National Sentinel Stroke Audit Phase I (organisational audit) 2006 Phase II (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 Report authors ...................................................................................................... 4 Glossary................................................................................................................ 5 Definitions of models of care................................................................................. 7 Priority Findings and Recommendations for Actions ............................................ 9 Executive Summary for Phase I Organisation of Stroke Care ............................ 11 Executive Summary for Phase II Clinical Audit ................................................... 15 Section 1 Audit of organisation of stroke care Chapter 1 – Background and Presentation of Results............................... 21 Chapter 2 – Organisation of Stroke Care Nationally as at 1 April 2006............................................................................................ 22 Chapter 3 – Organisation of Stroke Care by Domains............................... 29 Domain 1 – Acute Care ........................................................... 30 Description of domain...................................................... 30 Domain 2 – Organisation of Care............................................ 32 Description of domain...................................................... 32 Domain 3 – Interdisciplinary Service (overall service)............. 34 Description of domain...................................................... 34 Domain 4 – Interdisciplinary Services (stroke units only)........ 35 Description of domain...................................................... 35 Domain 5 – TIA Neurovascular Services ................................ 36 Description of domain...................................................... 36 Domain 6 – Continuing Education and Research ................... 37 Description of domain...................................................... 37 Domain 7 Multidisciplinary Records ........................................ 38 Description of domain...................................................... 38 Domain 8 – Team Working – Team Meetings......................... 39 Description of domain...................................................... 39 Domain 9 – Agreed Assessment Measures ............................ 40 Description of domain...................................................... 40 Domain 10 – Communication with Patients and Carers.......... 41 Description of domain...................................................... 41 Chapter 4 – National Organisational Audit Results by Region................... 43 Table 30 – Summary of Key Organisational Results by Hospital for Stroke Unit provision and quality and other models of stroke care ........................................................................................... 43 Table 31 – Summary of Key Organisational Results by Hospital Including Waiting Times for Scan, Presence of Neurovascular/TIA Clinic and Involvement With Patients.................................................. 58 --------------------------------------------------------------------------------------------------- 2 Section 2 Audit of process of care for stroke patients Chapter 1 – Background and Methods for Phase II Data Collection and Presentation of Results ....................................................................... 76 Chapter 2 – Key National Results 2006 & Compared With Previous Rounds....................................................................................................... 79 2.1 Overall results for key process indicators in 2006 compared with 2004 and 2001 ................................................. 79 2.2 Site variation for key process indicators in 2006...................................................................................... 80 2.3 Site variation for change in key process indicator score in 2004 compared to 2006 .............................................. 81 2.4 Site variation for key process indicator score in 2006 compared to the organisational score in 2006.......................... 81 2.5 Site variation for process domain and total scores in 2006.......................................................................................... 82 2.6 Site variation for process total and key process indicator scores in 2006............................................................ 83 2.7 Compliance with standards for patients admitted to a stroke unit compared to those not admitted to a stroke unit ................................................................................. 84 2.8 Applicability and compliance by standard in 2006 compared to previous rounds ................................................... 85 Chapter 3 – Key national results 2006 for England, Wales and Northern Ireland and in comparison with 2004 and 2001........................... 86 3.1 Clinico-demographic results 2006 ...................................... 86 3.2 Overall results for key process indicators in 2006 .............. 87 3.3 Site variation for key process indicator score in 2006 ....... 88 3.4 Site variation for process domain and total scores in 2006.......................................................................................... 88 3.5 Comparison of results in England from 2001-6 .................. 89 3.6 Comparison of results in Wales from 2001-6 ..................... 89 3.7 Comparison of results in Northern Ireland from 2001-6.............................................................................. 90 3.8 Site variation for key process indicator score in 2006 compared to 2004........................................................ 90 Chapter 4 – The key indicators national results 2006 for all hospitals regionally..................................................................................... 91 Table 12 Key clinical audit indicator scores for all hospitals in the 2006 Audit .................................................................................................. 92 Table 13 Total Key indicator scores for clinical audit all hospitals in each Strategic Health Authority and Region.................................................... 92 Conclusions .............................................................................................. 105 Appendix 1 – Questionnaire used for data collection phase I (organisational audit) Appendix 2 – Questionnaire used for data collection phase II (clinical audit) --------------------------------------------------------------------------------------------------- 3 Report authors 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 Measurement 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 non invasive 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 IST The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group CAST CAST: randomised placebo-controlled trial of early aspirin use in 20,000