National Report Appendices (2021)
Source: data.gov.uk (2023-09-06)

Sentinel Stroke National Audit Programme (SSNAP) - Acute Organisational Audit 2021. The SSNAP acute organisational audit is a snapshot audit which runs on a biennial basis and reports on the structure and organisation of acute stroke services in England, Wales and Northern Ireland. The results of the 2021 acute organisational audit contain national and hospital level findings on the organisation of stroke services, in particular acute care organisation, staffing levels and skill mix, provision of stroke treatments, TIA (mini stroke) services, engagement with patients and carers, and pathway at discharge. The results reflect the organisation of stroke services as of 1 October 2021. 100% of eligible hospitals in England, Wales and Northern Ireland participated in the audit.

The full results portfolio of named hospital results, available to download below, describes the performance for all 157 participating sites in England, Wales and Northern Ireland. All participating sites were measured against 10 key indicators of acute stroke service organisation enabling hospitals to compare their performance with others and benchmark themselves against national standards and results.

Full Results Portfolio: A very detailed file showing hospital level results for the 10 key indicators of acute stroke service organisation as well as every data item benchmarked against the national average.

National report: Includes national level results for the 2021 acute organisational audit. Includes national performance against 10 key indicators and many important aspects of acute stroke service organisation, clinical commentary, changes over time and country comparisons

Sentinel Stroke National Audit Programme
(SSNAP)

Acute Organisational Audit 2021
Appendices
Reporting the organisation of stroke services in England, Wales and
Northern Ireland on 1 October 2021

June 2022
Prepared by
King’s College London, Sentinel Stroke National Audit Programme on behalf of the
Intercollegiate Stroke Working Party

Title
SSNAP 2021 Acute Organisational Audit report
Appendices
Document
purpose
This document contains the appendices for the SSNAP 2021 Acute Organisational
Audit Report
Appendices
Appendix 1
List of participating hospitals and trusts by region
Full list of providers that participated in the acute organisational audit 2021 broken
down by ISDN or region
Appendix 2
Acute organisational audit proforma 2021
Paper version of questionnaire completed by providers for the acute organisational
audit 2021
Appendix 3
Full introduction and methodology
Full audit methodology for the acute organisational audit 2021
Appendix 4
Intercollegiate Stroke Working Party membership
Full list of members of the Intercollegiate Stroke Working Party (ICSWP) and the
organisations they represent
Appendix 5
Summary of denominators used in the report
Information on the main denominators used throughout the acute organisational
audit 2021 report
Contact
xxx@xxx.xx

i

Appendix 1: List of Participating Hospitals and Trusts by Region
Region
Site Name
Hospital(s)
Buckinghamshire,
Oxford and
Berkshire
Buckinghamshire Healthcare NHS Trust
Wycombe General Hospital
Oxford University Hospitals NHS Foundation Trust (John Radcliffe Hospital)
John Radcliffe Hospital
Royal Berkshire NHS Foundation Trust
Royal Berkshire Hospital
Cheshire and
Mersey
Countess of Chester Hospital NHS Foundation Trust
Countess of Chester Hospital
Liverpool University Hospitals NHS Foundation Trust (Royal Liverpool University Hospital)
Royal Liverpool University Hospital
Liverpool University Hospitals NHS Foundation Trust (University Hospital Aintree)
University Hospital Aintree
Southport and Ormskirk Hospital NHS Trust
Southport and Formby District General Hospital
St Helens and Knowsley Teaching Hospitals NHS Trust
Whiston Hospital
Walton Centre NHS Foundation Trust
Walton Centre Stroke Team
Warrington and Halton Hospitals NHS Foundation Trust
Warrington Hospital
Wirral University Teaching Hospital NHS Foundation Trust
Wirral Arrowe Park Hospital
Wirral Clatterbridge Rehabilitation Centre
East Midlands
Chesterfield Royal Hospital NHS Foundation Trust
Chesterfield Royal
Northampton General Hospital NHS Trust
Northampton General Hospital
Nottingham University Hospitals NHS Trust (Queens Medical Centre, Nottingham)
Queen's Medical Centre - Nottingham
Nottingham City Hospital
Sherwood Forest Hospitals NHS Foundation Trust
Kings Mill Hospital
United Lincolnshire Hospitals NHS Trust (Lincoln County Hospital)
Lincoln County Hospital
United Lincolnshire Hospitals NHS Trust (Pilgrim Hospital)
Pilgrim Hospital
University Hospitals of Derby and Burton NHS Foundation Trust (Queens Hospital Burton upon Trust)
Queens Hospital Burton upon Trent
University Hospitals of Derby and Burton NHS Foundation Trust (Royal Derby Hospital)
Royal Derby Hospital
University Hospitals of Leicester NHS Trust
Leicester Royal Infirmary
East of England
(North)
Cambridge University Hospitals NHS Foundation Trust
Addenbrooke's Hospital
East Suffolk and North Essex NHS Foundation Trust (Colchester General Hospital)
Colchester General Hospital
East Suffolk and North Essex NHS Foundation Trust (Ipswich Hospital)
Ipswich Hospital
James Paget University Hospitals NHS Foundation Trust
James Paget Hospital
Norfolk and Norwich University Hospitals NHS Foundation Trust
Norfolk and Norwich University Hospital
North West Anglia NHS Foundation Trust
Peterborough City Hospital
Hinchingbrooke Hospital
Queen Elizabeth Hospital King's Lynn NHS Foundation Trust
Queen Elizabeth Hospital Kings Lynn
West Suffolk Hospital NHS Foundation Trust
West Suffolk Hospital
East of England
(South)

Bedfordshire Hospitals NHS Foundation Trust (Bedford Hospital)
Bedford Hospital
Bedfordshire Hospitals NHS Foundation Trust (Luton and Dunstable Hospital)
Luton and Dunstable Hospital
East and North Hertfordshire NHS Trust
Lister Hospital
Mid and South Essex NHS Foundation Trust (Basildon University Hospital)
Basildon University Hospital
Mid and South Essex NHS Foundation Trust (Broomfield Hospital)
Broomfield Hospital
1

Region
Site Name
Hospital(s)
East of England
(South)
Mid and South Essex NHS Foundation Trust (Southend Hospital)
Southend Hospital
Milton Keynes University Hospital NHS Foundation Trust
Milton Keynes General Hospital
West Hertfordshire Hospitals NHS Trust
Watford General Hospital
Frimley ICS and
Surrey Heartlands
Ashford and St Peter's Hospitals NHS Foundation Trust
St Peter's Hospital
Epsom and St Helier University Hospitals NHS Trust (Epsom Hospital)
Epsom Hospital
Frimley Health NHS Foundation Trust (Frimley Park Hospital)
Frimley Park Hospital
Royal Surrey County Hospital NHS Foundation Trust
Royal Surrey County Hospital
Surrey and Sussex Healthcare NHS Trust
East Surrey Hospital
Greater
Manchester
Bolton NHS Foundation Trust
Royal Bolton Hospital
Manchester University NHS Foundation Trust (Manchester Royal Infirmary)
Manchester Royal Infirmary
Manchester University NHS Foundation Trust (Trafford General Hospital)
Trafford General Hospital
Northern Care Alliance NHS Foundation Trust (Salford Royal Hospital)
Salford Royal Hospital
Northern Care Alliance NHS Foundation Trust (Fairfield General Hospital)
Fairfield General Hospital
Stockport NHS Foundation Trust
Stepping Hill Hospital
Tameside and Glossop Integrated Care NHS Foundation Trust
Tameside General Hospital
Wrightington, Wigan and Leigh NHS Foundation Trust
Royal Albert Edward Infirmary
Humber Coast
and Vale
Hull University Teaching Hospitals NHS Trust
Hull Royal Infirmary
Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
Scunthorpe General Hospital
Diana Princess of Wales Hospital Grimsby
York and Scarborough Teaching Hospitals NHS Foundation Trust (York Hospital)
York Hospital
White Cross Court Stroke Rehabilitation Unit
Johnson Ward Stroke Rehabilitation Unit
Islands
Manx Care
Noble's Hospital
Kent and Medway
Dartford and Gravesham NHS Trust
Darent Valley Hospital
East Kent Hospitals University NHS Foundation Trust (Kent and Canterbury Hospital)
Kent and Canterbury Hospital
Maidstone and Tunbridge Wells NHS Trust (Maidstone Hospital)
Maidstone District General Hospital
Lancashire and
South Cumbria
Blackpool Teaching Hospitals NHS Foundation Trust
Blackpool Victoria Hospital
East Lancashire Hospitals NHS Trust
Royal Blackburn Hospital
Lancashire Teaching Hospitals NHS Foundation Trust
Royal Preston Hospital
University Hospitals of Morecambe Bay NHS Foundation Trust (Furness General Hospital)
Furness General Hospital
University Hospitals of Morecambe Bay NHS Foundation Trust (Royal Lancaster Infirmary)
Royal Lancaster Infirmary
London

Barking, Havering and Redbridge University Hospitals NHS Trust
Queens Hospital Romford
Barts Health NHS Trust (Newham University Hospital)
Newham General Hospital
Barts Health NHS Trust (Royal London Hospital)
Royal London Hospital
Barts Health NHS Trust (Whipps Cross University Hospital)
Whipps Cross University Hospital
Chelsea and Westminster Hospital NHS Foundation Trust (Chelsea and Westminster Hospital)
Chelsea and Westminster Hospital
Chelsea and Westminster Hospital NHS Foundation Trust (West Middlesex University Hospital)
West Middlesex University Hospital
Croydon Health Services NHS Trust
Croydon University Hospital
Epsom and St Helier University Hospitals NHS Trust (St Helier Hospital)
St Helier Hospital
2

Region
Site Name
Hospital(s)
London
Guy's and St Thomas' Hospital NHS Foundation Trust
St Thomas Hospital
Hillingdon Hospitals NHS Foundation Trust
Hillingdon Hospital
Homerton University Hospital NHS Foundation Trust
Homerton University Hospital
Imperial College Healthcare NHS Trust
Charing Cross Hospital
King's College Hospital NHS Foundation Trust (King's College Hospital)
King's College Hospital
King's College Hospital NHS Foundation Trust (Princess Royal University Hospital)
Princess Royal University Hospital
Kingston Hospital NHS Foundation Trust
Kingston Hospital
Lewisham and Greenwich NHS Trust
University Hospital Lewisham
London North West University Healthcare NHS Trust (Northwick Park Hospital)
Northwick Park Hospital
North Middlesex University Hospital NHS Trust
North Middlesex Hospital
Royal Free London NHS Foundation Trust (Barnet General Hospital)
Barnet General Hospital
Royal Free London NHS Foundation Trust (Royal Free Hospital)
Royal Free Hospital
St George's Healthcare NHS Foundation Trust
St George's Hospital
University College London Hospitals NHS Foundation Trust
University College Hospital
North East and
North Cumbria
County Durham and Darlington NHS Foundation Trust
University Hospital of North Durham
Gateshead Health NHS Foundation Trust
Queen Elizabeth Hospital Gateshead
Newcastle upon Tyne Hospitals NHS Foundation Trust
Royal Victoria Infirmary
North Cumbria Integrated Care NHS Foundation Trust
Cumberland Infirmary
West Cumberland Hospital
North Tees and Hartlepool NHS Foundation Trust
University Hospitals of North Tees and Hartlepool
Northumbria Healthcare NHS Foundation Trust
Northumbria Specialist Emergency Care Hospital
Hexham General Hospital
North Tyneside General Hospital
Wansbeck General Hospital
South Tees Hospitals NHS Foundation Trust
James Cook University Hospital
South Tyneside and Sunderland NHS Foundation Trust (Sunderland Hospital)
Sunderland Royal Hospital
North Midlands
Dudley Group NHS Foundation Trust
Russells Hall Hospital
Mid Cheshire Hospitals NHS Foundation Trust
Leighton Hospital
Shrewsbury and Telford Hospital NHS Trust
Princess Royal Hospital Telford
The Royal Wolverhampton Hospitals NHS Trust
New Cross Hospital
University Hospitals of North Midlands NHS Trust
Royal Stoke University Hospital
Northern Ireland

Belfast Health and Social Care Trust (Royal Victoria Hospital Belfast)
Royal Victoria Hospital Belfast
Northern Health and Social Care Trust (Antrim Area Hospital)
Antrim Area Hospital
Northern Health and Social Care Trust (Causeway Hospital)
Causeway Hospital
South Eastern Health and Social Care Trust (Ulster Hospitals)
Ulster Hospital
Southern Health and Social Care Trust (Craigavon Area)
Craigavon Area Hospital
Southern Health and Social Care Trust (Daisy Hill Hospital)
Daisy Hill Hospital
Western Health and Social Care Trust (Altnagelvin Hospitals)
Altnagelvin Hospital
Western Health and Social Care Trust (South West Acute Hospital)
South West Acute Hospital
3

Region
Site Name
Hospital(s)
South Yorkshire
and Bassetlaw
Barnsley Hospital NHS Foundation Trust
Barnsley Hospital
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
Doncaster Royal Infirmary
Rotherham NHS Foundation Trust
Rotherham Hospital
Sheffield Teaching Hospitals NHS Foundation Trust
Royal Hallamshire Hospital
Sussex
East Sussex Healthcare NHS Trust (Eastbourne District General Hospital)
Eastbourne District General Hospital
University Hospitals Sussex NHS Foundation Trust (Royal Sussex County Hospital)
Royal Sussex County Hospital
University Hospitals Sussex NHS Foundation Trust (St Richard's Hospital)
St Richards Hospital
University Hospitals Sussex NHS Foundation Trust (Worthing Hospital)
Worthing Hospital
SW Peninsula
Northern Devon Healthcare NHS Trust
North Devon District Hospital
Royal Cornwall Hospitals NHS Trust
Royal Cornwall Hospital
Royal Devon and Exeter NHS Foundation Trust
Royal Devon and Exeter Hospital
Torbay and South Devon NHS Foundation Trust
Torbay Hospital
University Hospitals Plymouth NHS Trust (Derriford Hospital)
Derriford Hospital
Wales
Aneurin Bevan University Health Board (Grange University Hospital, Nevill Hall Hospital, Royal Gwent and
Ysbyty Ystrad Fawr)
Grange University Hospital
Royal Gwent Hospital
Ysbyty Ystrad Fawr
Nevill Hall Hospital
Betsi Cadwaladr University Health Board (Glan Clwyd District General Hospital)
Glan Clwyd District General Hospital
Betsi Cadwaladr University Health Board (Wrexham Maelor Hospital)
Maelor Hospital
Betsi Cadwaladr University Health Board (Ysbyty Gwynedd)
Ysbyty Gwynedd
Cardiff and Vale University Health Board
University Hospital of Wales
Cwm Taf Morgannwg University Local Health Board (Prince Charles Hospital)
Prince Charles Hospital
Cwm Taf Morgannwg University Local Health Board (Princess of Wales Hospital)
Princess of Wales Hospital
Hywel Dda Health Board (Bronglais General Hospital)
Bronglais Hospital
Hywel Dda Health Board (Prince Philip Hospital)
Prince Philip Hospital
Hywel Dda Health Board (West Wales Hospital)
West Wales General
Hywel Dda Health Board (Withybush General Hospital)
Withybush General Hospital
Swansea Bay University Local Health Board (Morriston Hospital)
Morriston Hospital
Wessex

Dorset County Hospital NHS Foundation Trust
Dorset County Hospital
Hampshire Hospitals NHS Foundation Trust
Royal Hampshire County Hospital
Isle of Wight NHS Trust
St Mary's Hospital Newport
Portsmouth Hospitals University National Heath Service Trust
Queen Alexandra Hospital Portsmouth
University Hospital Southampton NHS Foundation Trust
Southampton General Hospital
University Hospitals Dorset NHS Foundation Trust
Royal Bournemouth General Hospital
Poole Hospital
West Midlands

George Eliot Hospital NHS Trust
George Eliot Hospital
Sandwell and West Birmingham Hospitals NHS Trust (Sandwell District Hospital)
Sandwell District Hospital
South Warwickshire NHS Foundation Trust
Warwick Hospital
University Hospitals Birmingham NHS Foundation Trust (Birmingham Heartlands)
Birmingham Heartlands Hospital
4

Region
Site Name
Hospital(s)
West Midlands
University Hospitals Birmingham NHS Foundation Trust (Good Hope Hospital)
Good Hope General Hospital
University Hospitals Birmingham NHS Foundation Trust (Queen Elizabeth Hospital Edgbaston)
Queen Elizabeth Hospital Edgbaston
University Hospitals Coventry and Warwickshire NHS Trust
University Hospital Coventry
Worcestershire Acute Hospitals NHS Trust (Worcestershire Royal Hospital)
Worcestershire Royal Hospital
Wye Valley NHS Trust
Hereford County Hospital
West of England
Gloucestershire Hospitals NHS Foundation Trust
Gloucestershire Royal Hospital
Cheltenham General Hospital
Great Western Hospitals NHS Foundation Trust
Great Western Hospital Swindon
North Bristol NHS Trust
North Bristol Hospitals
Royal United Hospital Bath NHS Foundation Trust
Royal United Hospital Bath
Salisbury NHS Foundation Trust
Salisbury District Hospital
Somerset NHS Foundation Trust
Musgrove Park Hospital
University Hospitals Bristol and Weston NHS Foundation Trust (University Hospitals Bristol Inpatient Team)
University Hospitals Bristol Inpatient Team
University Hospitals Bristol and Weston NHS Foundation Trust (Weston General Hospital)
Weston General Hospital
Yeovil District Hospital NHS Foundation Trust
Yeovil District Hospital
West Yorkshire
and Harrogate
Bradford Teaching Hospitals and Airedale NHS Foundation Trusts
Bradford Royal Infirmary
Airedale General Hospital
Calderdale and Huddersfield NHS Foundation Trust
Calderdale Royal Hospital
Harrogate and District NHS Foundation Trust
Harrogate District Hospital
Leeds Teaching Hospitals NHS Trust
Leeds General Infirmary
Mid Yorkshire Hospitals NHS Trust
Pinderfields Hospital

5

Appendix 2: Acute Organisational Audit Proforma 2021

Sentinel Stroke National
Audit Programme
(SSNAP)

Acute Organisational Audit Proforma 2021

School of Life Course and Population Health Science, King’s
College London

6

Acute Organisational Audit 2021
Sentinel Stroke National Audit Programme – Acute Organisational Audit 2021
xxx@xxx.xx
Instructions:
This proforma should describe your stroke services as on 1 October 2021. Please complete all questions.
Clarification is available online against each question (‘H’ button) and also in the supporting
documentation provided. In some cases, you will either be directed to a later question or a response will
not apply based on answers to key questions. Data should be submitted via the SSNAP web portal.

Final deadline: 29 October 2021. Checking week: 1-5 November 2021

Helpdesk
Telephone: xx-xxxx-xxxx
Email: xxx@xxx.xx

The Section tab will be either blue, green or red indicating whether the section has been successfully
completed. Remember to Save before you Exit. When all the tabs are green, the proforma is complete and
valid, the data should be locked (i.e. cannot be edited)

For the purpose of this audit the definition for in hours is between 08:00-18:00 Monday to Friday and out
of hours is all days and times outside this range

COVID-19 response
You should complete the audit questionnaire describing your service on the 1 October 2021. If you have
had to reorganise as a temporary or permanent response to COVID-19 then please report this reorganised
service and not as per your previously commissioned service.

Site code: [ ]

A. Core Organisational Information
A1. How many hospitals are covered by this form? [ ]
Please give the full name of each individual hospital. In this question, we are asking about acute
hospitals which directly admit acute stroke patients or routinely admit them within 7 days.

Full name of hospital
Total number of
stroke unit bed
SSNAP code for
hospital from clinical
audit
1

2

3

4

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TAB ONE
SECTION 1: ACUTE PRESENTATION

Care in the first 72 hours after stroke
1.1 Which of the following options best describes the service at your site for patients during the
first 72 hours after stroke? Select only one option
(i) We treat all of these patients
O
(ii) We treat some of these patients
O
(iii) We treat none of these patients
O
This should be what best describes your service and what happens to patients generally, not what
happens in exceptional circumstances. Please see helpnotes for further information and
instruction.

1.1a If 1.1(iii) is selected, give the SSNAP site code of main hospital treating your patients for the
first 72 hours
[ ] This is the organisational audit site code, not the SSNAP team code

1.2 Have you made any changes to your stroke service as part of the response to the COVID
pandemic?
Yes
O
No
O

1.2a If yes, which of the following were made?
Virtual assessment by a stroke clinician in the pre-hospital
setting

24/7 virtual assessment (on arrival at acute hospital) by a
stroke physician

Tele-stroke network (across several hospitals) for virtual
assessment

Separate pathways for COVID-19 positive and negative
stroke patients

Virtual ward rounds or multidisciplinary team (MDT)
meetings

Decision support software (AI) use

Virtual triage of patients with suspected TIA or minor
stroke

Use of one-lead ECG devices to assess heart rhythm

Patient self-reporting of blood pressure readings

Other

Please state: ______________

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Acute Organisational Audit 2021
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1.2b As of 1 October 2021, are any of these changes still in place?
Yes
O
No
O

Initial Review on Presentation – this section must be completed by all hospitals to treat some or
all patients seen during the first 72 hours after stroke.

1.3 Most of the time, who is the first person from any team to review a patient presenting to
hospital with a suspected stroke? Select only one option for in hours and one option for out of
hours

In Hours
Out of Hours
(i) Stroke Specialist Nurse
O
O
(ii) Stroke Junior Doctor (CMT/Foundation Trainee)
O
O
(iii) Stroke trained Registrar/Fellow
O
O
(iv) General Medical Registrar
O
O
(v) Stroke Specialist / General Neurology Consultant
O
O
(vi) Other Medical Specialty Consultant
O
O
(vii) ED Consultant
O
O
(viii) ED Junior Doctor/Registrar
O
O
(ix) Neurology Junior Doctor/Registrar
O
O
(x) Telemedicine link to own Trust Stroke Consultant
O
O
(xi) Telemedicine link to regional network Consultant
O
O

1.4 Most of the time, who is the first person from the stroke team to review a patient presenting
to hospital with a suspected stroke? Select only one option for in hours and one option for out of
hours

In Hours
Out of Hours
(i) Stroke Specialist Nurse
O
O
(ii) Stroke Junior Doctor (CMT/Foundation Trainee)
O
O
(iii) Stroke trained Registrar/Fellow
O
O
(iv) Stroke Specialist Consultant
O
O
(v) General Neurology Consultant
O
O
(vi) Neurology Junior Doctor/Registrar
O
O
(vii) Telemedicine link to own Trust Stroke Consultant
O
O
(viii) Telemedicine link to regional network Consultant
O
O

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Acute Organisational Audit 2021
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Scanning
1.5 Which initial acute brain imaging do you usually request for the following? Select only one
option for each of i-v

CT
CTA CTP MRI
(i) Clinical suspicion of stroke eligible for thrombolysis
O
O
O
O
(ii) Clinical suspicion of stroke eligible for thrombolysis & possible
thrombectomy
O
O
O
O
(iii) Clinical suspicion of stroke but over 4.5 hours since onset of
symptoms
O
O
O
O
(iv) Clinical suspicion of posterior circulation stroke but not a
thrombolysis candidate
O
O
O
O
(v) Clinical suspicion of alternative neurological diagnosis
O
O
O
O

CT = Computerised tomography, CTA =CT angiography, CTP= CT perfusion MRI= Magnetic
resonance imaging

1.6 Who is ultimately responsible for initial review of brain imaging to inform decisions about
thrombolysis / referral for thrombectomy? Select one option for in hours and one option for out of
hours

In Hours
Out of Hours
(i) Stroke Consultant on site
O
O
(ii) Stroke Consultant remotely via PACS
O
O
(iii) Stroke Registrar
O
O
(iv) Stroke Junior Doctor
O
O
(v) Neuroradiologist
O
O
(vi) General Radiologist
O
O
(vii) “Reporting Hub”
O
O
(viii) ED Consultant/Registrar
O
O
(ix) Medical Consultant/Registrar
O
O
(x) Stroke consultant at own Trust via telemedicine link
O
O
(xi) Stroke consultant in region/network via telemedicine link
O
O

1.6a Are you using artificial intelligence software for any part of the interpretation of your acute
stroke imaging?
Yes, in hours

Yes, out of hours

No
O

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1.7 If not during initial assessment, is brain imaging subsequently reviewed by a radiologist with a
specific competency in neurovascular imaging in the following patient groups? Select only one
option for each patient group
a. Thrombolysis patients
Yes, always

O

Yes, sometimes

O
Yes, rarely

O
No

O
b. Large Vessel Occlusion
Yes, always

O

Yes, sometimes

O
Yes, rarely

O
No

O
c. All stroke patients
Yes, always

O

Yes, sometimes

O
Yes, rarely

O
No

O

1.8 Do you have stroke specialist nurses (band 6 or above) who undertake hyper-acute
assessments of suspected stroke patients in A&E? Select one option for in hours and one option for
out of hours

In Hours
Out of Hours
Yes
O
O
No
O
O

1.9 Are your stroke specialist nurses counted within your ward based nurse establishment?
(i.e. they are not supernumerary to your ward based nurses) Select one option for in hours and one
option for out of hours
These are specialist nurses who have responsibilities outside the stroke unit

In Hours
Out of Hours
Yes
O
O
No
O
O

1.10 Do you ever use video telemedicine to review patients with your ambulance crews?
Yes
O
No
O

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Acute Organisational Audit 2021
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1.11 Do the stroke team receive a pre-alert (telephone or video call) from your ambulance crews
for suspected stroke patients? Select yes/no/sometimes for each type of patient

Yes
No
Sometimes
Thrombolysis candidates only
O
O
O
All FAST positive
O
O
O
All other suspected stroke
O
O
O

1.12 If the stroke team receive a pre-alert, who is the call usually made to? Select only one option
Stroke Specialist Nurse
O
Directly to the Emergency Department
O
Stroke Junior Doctor on call
O
Stroke Consultant on call
O
CT control room
O
Call to Stroke ward / HASU
O

1.13 If the stroke team receive a pre-alert, what information are they usually given by the
paramedic crew? Select all that apply
Name

Date of birth

Symptoms

Time of onset

BP measurement by Paramedics

List of medications

NHS number

Only that patient is on their way

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Acute Organisational Audit 2021
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1.14 Where are suspected stroke patients that arrive by ambulance usually taken for assessment?
Select one option for potential thrombolysis patients and one option for all other suspected stroke
patients

Potential thrombolysis
patients
All other suspected
stroke patients
Emergency Department
O
O
HASU/ASU
O
O
Neurology Ward
O
O
Combined stroke/neurology ward
O
O
Acute Medical Unit
O
O
HDU/ITU/CCU
O
O
CT scan
O
O

1.15 Do you routinely admit patients with subarachnoid haemorrhage to your stroke unit?
Yes
O
No
O

1.16 Do you routinely admit patients with subdural haematoma to your stroke unit?
Yes
O
No
O

Telemedicine
1.17 Does the stroke service at your site use telemedicine to allow remote access for the
management of acute stroke care?
Yes
O
No
O

1.18 Which of the following do you use? Select all that apply
(i) Remote viewing for brain imaging

(ii) Video enabled clinical assessment

1.19 Do you operate a telemedicine rota with other hospitals?
Yes
O
No
O

1.20 Which of the following groups of patients are assessed using telemedicine? Select only one
option
Only patients potentially eligible for thrombolysis
O
Some patients (regardless of eligibility for thrombolysis)
O
All patients (who require assessment during times when telemedicine is in use)
O

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Stroke mimics
1.21 How many acute stroke mimics have been seen by the stroke team in ED or any non-stroke
emergency admissions area during the past month? []

1.22 In the last three months, how many stroke mimics have received thrombolysis? []

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TAB TWO
SECTION 2: STROKE UNITS
2.1 Please give the following details on type and number of stroke unit beds for each of these
hospitals:

Answer separately for each hospital
(a) Full name of hospital

(b) Total
number of
stroke unit
beds (can
be 0)

(c) Number of
stroke unit
beds solely for
patients in first
72 hours after
stroke
Type 1 beds

(d) Number of
stroke unit
beds solely for
patients
beyond 72
hours after
stroke
Type 2 beds
(e) Number of
stroke unit
beds used for
both pre- and
post-72 hour
care
Type 3 beds

Total:

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Section 2A: Care on stroke unit beds used solely for patients in the first 72 hours after stroke
(type 1 beds) (please answer based on ALL beds records in Q2.1(c
2.2 How many of these beds have continuous physiological monitoring (ECG, oximetry, blood
pressure)?
[] beds

2.3 How many stroke consultant ward rounds are conducted on your acute stroke ward per week?

[] ward rounds per week
(If you have 2 consultant led ward rounds 7 days a week please enter 14. If there is more than
one location for these beds, please give an average e.g. if there are 20 beds overall and 10 have
ward rounds 7 times a week and the other 10 have ward rounds 5 times a week, you should
put 6. If you have permutations outside of this please contact the SSNAP helpdesk).

For questions 2.4 - 2.7 only the nursing staff for the beds solely used for patients in the first 72
hours after stroke (i.e. the total entered for Q2.1c) should be included.

2.4 How many of the following nursing staff are there usually on duty at 10AM for these
beds? (Enter 0 if no staff of that grade). Only the nursing staff for the beds which are solely
used for patients in the first 72 hours after stroke (i.e. the total entered for Q2.1c).
(N.B. please do not double count any nurses/care assistants listed in Q2.9 and Q2.16)

Weekdays
Saturdays
Sundays/Bank Holidays
(i) Registered nurses
[]
[]
[]
(ii) Care assistants
[]
[]
[]

2.5 How many nurses are there usually on duty for these beds at 10AM who are trained in
the following? (Enter 0 if none).
(N.B. please do not double count any nurses listed in Q2.10 and Q2.17)

Weekdays
Saturdays
Sundays/Bank Holidays
(i) Swallow screening
[]
[]
[]
(ii) Stroke assessment and
management
[]
[]
[]

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2.6 How many nurses are there usually on duty for these beds at 10PM? (Enter 0 if no staff of
that grade). Only the nursing staff for the beds which are solely used for patients in the first 72
hours after stroke (i.e. the total entered for Q2.1c).
(N.B. please do not double count any nurses/care assistants listed in Q2.11 and Q2.18)

Weekdays
Saturdays
Sundays/Bank Holidays
(i)
Registered nurses
[]
[]
[]
(ii) Care assistants
[]
[]
[]

2.7 What is the total establishment of whole time equivalents (WTEs) of the following
bands of nurses for your Type 1 beds (beds solely for patients in the first 72 hours after
stroke) in your site? (Enter 0 if no establishment)
Type 1 beds
(beds solely for patients in first 72 hours after stroke)
Whole time equivalents
(WTE)
Band 1

Band 2

Band 3

Band 4

Band 5

Band 6

Band 7

Band 8a

Band 8b

Band 8c

2.7a How are your type 1 beds currently funded? Select only one option
Block contract
O
Payment by results (PBR)

O
Uplifted/enhanced tariff

O
Unfunded (at risk)
O
Not known
O
Site in Wales or N/Ireland (N/A)
O

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Section 2B: Care on stroke unit beds used solely for patients beyond 72 hours after stroke (type
2 beds) (please answer based on ALL beds records in Q2.1(d))
2.8 How many days per week is there a stroke specialist consultant ward round for these beds?
[] days
(If there is more than one location for these beds, please give an estimated average e.g. if there are
20 beds overall and 10 have ward rounds 7 times a week and the other 10 have ward rounds 5
times a week, you should put 6. If you have permutations outside of this please contact the SSNAP
helpdesk).

For questions 2.9 - 2.13 only the nursing staff for the beds solely used for patients beyond 72 hours
after stroke (i.e. the total entered for Q2.1d) should be included.

2.9 How many of the following nursing staff are there usually on duty at 10AM for these
beds? (Enter 0 if no staff of that grade) Only the nursing staff for the beds which are solely
used for patients beyond the first 72 hours after stroke (i.e. the total entered for Q2.1d)
(N.B. please do not double count any nurses/care assistants listed in Q2.4 and Q2.16)

Weekdays
Saturdays
Sundays/Bank Holidays
(i) Registered nurses
[]
[]
[]
(ii) Care assistants
[]
[]
[]

2.10 How many nurses are there usually on duty for these beds at 10AM who are trained in
the following? (Enter 0 if none).
(N.B. please do not double count any nurses listed in Q2.5 and Q2.17)

Weekdays
Saturdays
Sundays/Bank Holidays
(i) Swallow screening
[]
[]
[]
(ii) Stroke assessment and
management
[]
[]
[]

2.11 How many of the following nursing staff are there usually on duty at 10PM for these
beds? (Enter 0 if no staff of that grade) Only the nursing staff for the beds which are solely
used for patients beyond the first 72 hours after stroke (i.e. the total entered for Q2.1d)
(N.B. Please do not double count any nurses/care assistants listed in Q2.6 and Q2.18)

Weekdays
Saturdays
Sundays/Bank Holidays
(i)
Registered nurses
[]
[]
[]
(ii) Care assistants
[]
[]
[]

2.12 What is the total establishment of whole time equivalents (WTEs) of the following
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bands of nurses for type 2 beds (beds solely for patients beyond 72 hours after stroke) in
your site? (Enter 0 if no establishment)
Type 2 beds
(beds for patients beyond 72 hours after stroke)
Whole time equivalents
(WTE)
Band 1

Band 2

Band 3

Band 4

Band 5

Band 6

Band 7

Band 8a

Band 8b

Band 8c

2.13 How are your type 2 beds currently funded? Select only one option
Block contract
O
Payment by results (PBR)

O
Uplifted/enhanced tariff

O
Unfunded (at risk)
O
Not known
O
Site in Wales or N/Ireland (N/A)
O

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Section 2C: Care on stroke unit beds which are used for both pre- and post-72 hours care (type 3
beds) (please answer based on ALL beds records in Q2.1(e))

2.14 How many of these beds have continuous physiological monitoring (ECG, oximetry, blood
pressure)?
[] beds

2.15 How many stroke consultant ward rounds are conducted on your acute stroke ward per
week? [] ward rounds per week
(If you have 2 consultant led ward rounds 7 days a week please enter 14. If there is more than
one location for these beds, please give an average e.g. if there are 20 beds overall and 10 have
ward rounds 7 times a week and the other 10 have ward rounds 5 times a week, you should
put 6. If you have permutations outside of this please contact the SSNAP helpdesk).

For questions 2.16 - 2.19 only the nursing staff for the beds solely used for both pre- and post-72h
hours care (i.e. the total entered for Q2.1e) should be included.

2.16 How many of the following nursing staff are there usually on duty at 10AM for these beds?
(Enter 0 if no staff of that grade). Only the nursing staff for beds used for patients pre and post-72
hour care (i.e. the total entered for 2.1e).
(N.B. please do not double count any nurses/care assistants listed in Q2.4 and Q2.9.)

Weekdays
Saturdays
Sundays/Bank Holidays
(i) Registered nurses
[]
[]
[]
(ii) Care assistants
[]
[]
[]

2.17 How many nurses are there usually on duty for these beds at 10AM who are trained in
the following? (Enter 0 if none).
(N.B. please do not double count any nurses listed in Q2.5 or Q2.10)

Weekdays
Saturdays
Sundays/Bank Holidays
(i) Swallow screening
[]
[]
[]
(ii) Stroke assessment and
management
[]
[]
[]

2.18 How many of the following nursing staff are there usually on duty at 10PM for these
beds? (Enter 0 if no staff of that grade). Only the nursing staff for beds used for patients pre
and post-72 hour care (i.e. the total entered for 2.1e).
(N.B. please do not double count any nurses/care assistants listed in Q2.6 and Q2.11.)

Weekdays
Saturdays
Sundays/Bank Holidays
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(i)
Registered nurses
[]
[]
[]
(ii) Care assistants
[]
[]
[]

2.19 What is the total establishment of whole time equivalents (WTEs) of the following
bands of nurses for type 3 beds (beds for both pre and post 72 hour care)? (Enter 0 if no
establishment)
Type 3 beds
(beds for both pre and post 72 hour care)
Whole time equivalents
(WTE)
Band 1

Band 2

Band 3

Band 4

Band 5

Band 6

Band 7

Band 8a

Band 8b

Band 8c

2.19a How are your type 3 beds funded? Select only one option

Block contract
O
Payment by results (PBR)

O
Uplifted/enhanced tariff

O
Unfunded (at risk)
O
Not known
O
Site in Wales or N/Ireland (N/A)
O

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TAB THREE
SECTION 3: THROMBOLYSIS AND THROMBECTOMY

Thrombolysis
3.1 Where are the majority of your patients thrombolysed for each procedure? Select one option
for bolus and one option for infusion

Bolus
Infusion
Emergency Department
O
O
In the CT scanner
O
O
Where your Type 1 or Type 3 beds are based
O
O
CCU/ITU/HDU
O
O
Acute Medical Unit /Medical Ward
O
O
Neurology ward
O
O

Thrombectomy
3.2 Are you a thrombectomy centre?
Yes
O
No
O

3.3 What are the hours of operation for your thrombectomy service? Enter a value from 0-24 for
each day
Monday
[] hours
Tuesday
[] hours
Wednesday
[] hours
Thursday
[] hours
Friday
[] hours
Saturday and Sunday
[] hours

3.4 How many consultant level doctors from your site carry out thrombectomy? []
(Please do not include doctors who work primarily at other sites - each doctor should only be counted
at one site. Please include doctors who have performed 1 or more thrombectomy procedures)
For each of these consultants, please state their specialty.
3.4a Which specialty is this
consultant?
Consultant:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
Interventional neuroradiology
O
O
O
O
O
O
O
O
O
O
Vascular interventional
neuroradiology
O
O
O
O
O
O
O
O
O
O
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3.4a Which specialty is this
consultant?
Consultant:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
Non-vascular interventional
neuroradiology
O
O
O
O
O
O
O
O
O
O
Cardiologist
O
O
O
O
O
O
O
O
O
O
Neuro-surgeon
O
O
O
O
O
O
O
O
O
O
Stroke Physician
O
O
O
O
O
O
O
O
O
O
Other
O
O
O
O
O
O
O
O
O
O

If no to Q3.2:
3.5 Do you refer appropriate patients to a thrombectomy centre?
Yes
O
No
O
N/A
O
N/A only available to those with type 2 beds only

3.6 Which centre do you refer patients to for thrombectomy? Select the centre which the majority
of your patients are referred to from the supplied list

3.7 For how many hours can you refer patients for thrombectomy each day? Enter a value from 0-
24 for each day
Monday
[] hours
Tuesday
[] hours
Wednesday
[] hours
Thursday
[] hours
Friday
[] hours
Saturday and Sunday
[] hours

3.8 How many patients have you transferred to a thrombectomy centre that did not have the
procedure in the 12 months prior to October 2021?
(Enter a number)
[]

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3.9 What is your usual process for IV thrombolysis prior to transfer for thrombectomy? Select only
one option
Give bolus and full infusion before transfer
O
Give bolus and infusion but stop infusion at point patient ready to be transferred
O
Give bolus and infusion which is continued in ambulance with support
of stroke nurse on transfer
O
Give bolus and infusion which is continued in ambulance with support
of ED nurse on transfer

O
Give bolus and infusion which is continued in ambulance with support
from paramedic crew
O
Process depends on ambulance service conveying patient
(i.e. different protocols for different services)

O

3.10 Who usually makes the decision that there is a large vessel occlusion on CTA imaging prior to
transferring for thrombectomy? Select one option for in hours and one option for out of hours

In Hours
Out of Hours
Stroke Junior Doctor making referral
O
O
Stroke Consultant
O
O
General Radiologist
O
O
Neuroradiologist at your hospital
O
O
Neuroradiologist at IAT Centre (if different)
O
O
Stroke team at thrombectomy centre
O
O
Remote tele-radiology service off site
O
O
No service

O

3.11 When a patient requires conveyance to thrombectomy centre at what point do you call the
first responder ambulance service? Select only one option
Paramedic crew are kept on standby and not released from initial call
O
At the point IV thrombolysis is complete
O
At the point CTA suggests occluded vessel
O
When accepted by thrombectomy centre
O

3.12 Do the stroke team use helicopter transfers for thrombectomy patients?

Yes
O
No
O

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3.13a What is the average time between call to ambulance from acute hospital to arrival of
ambulance crew at acute hospital for your last 5 cases / over last 12 months? Select only one
option

Call to Arrival of ambulance crew
10-30mins
O
31-60mins
O
61-90mins
O
91-120mins
O
>120 mins
O

3.13 b What is the average time between arrival of the ambulance at the acute hospital to
departure from acute hospital for your last 5 cases / over last 12 months? Select only one option

Time from arrival of ambulance
crew to departure

10-30mins
O
31-60mins
O
61-90mins
O
91-120mins
O
>120 mins
O

3.14 What are your arrangements (governance processes) for discussion of patients referred for
thrombectomy? Select only one option
Most patients referred reviewed with thrombectomy centre as part of regional
MDT
O
Most patients referred reviewed locally as part of local MDT
O
Informal feedback
O
No regular discussion
O

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TAB FOUR
SECTION 4: SPECIALIST INVESTIGATIONS FOR STROKE AND TIA PATIENTS

4.1 What is the usual inpatient waiting time for patients to receive carotid imaging? Select
only one option
(i) The same day (7 days a week)
O
(ii) The same day (5/6 days a week)
O
(iii) The next day
O
(iv) The next weekday
O
(v) Within a week
O
(vi) Longer than a week
O

4.2 What is the usual inpatient waiting time for patients to receive carotid endarterectomy? Select
only one option
(i) The same day (7 days a week)
O
(ii) The same day (5/6 days a week)
O
(iii) The next day
O
(iv) The next weekday
O
(v) Within a week
O
(vi) Longer than a week
O

4.3 Do you ever image intra-cranial vessels of your ischaemic stroke patients?
Yes
O
No
O

4.3a Which of the following best describes your practice for imaging these vessels? Select only one
option
It is a routine investigation
O
Only for patients that would be amenable to specific treatment if abnormality
detected
O

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4.3b Which of the following methods do you usually use first line? Select one option for in hours
and one option for out of hours

In hours
Out of hours
CTA
O
O
MRA – (CEMRA)
O
O
MRA – (ToF)
O
O
No service

O

MRA – (CEMRA) = contrast enhanced magnetic resonance imaging, MRA – (ToF) = time of flight
magnetic resonance imaging

4.4 Do you image extra cranial vessels of your ischaemic stroke patients?
Yes
O
No
O

4.4a Which of the following best describes your practice for imaging these vessels? Select
only one option
It is a routine investigation
O
Only for patients that would be amenable to specific treatment if abnormality
detected
O

4.4b Which imaging modality do you use as a first line to image extra-cranial vessels? Select only
one option for in hours and only one option for out of hours

In hours
Out of hours
Doppler Ultrasound
O
O
CTA
O
O
MRA – (CEMRA)
O
O
MRA – (ToF)
O
O
No service

O

MRA – (CEMRA) = contrast enhanced magnetic resonance imaging, MRA – (ToF) = time of flight
magnetic resonance imaging

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4.5 What is your usual pathway for detecting paroxysmal atrial fibrillation? Please list in the
sequence of investigations you apply i.e. 1=1st, 2= 2nd etc. Choose “not available” if not available.
HASU telemetry monitoring
1-7; Not available
Inpatient 24 hour tape
1-7; Not available
Outpatient 24 hour tape
1-7; Not available
Extended cardiac recording: 48 hours
1-7; Not available
Extended cardiac recording: 5- 7 days
1-7; Not available
Implantable loop recorder
1-7; Not available
Transdermal patch (e.g. Ziopatch)
1-7; Not available
Repeat extended 5-7 days cardiac monitor
1-7; Not available

4.6 In which stroke patients do you normally perform echocardiography? Select all that apply
In the majority of patients post stroke

Patients suggestive of cardioembolic source on brain imaging

Patients with an abnormal ECG

Patients with suspected valvular lesions

Patients with new heart failure

Patients with known heart failure

We rarely do echocardiography (N/A)
O

4.7 In which patients do you normally perform a bubble contrast echocardiography? Select all that
apply
All patients post stroke

All patients with suspected cardioembolic source on brain imaging

Patients with suspected cardioembolic source but initial
transthoracic echocardiogram (TTE) normal

We rarely do bubble contrast echocardiography (N/A)
O

4.8 In which patients do you normally perform TOE (trans-oesophageal echocardiography)? Select
all that apply
All patients post stroke

All patients with suspected cardioembolic source on brain imaging

Patients with suspected cardioembolic source but initial transthoracic
echocardiogram (TTE) normal

If patient has had a positive bubble contrast echo

We rarely do trans-oesophageal echocardiography (N/A)
O

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4.9 Is PFO closure available locally for your stroke patients? (this refers to NHS rather than private
provision)
Yes
O
No
O

4.9a Are all patients discussed at a specialist stroke/cardiology MDT before PFO closure is offered?
Yes
O
No
O

4.10 Which imaging modality do you most frequently use in your neurovascular clinic for
suspected TIAs? Select only one option for brain imaging and one option for carotid imaging

4.10a First line brain imaging:
CT
O
MRI
O
Rarely image TIAs
O

4.10b First line carotid artery imaging:
Carotid Doppler
O
CTA
O
MRA – (CEMRA)
O
MRA – (ToF)
O
Rarely image TIAs
O

MRA – (CEMRA) = contrast enhanced magnetic resonance imaging, MRA – (ToF) = time of flight
magnetic resonance imaging

4.11 How frequently do you use this first line imaging modality in your neurovascular clinic for
suspected TIAs? Select one option for brain and one option for carotid arteries

Brain Carotid arteries
Frequently (>70%)
O
O
Sometimes (30-70%)
O
O
Rarely (<30%)
O
O

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TAB FIVE
SECTION 5: SERVICES AND STAFF ACROSS ALL STROKE UNIT BEDS

5.1 Does your stroke unit have access to the following within 5 days of referral? Select yes or no
for each option

Yes
No
a) Social work
O
O
b) Orthotics
O
O
c) Orthoptics
O
O
d) Podiatry/foot health
O
O

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5.2 What is the total establishment of whole time equivalents (WTEs) and number of
individuals of the following qualified professionals and support workers for all your stroke
unit beds? (Enter 0 if no establishment).
NB Only tick the 6 day working or 7 day working option if these professionals treat stroke
patients in relation to stroke management at weekends on the stroke unit.

Whole time
equivalents
(WTE)
Individuals
5 day
working
6 day
working
7 day
working
(i) Clinical Psychology (qualified)

O
O
O
(ii) Clinical Psychology (support worker)

O
O
O
(iii) Dietetics (qualified)

O
O
O
(iv) Dietetics (support worker)

O
O
O
(v) Occupational Therapy (qualified)

O
O
O
(vi) Occupational Therapy (support
worker)

O
O
O
(vii) Physiotherapy (qualified)

O
O
O
(viii) Physiotherapy (support worker)

O
O
O
(ix) Speech & Language Therapy

O
O
O
(x) Speech & Language Therapy (support
worker)

O
O
O
(xi) Pharmacy (qualified)

O
O
O
(xii) Pharmacy (support worker)

O
O
O
(xiii) Nursing (registered): Band 6

O
O
O
(xiv) Nursing (registered): Band 7

O
O
O
(xv) Nursing (registered): Band 8a

O
O
O
(xvi) Nursing (registered): Band 8b

O
O
O
(xvii) Nursing (registered): Band 8c

O
O
O

5.2a How many MDT staff members are there usually on duty across all stroke beds at 10am who
are trained in Level 1 & 2 psychological interventions? (Enter 0 if none)

Weekdays
Saturdays
Sundays/Bank Holidays

[]
[]
[]

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Junior Doctor Sessions
5.3 How many sessions of junior doctor time are there per week in total for all stroke unit beds?
a. Specialty trainee 3 (ST3)/registrar grade or above
[] sessions
b. Foundation years/core training/ST1/ST2 or below
[] sessions
c. Non training grade junior doctor

[] sessions

5.4 Do you have Physician Associates as part of your clinical team?
Yes
O
No
O

5.4a How many whole time equivalents do these Physician Associates (Physician Assistants) work
across your stroke service? [] WTEs

Venous thromboembolism prevention
5.5 What is your first line treatment for preventing venous thromboembolism for patients with
reduced mobility? Select only one option
i) Short or long compression stockings
O
ii) Intermittent pneumatic compression (IPC) device
O
iii) Low molecular weight heparin
O
iv) None of the above
O

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5.5a Which of the 7 site-level practices set out in the ‘HSIB Best Practice Consensus for reducing
Venous Thromboembolism post-stroke’ do you employ at your site? Select all that apply
Generic Trust VTE assessment within 24 hours of admission with daily ward round
review and/or whenever clinical situation changes

If high risk of VTE, IPC are used within first 3 days of acute stroke for up to 30 days or
until mobile or discharged

IPC devices prescribed on electronic or paper prescription charts and are reviewed on a
daily basis by medical, nursing and pharmacy teams

Information provided to patient/family/carer of the risk of hospital acquired VTE and
benefits of IPC in reducing risk of DVT and improving survival

All members of multi-disciplinary team are trained in awareness and benefits of IPC,
and in the application of IPC sleeves after therapy, nursing interventions or
investigations

If patients cannot tolerate IPC, discussion with a senior member of the clinical team to
document consideration of alternative treatments, e.g. earlier use of Low Molecular
Weight Heparin

Regular review of SSNAP data on IPC use through clinical governance programmes to
maintain and improve compliance with VTE pathways and use of IPC devices

None of the above
O

Discharge information
5.6 Do patients receive specific falls prevention advice or training before discharge?
Yes
O
No
O

5.7 Do you provide personalised stroke information to patients before discharge (e.g. Stroke
Passport)?
Yes
O
No
O

5.8 Do you routinely collect patient-reported experience measures (PREMs) at any point before or
after discharge?
Yes
O
No
O

5.9 Do you regularly refer to voluntary sector services before or at discharge? (e.g. Stroke Connect
in England)
Yes
O
No
O

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5.9a What proportion of your patients have access to at least one of these voluntary sector
services if needed? []%

Post Discharge Reviews
Reviews at 6 weeks
5.10 Do you offer your stroke patients a post discharge review within 6 weeks of discharge from
hospital?
Yes
O
No
O

5.11 Who usually completes the 6 week reviews post discharge from hospital? Select only one
option
Primary care
O
Acute trust stroke team consultant/registrar
O
Stroke Nurse in hospital/community
O
Voluntary sector e.g. Stroke Association
O
ESD team

O
Community therapy team
O
Not routinely arranged
O

Reviews at 6 months
5.12 Are you commissioned (or in Wales and Northern Ireland expected) to carry out 6 month
reviews?
Yes
O
No
O

5.13 Are the patients that you discharge given a 6 month post stroke review?
All
O
Some
O
None
O

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5.14 Who usually carries out your 6 month reviews post discharge from hospital? Select only one
option
Specialist Stroke Nurses within hospital

O
Specialist Stroke Nurses in community
O
Stroke Association
O
Other voluntary sector
O
Primary care

O
Stroke Consultant/registrar at Acute Trust
O
MDT 6 month review clinic i.e. with therapy support
O
Community Therapists

O

5.15 On the 1 October 2021, how many patients on your stroke ward are ‘medically fit for
discharge’ (i.e., no longer requiring hospital bed based care)? []
Total must not be greater than total number of stroke unit beds)

5.16 Do you move patients no longer receiving specific stroke intervention to other wards if you
need the bed for another stroke patient? Select only one option
Yes
O
No
O
Only in exceptional circumstances
O

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TAB SIX
SECTION 6: REHABILITATION AFTER LEAVING HOSPITAL

EARLY SUPPORTED DISCHARGE TEAM
Definitions:
Early supported discharge team refers to a multidisciplinary team which provides
rehabilitation and support in a community setting with the aim of reducing the duration of
hospital care for stroke patients.
Specialist Early Supported Discharge Team: A stroke/neurology specific team is one which treats
stroke patients either solely or as well as general neurology patients. This question should not
include non-stroke/neurology specific teams.

6.1 Do you have access to at least one stroke/neurology specific early supported discharge
multidisciplinary team?
Yes
O
No
O

6.1a How many Specialist Early Supported Discharge (ESD) teams does your site have access to?
(Only include teams which see more than 10 patients a year.)
[] ESD teams

6.1b What percentage of your patients have access to at least one of these teams if needed?
[]%
Please answer for the team providing care for the majority of your patients if you have
multiple providers

6.1c For the ESD team that the majority of your patients attend, what duration of time post
discharge are they commissioned for? (please select option closest to the duration) Select only one
option
6 weeks
O
6 months
O
12 months
O
Needs based
O
No time limit
O

6.2 Do you have access to specialist spasticity services for the majority of your patients?
Yes
O
No
O
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LONGER TERM COMMUNITY REHABILITATION TEAM
Definition: A team working in the community delivering rehabilitation services.
We will ask you about two types of CRT team in this part - stroke/neurology specialist and non-
specialist (please make sure you answer the correct section(s) - this could be none, either or
both)
Specialist Community Rehabilitation Team: A stroke/neurology specific team is one which treats
stroke patients either solely or as well as general neurology patients.

6.3 Do you have access to at least one stroke/neurology specific community rehabilitation
team for longer term management?
Yes
O
No
O

6.3a How many specialist Community Rehabilitation teams does your site have access to? (Only
include teams which see more than 10 patients a year.)

[]

6.3b What percentage of your patients have access to at least one of these teams if needed? []%

Non-specialist Community Rehabilitation Team
Definition: A non-specialist team is one which treats stroke patients, general neurology patients
and other types of patients.

6.4 Do you have access to at least one non-specialist community rehabilitation team for longer
term management?
Yes
O
No
O

6.4a How many non-specialist Community Rehabilitation teams does your site have access to?
(Only include teams which see more than 10 patients a year.)

[]

6.4b What percentage of your patients have access to at least one of these teams if needed? []%

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TAB SEVEN
SECTION 7: TIA/NEUROVASCULAR SERVICE

7.1 Does your site have a neurovascular clinic?
Yes
O
No
O

7.2 If no, who provides this for your patients? Select one option only
(i) Another site within our trust
__________________________
Please give name and site code
[ ] 3 digit code

(ii) Another site not within our trust
__________________________
Please give name and site code:
[ ] 3 digit code

7.3 How many clinics within a 4 week period?
[]

7.4 How many new patients were seen during the past 4 weeks?
[]

7.4a How many of these new patients had a final diagnosis of a TIA? []

7.5 What is the current average waiting time for an appointment from referral? [] days

7.6 How are patients usually referred into your TIA / neurovascular service? Select only one option
Via email/electronic referral
O
Fax

O
Written referral via post to stroke team
O
Written referral via post to Choose and Book
O
Telephone referral to stroke team
O

7.7 Do the stroke team triage referrals to the TIA /neurovascular service?
Yes
O
No
O

7.8 Does this involve a telephone call to the patient?
Yes
O
No
O

7.9 Who usually triages the referrals? Select one option for in hours and one option for out of hours

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In Hours
Out of
Hours
Stroke Consultant
O
O
Stroke Junior Doctor
O
O
Stroke Specialist Nurse
O
O
Stroke Specialist Nurse followed by Stroke Doctor
O
O
Admin staff based on triage criteria
O
O
Stroke team contact all patient (tele-triage)
O
O
Other
O
O

7.10 Do you classify your patients as high risk or low risk of stroke using the ABCD2 score?
Yes
O
No
O

7.11 Within what timescale can you typically see, investigate and initiate treatment for ALL
your TIA patients? Select yes or no for each service
Tick which service(s) you have:
a) Inpatient Yes O No O
b) Outpatient Yes O No O
(i) The same day (7 days a week)
O
O
(ii) The same day (5 days a week)
O
O
(iii) The next day

O
O
(iv) The next weekday
O
O
(v) Within a week
O
O
(vi) Within a month
O
O
(vii) Longer than a month
O
O

TIA patients at your site
7.12 What is the total number of inpatients with confirmed or suspected TIA across all primary
admitting hospitals on 1 October 2021?

[] patients

7.13 How many inpatients with confirmed or suspected TIA are in stroke unit beds across all
primary admitting hospitals on 1 October 2021?
[] patients

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TAB EIGHT
SECTION 8: SPECIALIST ROLES

8.1 Do you have at least one accredited specialist registrar in a post registered for stroke specialist
training?
Yes
O
No
O

8.2 How many accredited specialist registrar posts do you have at your site? [] posts

8.3 How many of the posts in Q8.2 are currently filled? [] posts

Workforce Planning for the service as on 1 October 2021
The aim of this section is to match the stroke care you provide to the type of consultant workforce
that is, and may in the future, be available in your site. This may improve both national planning for
training of future consultant physicians working in stroke medicine and their equitable distribution

8.4 Do you have any unfilled stroke consultant posts?
Yes
O
No
O

8.4a How many programmed activities (PAs) do these posts cover? [] PAs

8.4b For how many months have these posts been funded but unfilled? [] months

Existing posts
8.5 How many programmed activities (PAs) do you have in total for Stroke Consultant Physicians?

[] PAs

8.5a How many consultants (individuals) are these PAs divided amongst?
[] Consultants

8.5b How many of these PAs are Direct Clinical Care (DCCs) for Stroke?

[] PAs

Planned future posts
This section refers to changes planned in the next 2 years.
8.6 How many new/additional programmed activities (PAs) do you plan to have for Stroke
Consultant Physicians?
[] PAs

8.6a How many new/additional consultants (individuals) will these PAs be divided amongst?
[] Consultants
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8.6b How many of these new/additional PAs will be for Direct Clinical Care (DCC) for Stroke?
[] PAs

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TAB NINE
SECTION 9: QUALITY IMPROVEMENT, TRAINING & LEADERSHIP AND PATIENTS

9.1 What level of management takes responsibility for the follow-up of the results and
recommendations of the Sentinel Stroke Audit? Select all that apply
(i) Executive on the Board

(ii) Non-executive on the Board

(iii) Chairman of Clinical Governance (or equivalent)

(iv) Directorate Manager

(v) Stroke Clinical Lead

(vi) Other

(vii) No specific individual
O

9.2 Is there a strategic group responsible for stroke? Select only one option
Yes
O
No
O

9.2a Which of the following does it include? Select all that apply - select at least one option
(i) Ambulance trust representative

(ii) Clinician

(iii) Patient representative

(iv) Commissioner

(v) Social Services

(vi) Stroke Network representative

(vii) Trust board member

9.3 Do you have formal meetings with your coding department to improve the quality of stroke
coding?
Yes
O
No
O

9.3a How frequently are these formal meetings held? Select only one option – the one
which is closest to the timeframe
(i) Weekly
O
(ii) Monthly
O
(iii) Quarterly
O
(iv) Annually
O
(v) Ad hoc/occasionally
O

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9.4 Do you have “breach” meetings to review performance against SSNAP quality
standards?
Yes
O
No
O

9.4a How often are these meetings held? Select only one option
(i) Daily

O
(ii) Weekly
O
(iii) Monthly

O
(iv) Quarterly
O
(v) Annually

O

9.5 Do you have stroke specific mortality meetings within your Trust? (i.e. formal process
to discuss all stroke deaths with stroke MDT team)
Yes
O
No
O

9.5a Which format is used? Select only one option
Some deaths reviewed
O
All deaths reviewed
O

9.6 Is there funding for external courses available for nurses and therapists?
Yes

O
No
O

9.6a If yes, how many external training sessions have these nurses and therapists attended
in the last 12 months? (1 session = half day) [] sessions

9.6b How many internal and external training sessions attended by nurses and therapists
have related specifically to psychological skills training?

(1 session = half day) [] sessions

9.7 How often is there a formal survey seeking patient/carer views on stroke service? (This
does not include the Friends and Family test) Select only one option
(i) Never
O
(ii) Less than once a year
O
(iii) 1-2 times a year
O
(iv) 3-4 times a year
O
(v) More than 4 a year
O
(vi) Continuous (every patient)
O

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Stroke audit
9.8 What is the total number of whole-time equivalents (WTEs) allocated in your site for stroke
data collection?
[] WTEs

9.8a Which disciplines are covered by the WTEs for stroke data collection? Select all that apply
Doctor

Manager

Nurse

Therapist

Clinical Audit/Clinical Governance staff member

Data clerk/analyst with specific responsibility for
stroke

Data clerk/analyst with general audit responsibilities

Links with patients and carers
9.9 Does the Stroke service have formal links with patients and carers organisations for
communication on any of the following?
Yes
O
No
O

9.9a Which areas are included? Select all that apply
(i) Service provision

(ii) Audit

(iii) Service reviews and future plans

(iv) Developing research

9.10 Does the stroke service have formal links with community user groups for stroke?
Yes
O
No
O

Research
9.11 How many open stroke research studies are registered with your Research & Development
Department on 1 October 2021? Total []

9.11a How many of the studies in 9.11 have enrolled at least 1 participant in the 12 months to 30
September 2021? [
] studies

9.12 How many participants in total has your site recruited into NIHR portfolio research studies in
the 12 months to 30 September 2021? [] participants

9.12a How many of the participants in 9.12 were recruited in a randomised controlled trial (RCT)?
[
] participants
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9.13 Number of current Good Clinical Practice (GCP)-certified members of staff involved in
delivering stroke research on the 1 October 2021?

(i) Clinical staff

[]

(ii) Research Network/CLRN staff
[]

9.14 How many inpatients over the last 4 weeks had documented screening undertaken for
inclusion in stroke specific clinical research trials? [] patients

45

Appendix 3: Full introduction and Methodology

Introduction
This report presents the results of the Sentinel Stroke National Audit Programme (SSNAP) 2021
Acute Organisational Audit. It describes the organisation of stroke care in England, Wales and
Northern Ireland as of 1 October 2021 and includes all acutely admitting hospitals. It provides
continuity from the 2012, 2014, 2016 and 2019 acute organisational audits and previous biennial
NSSA audits. The audit is based on standards agreed by representatives of the Intercollegiate Stroke
Working Party (ICSWP).

Its questions are well understood and the majority are comparable with previous rounds of the
audit. SSNAP also comprises of the SSNAP clinical audit which has prospectively collected a minimum
dataset for every stroke patient, including acute care, rehabilitation, 6-month follow up, and
outcome measures since December 2012. As a result of this SSNAP is the single source of stroke data
for England, Wales and Northern Ireland. The organisational audit complements the continuous
clinical audit and results from the SSNAP clinical audit are available to view using the results portal
(http://www.strokeaudit.org/results).

The aims of the SSNAP Acute Organisational Audit
1. To audit against the National Clinical Guideline for Stroke 2016 and other relevant evidence
and policy documents;
2. To enable trusts to benchmark the quality of their stroke services nationally and regionally;
3. To measure the extent to which the recommendations made in the 2019 acute
organisational audit have been implemented;
4. To measure changes over time in the resources available for specialist acute stroke care,
particularly workforce.

Organisation of the Audit
Data were collected at site level within trusts (or Health Boards in Wales) using a standardised
method. Clinical involvement and supervision at team level is provided by a lead clinician in each
hospital who has overall responsibility for data quality. The audit is guided by a multi-disciplinary
steering group responsible for the Sentinel Stroke National Audit Programme – the Intercollegiate
Stroke Working Party (ICSWP).

Details of membership of the ICSWP can be found in Appendix 4.

Availability of this Report in the Public Domain
A full national results portfolio was made available to participating hospitals (sites) in February 2022.
All named site results were published in April 2022 in line with the transparency agenda subject to
Healthcare Quality Improvement Partnership (HQIP’s) standard reporting process.

Participation
There is 100% participation of eligible trusts (130). These trusts covered 157 sites which contained a
total of 182 acute hospitals with 158 in England, 15 in Wales, 8 in Northern Ireland and 1 in the Isle
of Man.

Methods
Eligibility and Recruitment
All sites that routinely treat patients within 7 days of stroke were eligible to participate. Pre 2012,
only hospitals which directly admitted acute stroke patients were eligible, but due to the
centralisation of stroke services and the establishment of a hyperacute model of stroke care in
46

different parts of the country this was changed in 2012. Registration forms were submitted by each
site which confirmed service configuration and details of the lead clinician and clinical audit lead.
100% of eligible sites were recruited and participated in the 2021 audit. Due to changes in service
configurations and trust mergers the total number of sites has changed from 169 to 157 since the
2019 organisational audit.

Standards in the Audit
A number of changes were made to the 2021 audit proforma (Appendix 2) from the 2019 audit in
order to investigate some additional areas.

Data Collection Tool
Data were collected at site level which can be either the only site within a trust or several sites
within a trust (Health Board in Wales) using a standardised method. Clinical involvement and
supervision at team level is provided by a lead clinician in each hospital with overall responsibility for
data quality. Data were collected using a web-based tool accessible via the internet. Security and
confidentiality were maintained through the use of hospital codes and high data quality was ensured
through the use of built in validations which prevented illogical data being entered. All sites were
asked to export and check their data before final sign off on 5 November 2021. No changes to the
data were possible after this point.

Each participating site was provided with a standardised help booklet containing data definitions and
clarifications and this was context specific. These helpnotes were also available within the web-
based proforma itself. A telephone and email helpdesk was provided to answer any individual
queries. As this is a snapshot audit, sites were asked to reflect their service as of 1 October 2021.

Evidence Based Audit
The acute organisational audit measures the structure of acute stroke services. It is evidence-based
using standards and evidence from sources including the RCP National Clinical Guideline for Stroke,
4th edition, NICE Guidelines and the NICE Quality Standards.

Key Indicators of Acute Stroke Organisation
In order to future proof the acute organisational audit, SSNAP has invested existing resources to
streamline its data collection, analysis and reporting, ensuring future efficiencies in result
dissemination. Participating sites have been measured against the specific criteria for 10 Key
Indicators of acute stroke organisation identified for the 2019 audit. These Key Indicators were
identified using the domains and Key Indicators from the 2016 audit as well as recent research and
evidence. The full results portfolio includes site specific results for the 10 Key Indicators of acute
stroke organisation and all data items are benchmarked against national averages.

Standards
The current standards against which acute stroke services are compared are outlined throughout the
report. They include the 10 Key Indicator standards (blue boxes), the updated NICE Quality
Standards (green boxes) and the RCP Guidelines for Stroke (orange boxes). Some of the acute
criteria against which hospitals were measured in 2016 have been incorporated into the results
portfolio.

Definitions
Definition of a ‘Site’
Lead clinicians were asked to collect data on the basis of a unified service typically within a trust. For
most trusts the ‘site’ was the trust. For some trusts there were several ‘sites’ each offering a discrete
service. A site may include several hospitals.

47

Please note in this report ‘trusts’ is used as a generic term; however, it is acknowledged that in
Wales, these are Health Boards.

Definition of a ‘Stroke Unit’
The definition used for a stroke unit (and used in this audit) is: Stroke unit - a multi-disciplinary team
including specialist nursing staff based in a discrete ward which is geographically defined and has
been designated for stroke patients.
There are three categories of stroke unit beds used at different parts of the care pathway which are
referenced in this report:
Type 1 beds - used solely used for patients in the first 72 hours after stroke
Type 2 beds - solely used for patients beyond 72 hours after stroke
Type 3 beds - beds used for both the first 72 hours of care and beyond

How to Read this Report
This report presents national level data for many important aspects of the organisation of stroke
services. National results are presented as percentages or summarised by the median. The median is
the middle point of the data where 50% of the values lie on either side. Ratios of staffing numbers
per 10 stroke unit beds (or 30 beds for Key Indicator 2) are given rather than staffing numbers per
stroke unit (SU) to allow comparison to national standards.

Denominators
It is important to note that denominators vary throughout this report depending on the number of
hospitals to which the analyses relate. To illustrate, denominators can include all sites which
participated (157), sites with type 1 beds (83), sites with type two beds (98) and sites with type three
beds (73).

In addition, there is 1 site that have patients referred to them for intra-arterial treatment; however,
their participation in SSNAP is confined only to submitting data on the provision of thrombectomy.
This site has submitted data on their provision of thrombectomy only. Therefore, in these instances
the denominator will be 158.

Relationships between the acute organisational audit and the SSNAP clinical audit
The SSNAP clinical audit prospectively measures the processes of stroke care for every patient
through the longitudinal clinical audit and the acute organisational audit is a component of SSNAP
that measures the quality of acute stroke services.

Presentation of Results
Key aspects of acute stroke care organisation are addressed, including each of the 10 Key Indicators
for the audit. There are comparisons with the 2014, 2016, 2019 and 2021 acute organisational audit
(shown in the dark and light grey sections of data tables). Where possible throughout the report
results are placed in the context of clinical processes for patients and national standards and
guidelines (green and peach boxes). Clinical commentary is also given throughout.
48

Appendix 4: Intercollegiate Stroke Working Party Membership
Chair
Professor Martin James, Consultant Stroke Physician at the Royal Devon & Exeter Hospital, Exeter;
Honorary Clinical Professor at the University of Exeter Medical School; Clinical Director, King's
College London Stroke Programme

Associate Directors, Stroke Programme
Dr Ajay Bhalla, Consultant Stroke Physician and Lead Clinician at Guy’s and St Thomas’ Hospital,
London; Associate Clinical Director, King's College London Stroke Programme
Ms Louise Clark, Head of Occupational Therapy and AHP Lead for Stroke, Dorset County Hospital
Foundation Trust; Associate Director of the Sentinel Stroke National Audit Programme
Dr Rebecca Fisher, Stroke Association Senior Lecturer at the University of Nottingham; Associate
Director, King's College London Stroke Programme

Working Party Members
Association of British Neurologists
Professor David Werring, Professor of Clinical Neurology, Stroke Research Centre, UCL Queen Square
Institute of Neurology

Association of Chartered Physiotherapists in Neurology (ACPIN)
Professor Sarah Tyson, Professor of Rehabilitation, University of Manchester

British and Irish Orthoptic Society
Professor Fiona Rowe, Professor in Orthoptics, University of Liverpool

British and Irish Association of Stroke Physicians
Professor Gillian Mead, President of BASP; Professor of Stroke and Elderly Care Medicine, University
of Edinburgh; Honorary Consultant Physician, NHS Lothian

British Dietetic Association
Ms Cara Lewis, Stroke Dietitcian, Nutrition and Dietetics, St Thomas' Hospital

British Geriatrics Society
Dr Khalid Ali, Senior lecturer in Geriatrics and Stroke Medicine (Brighton and Sussex Medical School)

British Psychological Society
Dr Mark Griffiths, Consultant Lead Clinical Psychologist & Head of Psychology, Liverpool Heart &
Chest NHS Foundation Trust
Dr Shirley Thomas, Associate Professor in Rehabilitation Psychology, Division of Rehabilitation and
Ageing, University of Nottingham

British Society of Neuroradiologists
Dr Andrew Clifton, Interventional Neuroradiologist, St George’s University Hospitals NHS
Foundation Trust
49

British Society of Rehabilitation Medicine/Society for Research in Rehabilitation
Professor Diane Playford, Professor of Neurological Rehabilitation/Honorary Consultant in
Rehabilitation Medicine, Division of Health Sciences, Warwick Medical School

College of Paramedics
Mr Joseph Dent, Advanced Practitioner, Salford Royal Hospital; Lead for stroke at College of
Paramedics (British Paramedic Association)

Getting It Right First Time (GIRFT)
Dr David Hargroves, National Clinical Lead for Stroke, Getting it Right First Time & Urgent and
Emergency Stroke Care Work Stream Lead, Clinical Policy Unit, both for NHS England & NHS
Improvement. Consultant Stroke Physician and Clinical Lead for Stroke, East Kent Hospital University
Foundation Trust & NHS England and NHS Improvement – South East (Kent Surrey Sussex)

Health Economics Advice
Professor Anita Patel, Director of Health Economics & Evaluation at Ipsos MORI; Honorary Professor
at Queen Mary University of London

Healthcare Quality Improvement Partnership (HQIP)
Mr Mirek Skrypak, Associate Director for Quality and Development, Healthcare Quality Improvement
Partnership (HQIP)

SSNAP Data Science Project Director
Dr Andrew Hill, Consultant Stroke Physician and CCIO for St Helens and Knowsley Teaching Hospital

King’s College London
Professor Charles Wolfe, Professor of Public Health, School of Life Course and Population Sciences

Patient representatives
Mr Danny Lloyd
Mr Robert Norbury
Ms Marney Williams

National Clinical Director for Stroke (England)
Dr Deborah Lowe, National Clinical Director for Stroke, National Specialty Advisor for Stroke
Medicine – GIRFT, NHSI. Consultant Stroke Physician, Wirral University Teaching Hospital NHS
Foundation Trust

NIMAST (Northern Ireland Multidisciplinary Association of Stroke Teams)
Dr Patricia Gordon, Chair, NIMAST; Stroke Consultant, Royal Victoria Hospital, Belfast
Ms Nicola Moran, Website Liaison, NIMAST; Clinical Physiotherapy Specialist in Stroke, Royal Victoria
Hospital, Belfast

50

Royal College of General Practitioners
Dr Iain Marshall, GP partner, Greyswood Practice, London; Clinical Academic Fellow, King’s College
London; RCGP Clinical Representative for Stroke

Royal College of Nursing
Dr Gill Cluckie, Stroke Nurse Consultant, St George's University Hospitals NHS Foundation Trust
Ms Maria Ines de Sousa de Abreu, Neurology and Neurorehabilitation Clinical Nurse Specialist,
Bromley Healthcare Care Coordination Centre

Royal College of Occupational Therapists and Special Section Neurological Practice
Ms Louise Clark, Head of Occupational Therapy and AHP Lead for Stroke, Dorset County Hospital
Foundation Trust; Associate Director of the Sentinel Stroke National Audit Programme
Professor Avril Drummond, Professor of Healthcare Research and Occupational Therapist, School of
Health Sciences, University of Nottingham

Royal College of Physicians
Professor Thompson Robinson, Pro Vice-Chancellor and Head of the College of Life Sciences, and
Dean of Medicine, College of Life Sciences, University of Leicester

Royal College of Radiologists
Professor Philip White, Professor of Interventional and Diagnostic Neuroradiology, Translational &
Clinical Research Institute, Newcastle University

Royal College of Speech & Language Therapists
Professor Sue Pownall, Head of Speech & Language Therapy and Clinical Lead in Dysphagia, Sheffield
Teaching Hospitals NHS Foundation Trust

Stroke Association
Dr Rubina Ahmed, Associate Director of Systems Engagement, and Interim Executive Director of
Locality Impact
Mrs Juliet Bouverie, Chief Executive, Stroke Association

Stroke Implementation Group (Wales)
Dr Shakeel Ahmad, National Clinical Director for Stroke (Wales), Consultant Stroke Physician,
MBChB, FRCP
Ms Niki Turner, Welsh National AHP Lead for Stroke
Ms Claire Bryant, Welsh National Nursing Lead for Stroke
51

Appendix 5: Summary of Denominators Used in the Report

Summary of denominators used in the report
Total Number of Sites
157
Sites with 72h service
133
Sites with type 1 bed
83
Sites with type 2 beds
98
Sites with type 3 beds
73
Thrombectomy only sites
1
Sites in England
136
Sites in Wales
12
Sites Northern Ireland
8

52