Acute

Lead clinicians were asked to collect data on the basis of a unified service typically within a trust or a ‘site’. For most trusts the ‘site’ was the trust itself. For some trusts there are several ‘sites’ each offering a discrete service. A site may include several hospitals. Please note ‘trusts’ is used as a generic term; however, it is acknowledged that in Wales, these are Health Boards.

Data was collected at site level within trusts using a standardised method. Clinical involvement and supervision at team level was provided by a lead clinician in each hospital who had overall responsibility for data quality. Data was collected using a web-based tool accessible via the internet. High data quality was ensured through the use of built in validations which prevented illogical data being entered. Services entered data describing their service on a specific date (for the 2021 audit this was 1 October 2021) and were given 5 weeks to enter and check data, after which period no changes were permitted.

Participating sites were measured against specific criteria for 10 key indicators, with the same key indicators used in 2019 and 2021. These key indicators were identified using the domains and key indicators from the 2016 audit, as well as recent research and evidence. The standards against which acute stroke services were assessed were outlined throughout the written report. They include the 10 key indicator standards, the 2016 NICE Quality Standards and the National Clinical Guideline for Stroke (2016).

Data was reported for every data item from the audit at national and site level. The national median for each measure was given to enable benchmarking.  National results were presented as percentages, site variation was summarised by median and inter-quartile ranges (IQR), and denominators were given within the national results column (see here for statistical terminology used in SSNAP reports). Ratios of staffing numbers per 10 stroke unit beds (per 30 stroke unit beds for psychology) were given rather than staffing numbers per stroke unit, so as to allow direct comparison with national standards and other sites. To calculate numbers per 10 beds the whole-time equivalents (WTE) for each staffing discipline in a service was divided by the total number of beds used by stroke patients, then multiplied by 10. The same rule applied for staff numbers per 30 beds, but multiplied by 30.

To represent the care available to patients at sites which do not treat patients in the first 72 hours after their stroke, these sites were assigned the results of the site which provided this care from relevant sections. This applies to both the key indicator summary section and the full results section.
 

Post-Acute

The following methodology was used for the 2021 round of the audit.

Data was collected using a web-based tool accessible via the internet. High data quality was ensured through the use of built in validations which prevented illogical data being entered. Providers entered data describing their service on 1 April 2021 and were given 5 weeks to enter and check data, after which period no changes were permitted.


The audit measured the structure of post-acute stroke services. It assessed services against standards and evidence from sources including the National Clinical Guideline for Stroke (2016), the National Stroke Service Model description of an Integrated Community Stroke Service (ICSS), and British Society of Rehabilitation Medicine, Specialised Neurorehabilitation Service Standards.

Key indicators (KIs) were developed through research and reviewing the existing evidence. Participating services were measured against specific criteria for each of the 14 key indicators.

KI2 and KI4 were multi-level key indicators, meaning that there were multiple thresholds in order for the KI to be met. If some of the thresholds were met, then one point was given. If all the thresholds were met, then two points were given. So, although there were 14 KIs it was possible to score more than 14 points.

The key indicators were applied to the following services:

• Post-acute inpatient teams: A total of 10 key indicators (total score of 12) applied at team level. (KI1, KI2, KI3, KI4, KI5, KI6, KI0, K11, KI13, KI14)
• Community-based multidisciplinary rehabilitation teams: A total of 13 key indicators (total score of 15) applied at team level. (KI1, KI2, KI3, KI4, KI5, KI7, KI8, KI9, KI0, K11, KI12, KI13, KI14)
• Standalone 6-month assessment provider: A total of 1 key indicator (total score of 1) applied at team level.

Data was reported for every data item from the audit at national and provider level. The national median for each measure was given to enable benchmarking.  National results were presented as percentages, provider variation was summarised by median and inter-quartile ranges (IQR), and denominators were given within the national results column (see here for statistical terminology used in SSNAP reports). Ratios of staffing numbers per 5 stroke beds were given rather than staffing numbers per provider, so as to allow direct comparison with national standards and other sites. To calculate staffing numbers per 5 beds, the whole-time equivalent (WTE) for each staffing discipline in a service was divided by the total number of beds used by stroke patients then multiplied by 5. The same applied to WTE per 100 patients for non bed-based providers.

In 2015 the audit was carried out in two phases. The first phase obtained information from Clinical Commissioning Groups (CCGs) in England, Local Health Boards (LHBs) in Wales and Local Commissioning Groups (LCGs) in Northern Ireland on what post-acute stroke services were commissioned (provided). The second collected structural data from all identified post-acute stroke services on the make-up of their service.