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National Sentinel Stroke Audit 2006

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National Sentinel Stroke Audit 2006 National Sentinel Stroke Audit Phase 1 (organisational audit) 2006 Phase 2 (clinical audit) 2006 Report for England, Wales and Northern Ireland Prepared on behalf of the Intercollegiate Stroke Working Party by Clinical Effectiveness and Evaluation Unit Royal College of Physicians of London April 2007 TABLE OF CONTENTS Title Page Table of contents 2 Report authors 4 Glossary 5 Definitions 7 Executive Summary for Phase 1 (organisational audit) 9 Executive Summary for Phase 2 (clinical audit) 13 Conclusions and Recommendations 19 Section 1 Organisation of Care Chapter One -Background and presentation of results 20 Chapter Two – Organisation of Stroke Care Nationally as at 1 April 2006 21 Organisation of Stroke Care by Region 26 Chapter Three – Organisation of Stroke Care by domains 28 1 Acute Stroke Care Organisation 29 2 Organisation of Care 31 3 Interdisciplinary Services (Overall Service) 33 4 Interdisciplinary Services (Stroke Units only) 34 5 TIA/neurovascular services 35 6 Continuing Education and research in stroke 36 7 Team working – Multidisciplinary Records 37 8 Team working – Team meetings 38 9 Agreed Assessment Measures 39 10 Communication with Patients and Carers 40 Scanning services 41 National Organisational Audit Results by region 42 Section 2 Clinical Audit Chapter 1. Background and Methods for Phase II data collection and presentation of results 74 Chapter 2. Key National Results 2006 Phase 2 and compared to previous 77 rounds Overall results for key clinical indicators in 2006 compared to 2004 and 2001 77 Site variation for key indicators in 2006 78 Site variation for key indicators in 2006 compared to 2004 79 Site variation for key indicators in 2006 compared to organisational score in 2006 80 Site variation for domain and total scores in 2006 Site variation for total and key indicator score in 2006 81 Applicability and Compliance by standard in 2006 compared to 2004 82 --------------------------------------------------------------------------------------------------- 2 Chapter 3. Key Results Phase 2 2006 for England, Wales & Northern Ireland, and in comparison with previous rounds 83 Clinico-demographic results 2006 83 Overall key results for key indicator score in 2006 National England, Wales and N Ireland 84 Site variation for key indicator score in 2006 85 Site variation for domain and total scores in 2006 85 Comparison of results in England from 2001-2006 86 Comparison of results for Wales from 2001-2006 Comparison of results for Northern Ireland from 2001-2006 86 Site variation for key indicator score in 2006 compared to 2004 87 National Clinical Audit Results by region 88 Conclusions and Recommendations 104 Appendix 1 Questionnaire used for data collection (organisational audit) Appendix 2 Questionnaire used for data collection (clinical audit) --------------------------------------------------------------------------------------------------- 3 NATIONAL SENTINEL AUDIT OF STROKE 2006 – Organisational audit REPORT PREPARED BY Mrs Alex Hoffman LCST MSc National Stroke Audit Co-ordinator, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Mr Calvin Down BA Stroke Programme Administrator, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Mr Robert Grant BSc DipStat Medical Statistician, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Ms Fatima Wurie (BSc Hons) Stroke Programme Co-ordinator, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Mr Derek Lowe MSc/C.Stat Medical Statistician, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Dr Anthony Rudd FRCP Chair of the Intercollegiate Stroke Group, Associate Director for Stroke (CEEU), Consultant Stroke Physician, Guy’s and St Thomas’ Hospital This report is a concise version of a generic format of the trust report which is available by written request to the Stroke Programme, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians 11 St Andrews Place London NW1 4LE. --------------------------------------------------------------------------------------------------- 4 GLOSSARY Benchmarking Measuesrement of performance against a standard reached by others. For example in national audit this could be the top score or the national average Carer Someone (commonly the patient’s spouse, a close relative or a friend) who provides ongoing, unpaid support and personal care at home Carotid Doppler A noninvasive test which uses high frequency sounds waves to determine extent of blood flow through the carotid arteries in the neck. Used in the evaluation of stoke and TIA symptoms Carotid Carotid endarterectomy is a surgical procedure in which a Endarterectomy stenosis (narrowing) or ulceration of an atherosclerotic plaque in the carotid artery is removed. CT scan A CT scan (computerised tomography) of the head. A CT scan X-rays the body from many angles. The X-ray beams are detected by the scanner and analyzed by a computer. The computer compiles the images into a picture of the body area being scanned. These images can be viewed on a monitor or reproduced as photographs. Domain The organisation of stroke care was divided into key areas for summary presentation of results Inter Quartile Range The IQR is the range between 25th and 75th centile which (IQR) is equivalent to the middle half of all values Transient Ischaemic A transient ischaemic attack is less severe than a stroke Attack (TIA) in that all the symptoms disappear within a day (and often last for less than half an hour) Magnetic Resonance A non-invasive procedure that produces a picture of the Imaging (MRI) inside of the head without exposure to ionising radiation (X rays) 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 National Clinical National evidence based guidelines for stroke care Guidelines For published by the Intercollegiate Working Party Stroke (2004) for Stroke second edition 2004 http://www.rcplondon.ac.uk/pubs National Sentinel National audit at a specific point in time to identify levels of Audit practice and service provision across the country ------------------------------------------------------------------------------------------------------------------- 5 National Service The NSF for older people was published in March Framework for 2001. It set national standards and service models Older People of care across health and social services for all older Department of people whether they live at home, in residential care Health (NSF) or are being cared for in hospital. http//:www.publications.doh.gov.uk/nsf/olderpeople/index.htm Neurovascular An outpatient clinic for patients with Transient Ischaemic Clinic Attacks or minor stroke for further investigation Organisational Audit of the service organisation, particularly relevant in stroke audit due to the evidence supporting organised stroke services. Organisational The data was analysed using a formula to combine Score similar questions into an overall score for domains or key areas in the organisation of care. A score of 100 is the optimal score Secondary Measures to prevent recurrence of the same illness prevention Stroke Research A nationally funded organisation to increase participation in Network stroke research http://www.uksrn.ac.uk/ Stroke Unit Stroke Unit Trialists' Collaboration Trialists’ Organised inpatient (stroke unit) care for stroke (Cochrane Collaboration Review). In: The Cochrane Library, Issue 3, 2004. (SUTC) Chichester, UK: John Wiley & Sons, Ltd. Thrombolysis The use of drugs to break up a blood clot Trusts In the context of the UK’s National Health Service (NHS), trusts are organisational units, eg hospital trusts, community trusts, primary care trusts or combinations thereof. In this report it usually refers to hospitals --------------------------------------------------------------------------------------------------- 6 Definitions of models of care The NSF for Older People (which applies to England only) set out that all hospitals caring for people with stroke should have ‘a specialised stroke service” by April 2004. The definition used for a stroke unit (and used in this audit) is: Stroke unit - a multidisciplinary team including specialist nursing staff based in a discrete ward which has been designated for stroke patients. This category includes the following sub-divisions: Acute stroke units that accept patients acutely but discharge early (usually within 7 days). This could include an “intensive” model of care with continuous monitoring and high nurse staffing levels. Rehabilitation stroke units which accept patients after a delay of usually 7 days or more and focus on rehabilitation Combined stroke units (ie no separation between acute and rehabilitation beds) that accept patients acutely but also provide rehabilitation for at least several weeks if necessary. Key characteristics of all stroke units Five key characteristics were chosen from the Stroke Unit Trialists' Collaboration (SUTC) http://www.update-software.com/abstracts/AB000197.htm and subsequent papers, as markers of stroke unit organisation. The audit has assessed how many of these are in place. The 5 characteristics are: • Consultant physician with responsibility for stroke • Formal links with patient and carer organisations • Multidisciplinary meetings at least weekly to plan patient care • Provision of information to patients about stroke • Continuing education programmes for staff The Department of Health National Performance Indicator on the
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