 
7:30 
7:40 
H3.4 
H3.5 
Median time from symptom onset to 
arrival at stroke unit (IQR) (h:mm) 
(4:18-20:04) 
(4:20-21:01) 
(4:10-20:17) 
(4:18-20:00) 
H3.6 
 
Aug-Nov 
2016 
'No but' reasons for not thrombolysing Patient arrived outside the time window for thrombolysis 
32.5% 
31.6% 
34.0% 
34.0% 
H16.25 
Wake up time unknown 
36.8% 
37.6% 
36.0% 
35.7% 
H16.39 
Stroke too mild/severe 
13.8% 
13.7% 
13.8% 
13.0% 
H16.37 
Haemorrhagic stroke 
14.7% 
14.6% 
13.6% 
14.4% 
H16.23 
 
Thrombolysis timings 
Aug-Nov 
2016 
0:51 
0:52 
0:50 
0:50 
H16.42  
H16.43 
Median time from clock start to thrombolysis (IQR) (h:mm) 
(0:36-1:15) 
(0:36-1:15) 
(0:34-1:12) 
(0:35-1:14) 
H16.44 
2:25 
2:25 
2:24 
2:25 
H3.10 H3.11 
Median time from onset to thrombolysis (IQR) (h:mm) 
(1:50-3:09) 
(1:51-3:09) 
(1:50-3:08) 
(1:51-3:10) 
H3.12 
If thrombolysed, median time from onset to clock start (IQR) (h:mm) 
1:23 
1:23 
1:22 
1:25 
H16.45 
If thrombolysed, median time from clock start to scan (IQR) (h:mm) 
0:19 
0:19 
0:18 
0:19 
H16.46 
If thrombolysed, median time from scan to thrombolysis (IQR) (h:mm) 
0:29 
0:30 
0:28 
0:29 
H16.47 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
Dec 2016-
Mar 2017 
Apr-Jul 
2017 
Aug-Nov 
2017 
Ref 
| Name                                                                   | Representative Organisation                                               |
|------------------------------------------------------------------------|---------------------------------------------------------------------------|
| Mrs Juliet Bouverie                                                    | Stroke Association                                                        |
| Dr Benjamin Bray                                                       | Royal College of Physicians/Public Health England                         |
| Dr Andrew Clifton                                                      | British Society of Neuroradiologists                                      |
| Dr Gill Cluckie                                                        | Royal College of Nursing                                                  |
| Ms Ismalia de Sousa                                                    | Royal College of Nursing                                                  |
| Mr Joseph Dent                                                         | College of Paramedics                                                     |
| Professor Avril Drummond                                               | Royal College of Occupational Therapists and Special Section              |
| Neurological Practice                                                  |                                                                           |
| Emeritus Professor Pam Enderby                                         | Professor of Community Rehabilitation                                     |
| Mr Ian Evans                                                           | Community Nursing                                                         |
| Dr Patrick Gompertz                                                    | National Cardiovascular Intelligence Network                              |
| Dr Nicola Hancock                                                      |                                                                           |
| Dr Andrew Hill                                                         |                                                                           |
| Association of Chartered Physiotherapists In Neurology                 |                                                                           |
| Informatics lead for SSNAP/  St Helens and Knowsley Teaching Hospitals |                                                                           |
| NHS Trust                                                              |                                                                           |
| Dr Martin James                                                        | Royal College of Physicians Stroke Programme / British Association of     |
| Stroke Physicians                                                      |                                                                           |
| Dr Phil Jones                                                          | Clinical Lead for Wales/Welsh Government Stroke Implementation            |
| Group                                                                  |                                                                           |
| Mrs Alexis Kolodziej                                                   | Stroke Association                                                        |
| Mr Alex Lang                                                           | British Dietetic Association                                              |
| Dr Deborah Lowe                                                        | Getting It Right First Time (GIRFT)                                       |
| Dr Iain Marshall                                                       | GP member                                                                 |
| Dr Michael McCormick                                                   | NIMAST/Southern Health and Social Care Trust                              |
| Dr Walter Muruet Gutierrez                                             | RCP/KCL Stroke Clinical Fellow                                            |
| Mr Robert Norbury                                                      | Lay Member                                                                |
| Professor Anita Patel                                                  | Health Economics Advisor                                                  |
| Professor Sue Pownall                                                  | Royal College of Speech & Language Therapists                             |
| Professor Thompson Robinson                                            | British Association of Stroke Physicians                                  |
| Professor Helen Rodgers                                                | British Geriatrics Society                                                |
| Dr Fiona Rowe                                                          | British and Irish Orthoptic Society                                       |
| Professor Anthony Rudd                                                 | Guy's and St Thomas' NHS Foundation Trust                                 |
| Mr Stephen Simpson                                                     | Stroke Association (Lay Member)                                           |
| Dr Viki  Teggart                                                       | British Psychological Society                                             |
| Dr Shirley Thomas                                                      | British Psychological Society                                             |
| Dr Neil Thomson                                                        | Faculty of Pre-Hospital Care for the Royal Surgeons College of Edinburgh; |
| National Ambulance Service Medical Director's Group (NASMeD)           |                                                                           |
| Professor Pippa Tyrrell                                                | Royal College of Physicians Stroke Programme                              |
| Professor Derick Wade                                                  | British Society of Rehabilitation Medicine/Society for Research in        |
| Rehabilitation                                                         |                                                                           |
| Prof Philip White                                                      | Royal College of Radiologists                                             |
| Ms Marney Williams                                                     | Lay Member                                                                |
| Professor Charles Wolfe                                                | King's College London                                                     |
| Dr Gavin Young                                                         | Association of British Neurologists                                       |
| Senior CQID Representatives                                            | Royal College of Physicians London                                        |


## Ssnap Core Dataset 3.1.1

 
For queries, please contact ssnap@rcplondon.ac.uk  
Webtool for data entry: www.strokeaudit.org  
 
NB. There is a stand-alone intra-arterial proforma available in the support section of the dataset which 
lists only those additional questions related to this intervention. The changes in the SSNAP Core Dataset 
3.1.1 are all related to these new dataset questions.  
 

| Version                                                                                           | Date                                                              | Changes    |
|---------------------------------------------------------------------------------------------------|-------------------------------------------------------------------|------------|
| 1.1.1                                                                                             | 12 Dec                                                            |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| Official core dataset following pilot versions (most recent 3.6.16)                               |                                                                   |            |
| 2012                                                                                              |                                                                   |            |
| 1.1.2                                                                                             | 18 Feb                                                            |            |
| 2013                                                                                              |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 1.12.2 - word 'incident' added to question and allowed values changed to 10 characters            |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 2.8 - sub questions renumbered                                                                    |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 6.10 - word 'First' added                                                                         |                                                                   |            |
| 2.1.1                                                                                             | 02 Apr                                                            |            |
| 2014                                                                                              |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 1.14 Which was the first ward the patient was admitted to at the first hospital? (wording         |                                                                   |            |
| change from 'Which was the first ward the patient was admitted to?')                              |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 3.1 Has it been decided in the first 72 hours that the patient is for palliative care? (wording   |                                                                   |            |
| change from 'If yes, does the patient have a plan for their end of life care?')                   |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 3.1.2 - If yes, does the patient have a plan for their end of life care? (wording change from 'Is |                                                                   |            |
| the patient on an end of life pathway?')                                                          |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 4.4.1 - New question: 'If yes, at what date was the patient no longer considered to require       |                                                                   |            |
| this therapy?'                                                                                    |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 4.5.1 Question removed                                                                            |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 4.6.1 Question removed                                                                            |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 6.9.2 - If yes, does the patient have a plan for their end of life care? (wording change from 'Is |                                                                   |            |
| the patient on an end of life pathway?')                                                          |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 6.11 - New question: 'Was intermittent pneumatic compression applied? '                           |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 6.11.1 - New question:  'If yes, what date was intermittent pneumatic compression first           |                                                                   |            |
| applied?'                                                                                         | Validations: Cannot be before clock start and cannot be after 7.3 |            |
|                                                                                                   |                                                                   |            |
| −                                                                                                 |                                                                   |            |
|                                                                                                   |                                                                   |            |
| 6.11.2 - New question:  'If yes, what date was intermittent pneumatic compression finally         |                                                                   |            |
| removed?'                                                                                         | Cannot be before clock start or 6.11.1 and cannot be after 7.3    |            |

− 7.1 - Additional answer options: 'Was transferred to another inpatient care team, not 
participating in SSNAP'; 'Was transferred to an ESD/community team, not participating in SSNAP'. Validations: Selecting either of these has same effect as selecting 'discharged 
somewhere else' 
− 7.3.1 - 'Date patient considered by the multidisciplinary team to no longer require inpatient 
care?' (wording change from 'Date patient considered by the multidisciplinary team to no longer require inpatient rehabilitation?') 
− 8.4 - Additional answer option: 'Not Known'. ('What is the patient's modified Rankin Scale 
score?') 
− 8.5 - Additional answer option: 'Not Known'. ('Is the patient in persistent, permanent or 
paroxysmal atrial fibrillation?') 
− 8.6.1 - Additional answer option: 'Not Known'. ('Is the patient taking: Antiplatelet?')  
− 8.6.2 - Additional answer option: 'Not Known'. ('Is the patient taking: Anticoagulant?') 
− 8.6.3 - Additional answer option: 'Not Known'. ('Is the patient taking: Lipid Lowering?') 
− 8.6.4 - Additional answer option: 'Not Known'. ('Is the patient taking: Antihypertensive?') 
− 8.7.1 - Additional answer option: 'Not Known'. ('Since their initial stroke, has the patient had 
any of the following: Stroke') 
− 8.7.2 - Additional answer option: 'Not Known'. ('Since their initial stroke, has the patient had 
any of the following: Myocardial infarction') 
− 8.7.3 - Additional answer option: 'Not Known'. ('Since their initial stroke, has the patient had 
any of the following: Other illness requiring hospitalisation') 

| 3.1.1                                                                                  |
|----------------------------------------------------------------------------------------|
| −                                                                                      |
|                                                                                        |
| 2.11 - New question - 'Did the patent receive an intra-arterial intervention for acute |
| 2015                                                                                   |
| stroke?'                                                                               |

− 
2.11.1 - New question - 'Was the patient enrolled into a clinical trial of intra-arterial 
intervention?' 
− 
2.11.2 - New question - 'What brain imaging technique was carried out prior to the 
intra-arterial intervention?' 
− 
2.11.3 - New question - 'How was anaesthesia managed during the intra-arterial 
intervention?' 
− 
2.11.4 - New question - 'What was the speciality of the lead operator?' 
− 
2.11.5 - New question - 'Were any of the following used?' 
− 
2.11.6 - New question - 'Date and time of:' 
− 
2.11.7 - New question - 'Did any of the following complications occur?' 
− 
2.11.8 - New question - 'Angiographic appearance of culprit vessel and result 
assessed by operator (modified TCI score):' 
− 
2.11.9 - New question - 'Where was the patient transferred after the completion of 
the procedure?' 
 
 
Auto-completed on web tool 

Hospital / Team  
                         

Patient Audit Number  
                         

Auto-completed on web tool 

## Demographics/ Onset/ Arrival (Must Be Completed By The First Hospital)

1.1. 
Hospital Number 


Free text (30 character limit) 
10 character numeric 
1.2. 
NHS Number               

                                   
or 
No NHS Number    
 
1.3. 
Surname  

       
Free text (30 character limit) 
 
 
1.4. 
Forename  


Free text (30 character limit) 
 
dd
1.5. 
Date of birth  

  
 
mm 
 
yyyy 
 
1.6. 
Gender      
 
       Male               Female     
 
2-4 alphanumerics 
3 alphanumerics 
1.7. 
Postcode of usual address 
  


1.8. 
Ethnicity   
 
     


or      
Not Known    
 
A - Z (select radio button) 
 

1.9.  
What was the diagnosis?     Stroke  TIA  Other     (*If TIA or Other please go to relevant section)* 
 

| 1.10.                                                                                                                | Was the patient already an inpatient at the time of stroke?                 | Yes     |
|----------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------|---------|
|                                                                                                                     |                                                                             |         |
| No                                                                                                                   |                                                                             |         |
|                                                                                                                     |                                                                             |         |
|                                                                                                                      |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| 1.11.                                                                                                                | Date/time of onset/awareness of symptoms                                    |         |
| dd                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| mm                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| yyyy                                                                                                                 |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| hh                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| mm                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| 1.11.1. The date given is:                                                                                           | Precise                                                                     |         |
|                                                                                                                     |                                                                             |         |
| Best estimate                                                                                                        |                                                                             |         |
|                                                                                                                     |                                                                             |         |
| Stroke during sleep                                                                                                  |                                                                             |         |
|                                                                                                                     |                                                                             |         |
|                                                                                                                      |                                                                             |         |
|                                                                                                                      |                                                                             |         |
|                                                                                                                      | 1.11.2. The time given is:                                                  | Precise |
|                                                                                                                     |                                                                             |         |
| Best estimate                                                                                                        |                                                                             |         |
|                                                                                                                     |                                                                             |         |
| Not known                                                                                                            |                                                                             |         |
|                                                                                                                     |                                                                             |         |
|                                                                                                                      |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| 1.12.                                                                                                                | Did the patient arrive by ambulance?                                        | Yes     |
|                                                                                                                     |                                                                             |         |
| No                                                                                                                   |                                                                             |         |
|                                                                                                                     |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| Default                                                                                                              | Drop-down of all trusts                                                     |         |
| If yes:                                                                                                              |                                                                             |         |
| 1.12.1. Ambulance trust                                                                                              |                                                                             |         |
| 10 characters                                                                                                        |                                                                             |         |
|                                                                                                                      |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| 1.12.2. Computer Aided Despatch (CAD) / Incident Number                                              or    Not known |                                                                             |         |
|                                                                                                                     |                                                                             |         |
|                                                                                                                      |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| 1.13.                                                                                                                | Date/ time patient arrived at first hospital                                |         |
|                                                                                                                      |                                                                             |         |
| dd                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| mm                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| yyyy                                                                                                                 |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| hh                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| mm                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| 1.14.                                                                                                                | Which was the first ward the patient was admitted to at the first hospital? |         |
| MAU/ AAU/ CDU                                                                                                        |                                                                             |         |
|                                                                                                                     |                                                                             |         |
|                                                                                                                      | Stroke Unit                                                                 |         |
|                                                                                                                     |                                                                             |         |
| ITU/CCU/HDU                                                                                                          |                                                                             |         |
|                                                                                                                     |                                                                             |         |
|                                                                                                                      | Other                                                                       |         |
|                                                                                                                     |                                                                             |         |
|                                                                                                                      |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| dd                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| mm                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| yyyy                                                                                                                 |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| hh                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| mm                                                                                                                   |                                                                             |         |
|                                                                                                                      |                                                                             |         |
| 1.15.                                                                                                                | Date/time patient first arrived on a stroke unit                            |         |
| or Did not stay on stroke unit                                                                                       |                                                                             |         |
|                                                                                                                     |                                                                             |         |
|                                                                                                                      |                                                                             |         |
|                                                                                                                      |                                                                             |         |

Casemix/ First 24 hours (if patient is transferred to another setting after 24 hours, this section must be complete) 

2.1.  
Did the patient have any of the following co-morbidities prior to this admission?   

| 2.1.1    | Congestive Heart Failure:      | Yes    |
|----------|--------------------------------|--------|
|         |                                |        |
| No       |                                |        |
|         |                                |        |
|          |                                |        |
| 2.1.2    | Hypertension:                  |        |
|         |                                |        |
| No       |                                |        |
|         |                                |        |
|          |                                |        |
| 2.1.3    | Atrial fibrillation:           |        |
|         |                                |        |
| No       |                                |        |
|         |                                |        |
|          |                                |        |
| 2.1.4    | Diabetes:                      |        |
|         |                                |        |
| No       |                                |        |
|         |                                |        |
|          |                                |        |
| 2.1.5    | Stroke/TIA:                    |        |
|         |                                |        |
| No       |                                |        |
|         |                                |        |
|          |                                |        |
|          |                                |        |

 2.1.6 
If 2.1.3 is yes, was the patient on antiplatelet medication prior to admission?  Yes    No      No but  
2.1.7  If 2.1.3 is yes was the patient on anticoagulant medication prior to admission?  Yes    No     No but  
 

0 - 5 

2.2.  
What was the patient's modified Rankin Scale score before this stroke? 

Automated calculation of total score 
2.3.  
What was the patient's NIHSS score on arrival?                        
 
 
0 
1 
2 
3 
4 
Not 
known 
2.3.1 
Level of Consciousness (LOC) 
 
 
 
 
 
 
2.3.2 
LOC Questions 
 
 
 
 
 
 
2.3.3 
LOC Commands 
 
 
 
 
 
 
2.3.4 
Best Gaze 
 
 
 
 
 
 
2.3.5 
Visual 
 
 
 
 
 
 
2.3.6 
Facial Palsy 
 
 
 
 
 
 
2.3.7 
Motor Arm (left) 
 
 
 
 
 
 
2.3.8 
Motor Arm (right) 
 
 
 
 
 
 
2.3.9 
Motor Leg (left) 
 
 
 
 
 
 
2.3.10 
Motor Leg (right) 
 
 
 
 
 
 
2.3.11 
Limb Ataxia 
 
 
 
 
 
 
2.3.12 
Sensory 
 
 
 
 
 
 
2.3.13 
Best Language 
 
 
 
 
 
 
2.3.14 
Dysarthria 
 
 
 
 
 
 
2.3.15 
Extinction and Inattention 
 
 
 
 
 
 
 
dd 
 
mm 
 
yyyy 
 
hh 
 
mm 
 
2.4.  
Date and time of first brain imaging after stroke                                               
or    Not imaged   
 

2.5.  
What was the type of stroke? 
Infarction  
Primary Intracerebral Haemorrhage  
 
2.6.  
Was the patient given thrombolysis?   Yes     No      No but   (auto-selected if 2.5=PIH) 

| 2.6.1                                         | If no, what was the reason:                                        |
|-----------------------------------------------|--------------------------------------------------------------------|
| Thrombolysis not available at hospital at all |                                                                    |
|                                              |                                                                    |
|                                               | Outside thrombolysis service hours                                 |
|                                              |                                                                    |
|                                               |                                                                    |
| Unable to scan quickly enough                 |                                                                    |
|                                              |                                                                    |
|                                               | None                                                               |
|                                              |                                                                    |
|                                               |                                                                    |
| 2.6.2                                         | If no but, please select the reasons:                              |
| Haemorrhagic stroke                           | (auto-selected if 2.5=PIH)                                         |
|                                              |                                                                    |
| Age                                           |                                                                    |
|                                              |                                                                    |
|                                               |                                                                    |
| Arrived outside thrombolysis time window      |                                                                    |
|                                              |                                                                    |
| Symptoms improving                            |                                                                    |
|                                              |                                                                    |
|                                               |                                                                    |
| Co-morbidity                                  |                                                                    |
|                                              |                                                                    |
|                                               |                                                                    |
|                                              |                                                                    |
|                                               |                                                                    |
| Contraindicated medication                    |                                                                    |
|                                              |                                                                    |
|                                               |                                                                    |
|                                              |                                                                    |
|                                               |                                                                    |
| Patient or relative refusal                   |                                                                    |
|                                              |                                                                    |
|                                               |                                                                    |
|                                              |                                                                    |
|                                               |                                                                    |
|                                               |                                                                    |
| dd                                            |                                                                    |
|                                               |                                                                    |
| mm                                            |                                                                    |
|                                               |                                                                    |
| yyyy                                          |                                                                    |
|                                               |                                                                    |
| hh                                            |                                                                    |
|                                               |                                                                    |
| mm                                            |                                                                    |
|                                               |                                                                    |
| 2.7.                                          | Date and time patient was thrombolysed                             |
|                                               |                                                                    |
| 2.8.                                          | Did the patient have any complications from the thrombolysis?  Yes |
|                                              |                                                                    |
|                                               | No                                                                 |
|                                              |                                                                    |
|                                               |                                                                    |
| 2.8.1                                         | If yes, which of the following complications:                      |
| Symptomatic intracranial haemorrhage          |                                                                    |
|                                              |                                                                    |
| Angio oedema                                  |                                                                    |
|                                              |                                                                    |
| Extracranial bleed                            |                                                                    |
|                                              |                                                                    |
| Other                                         |                                                                    |
|                                              |                                                                    |
|                                               |                                                                    |
| 2.8.2                                         | If other, please specify                                           |
|                                               |                                                                    |
| Free text (30 character limit)                |                                                                    |
|                                               |                                                                    |
| 0 - 42                                        |                                                                    |
| 2.9.                                          | What was the patient's NIHSS score at 24 hours after thrombolysis? |
|                                              |                                                                    |
|                                               |                                                                    |
|                                               |                                                                    |
| 2.10.                                         | Date and time of first swallow screen                              |
| dd                                            |                                                                    |
|                                               |                                                                    |
| mm                                            |                                                                    |
|                                               |                                                                    |
| yyyy                                          |                                                                    |
|                                               |                                                                    |
| hh                                            |                                                                    |
|                                               |                                                                    |
| mm                                            |                                                                    |
|                                               |                                                                    |
| or   Patient not screened in first 4 hours    |                                                                    |
|                                              |                                                                    |
|                                               |                                                                    |
| Enter relevant code (see appendix)            |                                                                    |

2.10.1  If screening was not performed within 4 hours, what was the reason? 

| 2.11                                                                                                   | Did the patient receive an intra-arterial intervention for acute stroke?      | Yes     |
|--------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------|---------|
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| 2.11.1 Was the patient enrolled into a clinical trial of intra-arterial intervention?                  | Yes                                                                           |         |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| 2.11.2 What brain imaging technique(s) was carried out prior to the intra-arterial intervention?       |                                                                               |         |
|                                                                                                        | a. CTA or MRA                                                                 |         |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| b. Measurement of ASPECTS score                                                                        |                                                                               |         |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| c. Assessment of ischaemic penumbra by perfusion imaging                                               | Yes                                                                           |         |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| 2.11.3 How was anaesthesia managed during the intra-arterial intervention?                             |                                                                               |         |
| Local anaesthetic only (anaesthetist NOT present)                                                      |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| Local anaesthetic only (anaesthetist present)                                                          |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| Local anaesthetic and conscious sedation (anaesthetist NOT present)                                    |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| Local anaesthetic and conscious sedation (anaesthetist present)                                        |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| General anaesthetic                                                                                    |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| Other                                                                                                  |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| 2.11.4 What was the specialty of the lead operator?                                                    |                                                                               |         |
|                                                                                                        | Interventional neuroradiologist                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| Cardiologist                                                                                           |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| Interventional radiologist                                                                             |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| Other                                                                                                  |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| 2.11.5 Were any of the following used?                                                                 |                                                                               |         |
| a. Thrombo-aspiration system                                                                           |                                                                               | Yes     |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| b. Stent retriever                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| c. Proximal balloon/flow arrest guide catheter Yes                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| d. Distal access catheter                                                                              |                                                                               |         |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| 2.11.6 Date and time of:                                                                               |                                                                               |         |
| dd                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| mm                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| yyyy                                                                                                   |                                                                               |         |
|                                                                                                        |                                                                               |         |
| hh                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| mm                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| dd                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| mm                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| yyyy                                                                                                   |                                                                               |         |
|                                                                                                        |                                                                               |         |
| hh                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| mm                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| a. Arterial puncture:                                                                                  |                                                                               |         |
|                                                                                                        |                                                                               |         |
| b. First deployment of device for thrombectomy or aspiration                                           |                                                                               |         |
|                                                                                                        |                                                                               |         |
|                                                                                                       |                                                                               |         |
| Not performed                                                                                          |                                                                               |         |
| c. End of procedure (time of last angiographic run on treated vessel):                                 |                                                                               |         |
| dd                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| mm                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| yyyy                                                                                                   |                                                                               |         |
|                                                                                                        |                                                                               |         |
| hh                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| mm                                                                                                     |                                                                               |         |
|                                                                                                        |                                                                               |         |
| 2.11.7 Did any of the following complications occur?                                                   |                                                                               |         |
| a. Symptomatic intra-cranial haemorrhage                                                               |                                                                               |         |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| b. Extra-cranial haemorrhage                                                                           |                                                                               |         |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| c. Other procedural complication resulting in harm to the patient                                      | Yes                                                                           |         |
|                                                                                                       |                                                                               |         |
| No                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| 2.11.8 Angiographic appearance of culprit vessel and result assessed by operator (modified TICI score) |                                                                               |         |
| a. Pre intervention                                                                                    | 0                                                                             |         |
|                                                                                                       |                                                                               |         |
| 1                                                                                                      |                                                                               |         |
|                                                                                                       |                                                                               |         |
| 2a                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
| 2b                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
| 3                                                                                                      |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| b. Post intervention                                                                                   | 0                                                                             |         |
|                                                                                                       |                                                                               |         |
| 1                                                                                                      |                                                                               |         |
|                                                                                                       |                                                                               |         |
| 2a                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
| 2b                                                                                                     |                                                                               |         |
|                                                                                                       |                                                                               |         |
| 3                                                                                                      |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| 2.11.9 Where was the patient transferred after the completion of the procedure?                        |                                                                               |         |
| Intensive care unit or high dependency unit                                                            |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| Stroke unit                                                                                            |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |
| Other                                                                                                  |                                                                               |         |
|                                                                                                       |                                                                               |         |
|                                                                                                        |                                                                               |         |


| 3.1.                                                                     | Has it been decided in the first 72 hours that the patient is for palliative care?       Yes      |       |
|--------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------|-------|
|                                                                         |                                                                                                   |       |
| No                                                                       |                                                                                                   |       |
|                                                                         |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| If yes:                                                                  |                                                                                                   |       |
| dd                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| yyyy                                                                     |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| 3.1.1.  Date of palliative care decision                                 |                                                                                                   |       |
| 3.1.2.  If yes, does the patient have a plan for their end of life care? |                                                                                                   | Yes   |
|                                                                         |                                                                                                   |       |
| No                                                                       |                                                                                                   |       |
|                                                                         |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| 3.2.                                                                     | Date/time first assessed by nurse trained in stroke management                                    |       |
|                                                                          | or No assessment in first 72 hours                                                                |       |
|                                                                         |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| dd                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| yyyy                                                                     |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| hh                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| 3.3.                                                                     | Date/time first assessed by stroke specialist consultant physician                                |       |
| dd                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| yyyy                                                                     |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| hh                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
|                                                                          | or No assessment in first 72 hours                                                                |       |
|                                                                         |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| dd                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| yyyy                                                                     |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| hh                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| 3.4.                                                                     | Date/time of first swallow screen                                                                 |       |
| (If date/time already entered for                                        |                                                                                                   |       |
| screening within 4 hours (2.10), 3.4 does not need to be answered)       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| or   Patient not screened in first 72 hours                              |                                                                                                   |       |
|                                                                         |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| Enter relevant code                                                      |                                                                                                   |       |
| 3.4.1                                                                    | If screening was not performed within 72 hours, what was the reason?                              |       |
|                                                                          |                                                                                                   |       |
| 3.5.                                                                     | Date/time first assessed by an Occupational Therapist                                             |       |
| dd                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| yyyy                                                                     |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| hh                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
|                                                                          | or No assessment in first 72 hours                                                                |       |
|                                                                         |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| Enter relevant code                                                      |                                                                                                   |       |
| 3.5.1                                                                    | If assessment was not performed within 72 hours, what was the reason?                             |       |
|                                                                          |                                                                                                   |       |
| 3.6.                                                                     | Date/time first assessed by a Physiotherapist                                                     |       |
| dd                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| yyyy                                                                     |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| hh                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
|                                                                          | or No assessment in first 72 hours                                                                |       |
|                                                                         |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| Enter relevant code                                                      |                                                                                                   |       |
| 3.6.1                                                                    | If assessment was not performed within 72 hours, what was the reason?                             |       |
|                                                                          |                                                                                                   |       |
| 3.7.                                                                     | Date/time communication first assessed by Speech and Language Therapist                           |       |
| dd                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| yyyy                                                                     |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| hh                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
|                                                                          | or No assessment in first 72 hours                                                                |       |
|                                                                         |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| Enter relevant code                                                      |                                                                                                   |       |
| 3.7.1                                                                    | If assessment was not performed within 72 hours, what was the reason?                             |       |
|                                                                          |                                                                                                   |       |
| 3.8.                                                                     | Date/time of formal swallow assessment by a Speech and Language Therapist or another professional |       |
| trained in dysphagia assessment                                          |                                                                                                   |       |
| dd                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| yyyy                                                                     |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| hh                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| mm                                                                       |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
|                                                                          | or No assessment in first 72 hours                                                                |       |
|                                                                         |                                                                                                   |       |
|                                                                          |                                                                                                   |       |
| Enter relevant code                                                      |                                                                                                   |       |
| 3.8.1                                                                    | If assessment was not performed within 72 hours, what was the reason?                             |       |
|                                                                          |                                                                                                   |       |
| This admission                                                            |                                                                                                         | (this section must be completed by every team/ hospital/ care setting)   |               |
|---------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------|---------------|
|                                                                           |                                                                                                         |                                                                          |               |
| 4.1.                                                                      | Date/ time patient arrived at this hospital/team                                                        |                                                                          |               |
| dd                                                                        |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| mm                                                                        |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| yyyy                                                                      |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| hh                                                                        |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| mm                                                                        |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| 4.2.                                                                      | Which was the first ward the patient was admitted to at this hospital?                                  |                                                                          |               |
| MAU/ AAU/ CDU                                                             |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           | Stroke Unit                                                                                             |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
| ITU/CCU/HDU                                                               |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           | Other                                                                                                   |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| 4.3.                                                                      | Date/time patient arrived on stroke unit at this hospital                                               |                                                                          |               |
| dd                                                                        |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| mm                                                                        |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| yyyy                                                                      |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| hh                                                                        |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| mm                                                                        |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
|                                                                           | or Did not stay on stroke unit                                                                          |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| 4. Psychology                                                             |                                                                                                         | 1.                                                                       |               |
| Physiotherapy                                                             |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| 2.                                                                        |                                                                                                         |                                                                          |               |
| Occupational                                                              |                                                                                                         |                                                                          |               |
| Therapy                                                                   |                                                                                                         |                                                                          |               |
| 3. Speech                                                                 |                                                                                                         |                                                                          |               |
| and language                                                              |                                                                                                         |                                                                          |               |
| therapy                                                                   |                                                                                                         |                                                                          |               |
|                                                                           | 4.4. Was the patient considered to require this                                                         |                                                                          |               |
| therapy at any point in this admission?                                   |                                                                                                         |                                                                          |               |
| Yes                                                                       |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
| No                                                                        |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| Yes                                                                       |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
| No                                                                        |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           | Yes                                                                                                     |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
| No                                                                        |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| Yes                                                                       |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
| No                                                                        |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| longer considered to require this therapy?                                |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| therapy across their total stay in this hospital/team?                    |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| the patient receive during their stay in this                             |                                                                                                         |                                                                          |               |
| hospital/team?                                                            |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| 4.7.                                                                      | Date rehabilitation goals agreed:                                                                       |                                                                          | or   No goals |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| dd                                                                        |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| mm                                                                        |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| yyyy                                                                      |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| 4.7.1. If no goals agreed, what was the reason?                           |                                                                                                         |                                                                          |               |
| Not known                                                                 |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           | Patient medically unwell for entire admission                                                           |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| Patient refused                                                           |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           | Patient has no impairments                                                                              |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| Organisational reasons                                                    |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
| Patient considered to have no rehabilitation potential                    |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| Patient Condition in first 7 days                                         |                                                                                                         |                                                                          |               |
| (if patient is transferred after 7 days, this section must be complete)   |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |
| 5.1.                                                                      | What was the patient's worst level of consciousness in the first 7 days following initial admission for |                                                                          |               |
| stroke? (Based on patient's NIHSS Level of Consciousness (LOC) score):  0 |                                                                                                         |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           | 1                                                                                                       |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           | 2                                                                                                       |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           | 3                                                                                                       |                                                                          |               |
|                                                                          |                                                                                                         |                                                                          |               |
|                                                                           |                                                                                                         |                                                                          |               |

5.2.  
Did the patient develop a urinary tract infection in the first 7 days following initial admission for stroke 
as defined by having a positive culture or clinically treated?    Yes    
No        Not known  

 5.3.  
Did the patient receive antibiotics for a newly acquired pneumonia in the first 7 days following initial 
admission for stroke? 
Yes    
No    
Not known  
 
6.1.  
Date/time first assessed by an Occupational Therapist 
|                                                                        | or No assessment by discharge                                                                     |
|------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------|
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| dd                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| yyyy                                                                   |                                                                                                   |
|                                                                        |                                                                                                   |
| hh                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| Enter relevant code                                                    |                                                                                                   |
| 6.1.1 If no assessment, what was the reason?                           |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.2.                                                                   | Date/time first assessed by a Physiotherapist                                                     |
| dd                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| yyyy                                                                   |                                                                                                   |
|                                                                        |                                                                                                   |
| hh                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
|                                                                        | or No assessment by discharge                                                                     |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| Enter relevant code                                                    |                                                                                                   |
| 6.2.1 If no assessment, what was the reason?                           |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.3.                                                                   | Date/time communication first assessed by Speech and Language Therapist                           |
|                                                                        |                                                                                                   |
| or No assessment by discharge                                          |                                                                                                   |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| dd                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| yyyy                                                                   |                                                                                                   |
|                                                                        |                                                                                                   |
| hh                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.3.1 If no assessment, what was the reason?                           |                                                                                                   |
| Enter relevant code                                                    |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.4.                                                                   | Date/time of formal swallow assessment by a Speech and Language Therapist or another professional |
| trained in dysphagia assessment                                        |                                                                                                   |
| dd                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| yyyy                                                                   |                                                                                                   |
|                                                                        |                                                                                                   |
| hh                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
|                                                                        | or No assessment by discharge                                                                     |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| Enter relevant code                                                    |                                                                                                   |
| 6.4.1 If no assessment, what was the reason?                           |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.5.                                                                   | Date urinary continence plan drawn up                                                             |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| dd                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| yyyy                                                                   |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.5.1 If no plan, what was the reason?                                 |                                                                                                   |
| Enter relevant code                                                    |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.6.                                                                   | Was the patient identified as being at high risk of malnutrition following nutritional screening? |
| Yes                                                                    |                                                                                                   |
|                                                                       |                                                                                                   |
| No                                                                     |                                                                                                   |
|                                                                       |                                                                                                   |
| Not screened                                                           |                                                                                                   |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.6.1 If yes, date patient saw a dietitian                             |                                                                                                   |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| dd                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| yyyy                                                                   |                                                                                                   |
|                                                                        |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.7.                                                                   | Date patient screened for mood using a validated tool                                             |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| dd                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| yyyy                                                                   |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.7.1 If not screened, what was the reason?                            |                                                                                                   |
| Enter relevant code                                                    |                                                                                                   |
|                                                                        |                                                                                                   |
| dd                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| yyyy                                                                   |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.8.                                                                   | Date patient screened for cognition using a simple standardised measure?                          |
| or Not screened                                                        |                                                                                                   |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| Enter relevant code                                                    |                                                                                                   |
| 6.8.1 If not screened, what was the reason?                            |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.9.                                                                   | Has it been decided by discharge that the patient is for palliative care?    Yes                  |
|                                                                       |                                                                                                   |
| No                                                                     |                                                                                                   |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| If yes:                                                                |                                                                                                   |
| dd                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| yyyy                                                                   |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.9.1 Date of palliative care decision                                 |                                                                                                   |
| 6.9.2 If yes, does the patient have a plan for their end of life care? | Yes                                                                                               |
|                                                                       |                                                                                                   |
| No                                                                     |                                                                                                   |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
|                                                                        |                                                                                                   |
| 6.10.                                                                  | First date rehabilitation goals agreed:                                                           |
|                                                                       |                                                                                                   |
|                                                                        |                                                                                                   |
| dd                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| mm                                                                     |                                                                                                   |
|                                                                        |                                                                                                   |
| yyyy                                                                   |                                                                                                   |
|                                                                        |                                                                                                   |

 
This question is auto-completed. It will be based on the first date that is entered for 4.7. If no hospitals / care settings in the pathway enter a date (i.e. all select 'no goals'), then 'no goals' will be selected here 

 6.11 
Was intermittent pneumatic compression applied? 
Yes   No   Not Known  
 
mm 
dd 
 
 
yyyy 
 
6.11.1 If yes, what date was intermittent pneumatic compression first applied? 6.11.2 If yes, what date was intermittent pneumatic compression finally removed? 
mm 
dd 
 
 
yyyy 

## Discharge / Transfer

7.1.  
The patient: 
Died   
Was discharged to a care home     
Was discharged home   Was discharged to somewhere else  
Was transferred to another inpatient care team  
Was transferred to an ESD / community team  
Was transferred to another inpatient care team, not participating in SSNAP  
Was transferred to an ESD/community team, not participating in SSNAP   
 

dd 
 
mm 
 
yyyy 
 

7.1.1 If patient died, what was the date of death? 
 
7.1.2 Did the patient die in a stroke unit?  Yes       No  
 
7.1.3 What hospital/team was the patient transferred to? 
Enter team code 7.2. 
Date/time of discharge from stroke unit  

dd 
 
mm 
 
yyyy 
 
hh 
 
mm 
 
dd 
 
mm 
 
yyyy 
 
hh 
 
mm 
 

 7.3.  
Date/time of discharge/transfer from team 
7.3.1 Date patient considered by the multidisciplinary team to no longer require inpatient care? 

dd 
 
mm 
 
yyyy 
 

0 - 6 
7.4.  
Modified Rankin Scale score at discharge/transfer   
      (defaults to 6 if 7.1 is died in hospital) 
 
7.5. 
If discharged to a care home, was the patient:    Previously a resident     Not previously a resident   
7.5.1 If not previously a resident, is the new arrangement: 
Temporary       Permanent  7.6.  
If discharged home, is the patient:    Living alone  
Not living alone  
Not known  7.7. 
Was the patient discharged with an Early Supported Discharge multidisciplinary team? 
 
Yes, stroke/neurology specific   
Yes, non-specialist  
 
No  7.8.  
Was the patient discharged with a multidisciplinary community rehabilitation team? 

|     | Yes, stroke/neurology specific    |
|-----|-----------------------------------|
|    |                                   |
|     | Yes, non-specialist               |
|    |                                   |
|     |                                   |
|    |                                   |
|     |                                   |

 7.9.  
Did the patient require help with activities of daily living (ADL)? Yes   
No  
If yes: 
7.9.1 What support did they receive? 

| Paid carers              |                                |        |
|--------------------------|--------------------------------|--------|
|                         |                                |        |
|                          | Paid care services unavailable |        |
|                         |                                |        |
|                          |                                |        |
| Informal carers          |                                |        |
|                         |                                |        |
|                          | Patient refused                |        |
|                         |                                |        |
|                          |                                |        |
| Paid and informal carers |                                |        |
|                         |                                |        |
|                          |                                |        |

7.9.2 At point of discharge, how many visits per week were social services going to provide?   

0 - 100 

or Not known  
 
7.10. 
Is there documented evidence that the patient is in atrial fibrillation on discharge? Yes     No   
7.10.1 If yes, was the patient taking anticoagulation (not anti-platelet agent) on discharge or discharged with a 
plan to start anticoagulation within the next month?   
Yes         No         No  but  7.11.  
Is there documented evidence of joint care planning between health and social care for post discharge 
management?          Yes   
 
No    
Not applicable  7.12.  
Is there documentation of a named person for the patient and/or carer to contact after discharge?  
Yes   No   

Six month (post admission) follow-up assessment 
8.1.  
Did this patient have a follow-up assessment at 6 months post admission (plus or minus two months)? 
Yes   
No    
No but   
No, patient died within 6 months of admission  
N.B. 'No but' should only be answered for DNAs, patients who are not registered with a GP, or patients who have had another stroke and a new SSNAP record started 

 
8.1.1 What was the date of follow-up?  

dd 
 
mm 
 
yyyy 
 

 
8.1.2 How was the follow-up carried out:  In person      By telephone         Online           By post  
 
8.1.3 Which of the following professionals carried out the follow-up assessment: 

| GP                 |                             |     |
|--------------------|-----------------------------|-----|
|                   |                             |     |
|                    | District/community nurse    |     |
|                   |                             |     |
|                    |                             |     |
| Stroke coordinator |                             |     |
|                   |                             |     |
|                    | Voluntary Services employee |     |
|                   |                             |     |
|                    |                             |     |
| Therapist          |                             |     |
|                   |                             |     |
|                    | Secondary care clinician    |     |
|                   |                             |     |
|                    |                             |     |
| Other              |                             |     |
|                   |                             |     |
|                    |                             |     |

8.1.4 If other, please specify  
 
Free text (30 character limit) 
 
8.1.5 Did the patient give consent for their identifiable information to be included in SSNAP?* 

Yes, patient gave consent  
  No, patient refused consent   
Patient was not asked 8.2  
Was the patient screened for mood, behaviour or cognition since discharge using a validated tool?  
Yes   
No    
No but   
8.2.1 If yes, was the patient identified as needing support? 
Yes   
No   
8.2.2 If yes, has this patient received psychological support for mood, behaviour or cognition since discharge? 
Yes   
No    
No but   8.3.  
Where is this patient living?  
Home   
Care home   
Other   
8.3.1 If other, please specify    
Free text (30 character limit) 
 
0 - 6 8.4.  
What is the patient's modified Rankin Scale score?  
 
Not known    

 8.5. 
Is the patient in persistent, permanent or paroxysmal atrial fibrillation? Yes  
No    Not known  8.6.  
Is the patient taking:   

| 8.6.1 Antiplatelet:       | Yes       |
|---------------------------|-----------|
|                          |           |
| No                        |           |
|                          |           |
|                           | Not known |
|                          |           |
|                           |           |
| 8.6.2 Anticoagulant:      | Yes       |
|                          |           |
| No                        |           |
|                          |           |
|                           | Not known |
|                          |           |
|                           |           |
| 8.6.3 Lipid Lowering:     | Yes       |
|                          |           |
| No                        |           |
|                          |           |
|                           | Not known |
|                          |           |
|                           |           |
| 8.6.4 Antihypertensive:   |           |
| Yes                       |           |
|                          |           |
| No                        |           |
|                          |           |
|                           | Not known |
|                          |           |
|                           |           |

 8.7.  
Since their initial stroke, has the patient had any of the following:   

| 8.7.1 Stroke                                  |     |     |     |
|-----------------------------------------------|-----|-----|-----|
|                                              |     |     |     |
| No                                            |     |     |     |
|                                              |     |     |     |
| Not known                                     |     |     |     |
|                                              |     |     |     |
|                                               |     |     |     |
| 8.7.2 Myocardial infarction                   |     |     | Yes |
|                                              |     |     |     |
| No                                            |     |     |     |
|                                              |     |     |     |
| Not known                                     |     |     |     |
|                                              |     |     |     |
|                                               |     |     |     |
| 8.7.3 Other illness requiring hospitalisation | Yes |     |     |
|                                              |     |     |     |
| No                                            |     |     |     |
|                                              |     |     |     |
| Not known                                     |     |     |     |
|                                              |     |     |     |
|                                               |     |     |     |

 
*8.1.5. This question is mandatory to be collected at the 6 month review and is a requirement for 
collecting patient identifiable information as part of our section 251 (NHS Act 2006) approval from the 
Ethics and Confidentiality Committee of the National Information Governance Board.