SENTINEL STROKE NATIONAL AUDIT PROGRAMME

SSNAP THE REALITY Alison Beattie Stroke Services Co-ordinator

We all agree

• Evidence based practice is the corner stone to safe, high quality service delivery

• Audit drives forward improvements in care and service delivery

Stroke Audit Evolution

RCP- Biennial

Retrospective

10% of all stroke admissions over 2 years

SINAP

Prospective

Every stroke admission starting at time of hospital registration, finishing at 72hrs

SSNAP

Prospective

Every stroke admission starting at time of hospital registration, finishing at 6 month review

April 2011

December 2012

1998

Where to start?

• Don’t try to take it on single handed

• This requires team effort, it will fail without all staff on board

• Don’t assume everyone will share your enthusiasm

How did we set it up in the WHSCT

KEY FIRST STEPS:

• Partnership with your audit department

• Senior management support in all disciplines

What to watch out for – No. 1 Case Ascertainment Each Trust will have their set number of cases to be uploaded

A minimum of 75% of all cases must be closed for ‘pre 72hrs’

A minimum of 60% of all cases must be closed for ‘post 72hrs’

What to watch out for – No. 2 Audit Compliance

• Sections 1-3 should be closed within 1 week from time of clock start

• Sections 4-7 should be closed within 1 week from date of discharge

•

• Transfer deadline to rehabilitation post acute phase

FAILURE TO CLOSE ON TIME CAN RESULT IN YOUR OVERALL AUDIT SCORE BEING REDUCED

How your overall score is reduced

Patient

Identification

SWAH

What to watch out for – No.3

NameHospital

No.ID

Admission

Date Discharge

Date

CommentStroke Nurse

SpecialistNursing Medical

Speech

Therapy

Occupational

Therapy

Physiotherap

ySocial Work

xxxxxxxxxxxxxx

08/02/2015 INPAT

Completed to

Discharge

Completed to

72hrs

Completed to

Discharge

Completed to

Discharge

xxxxxxxxxxxxxx

12/03/2015 02/04/2015 TCH

Completed to

Discharge

Completed to

Discharge

Completed to

Discharge

Completed to

Discharge

Completed to

Discharge

Completed to

Discharge

Completed to

Discharge

xxxxxxxxxxxxxx

14/03/2015 27/04/2015 DECEASED

Completed to

Discharge

Completed to

Discharge

Completed to

Discharge

Completed to

Discharge

xxxxxxx

xxxxxxx

18/03/2015 INPAT

Completed to

Discharge

Completed to

72hrs

Completed to

72hrs

Completed to

Discharge

xxxxxxxxxxxxxx

15/04/2015 22/05/2015

Completed to

Discharge

Completed to

Discharge

Completed to

Discharge

Completed to

72hrs

Completed to

Discharge

Completed to

Discharge

Completed to

Discharge

xxxxxxxxxxxxxx

21/04/2015 INPAT

Completed to

Discharge

Completed to

72hrs

Completed to

72hrs

Completed to

72hrs

xxxxxxxxxxxxxx

12/04/2015 01/05/2015 TO TCH

Completed to

Discharge Not Referred

Completed to

Discharge

Completed to

Discharge

SSNAP Current Patient List - South West Acute Hospital

Patient

Identification

Altnagelvin

What to watch out for – No.3

Audit Flow

Registration-72hrs

72hrs - Discharge

Discharge TCH ESD

6 Month Review

How do we do it – Registration to 72hrs?

Patient Admitted

Stroke Specialist Nurse

Identifies all new admissions Monday-Friday. Registers onto SSNAP, completing sections 1-2.

Updates stroke shared folder with patient details

and SSNAP ID number.

Allied Health Professionals

Complete section 3 (SWAH)

Date and time of assessment or list reason for not completed.

Complete shared stroke folder.

Audit Department

Monitor and close cases completed.

Inform staff of cases that remain open past their

deadline.

How do we do it – 72hrs to Discharge?

Patient Discharged

Allied Health Professionals

Complete sections 4 & 6.

Number of minutes and days

of therapy.

Ward Clerk

Leaves medical notes of stroke discharges on SSNAP shelf.

Stroke Co-ordinator

Complete section 6 and 7.

Close cases completed.

Audit Department

Monitor and close cases completed. Inform staff of cases that remain open past their deadline. Ensures cases are transferred to ESD/TCH

How do we do it – Discharge to 6 month review?

Patient Transferred / Reviewed

Audit Department

Tyrone County Hospital / ESD team

Complete sections 4 and 7.

Audit Department

Stroke Specialist Nurse

Reviews all patients at 6 months.

Completes written proforma.

Audit Department

Inputs data from SSN. Monitor and close cases completed.

Inform staff of cases that remain open past their

deadline.

For patients transferred to TCH, transfers audit ID information onto TCH stroke shared folder.

Monitor and close cases completed. Inform staff of cases that remain open past their

deadline

Support mechanisms for staff

• Proforma broken down

• Stroke shared folder

• Held monthly meetings initially to support staff

• Protected 1 hour per week for staff to bring the data to be supported to input

• AUDIT TEAM

Patient Transfer Flow

Local ED

RVH

Local SU

Rehab

bed

Community

+

6 Month Rv

Need the Regional Neurosciences Centre participating in SSNAP

SSNAP Scoring Summary SSNAP Scoring Summary: Team type Routinely admitting team Routinely admitting team Routinely admitting team Routinely admitting team

SCN Northern Ireland Northern Ireland Northern Ireland Northern Ireland

Trust Western Health and Social Care Trust Western Health and Social Care Trust Western Health and Social Care Trust Western Health and Social Care Trust

Team South West Acute Hospital South West Acute Hospital South West Acute Hospital South West Acute Hospital

Quarter Jan-Mar 2014 Apr-June 2014 July-Sep 2014 Oct-Dec 2014

SSNAP level E D D C

SSNAP score 39.6 43.7 53.2 63.7

Case ascertainment band A A B A

Audit compliance band C B B B

Combined Total Key Indicator level D D D C

Combined Total Key Indicator score 44 46 59 67

Number of records completed: Team-centred post-72h all teams cohort 53 49 46 39

Patient-centred KI levels:

Patient-centred Domain levels: 1) Scanning D E E C

2) Stroke unit C D C C

3) Thrombolysis A B C A

4) Specialist Assessments B D B B

5) Occupational therapy E C C C

6) Physiotherapy E C B C

7) Speech and Language therapy E E D C

8) MDT working E E C B

9) Standards by discharge D D D D

10) Discharge processes D B B B

Patient-centred KI level Patient-centred Total KI level D D D C

Patient-centred Total KI score 44 46 58 68

Patient-centred SSNAP level Patient-centred SSNAP level (after adjustments)

E D D C

Patient-centred SSNAP score 39.6 43.7 52.3 64.6

Team-centred KI levels:

Team-centred Domain levels: 1) Scanning D E E C

2) Stroke unit C D C C

3) Thrombolysis A B C A

4) Specialist Assessments B D B B

5) Occupational therapy E C C D

6) Physiotherapy E C B C

7) Speech and Language therapy E E D C

8) MDT working E E B B

9) Standards by discharge D D D D

10) Discharge processes D B B B

Team-centred KI level Team-centred Total KI level D D C C

Team-centred Total KI score 44 46 60 66

Team-centred SSNAP level Team-centred SSNAP level (after adjustments)

E D D C

Team-centred SSNAP score 39.6 43.7 54.2 62.7

Last thoughts

• SSNAP is an exceptional audit

• Reporting and analysis of results is phenomenal

• SSNAP support staff are excellent and highly efficient

• To complete the ‘Audit Process’, quarterly reporting is intense

• Workshop hosted by SSNAP would benefit us regionally

Thank you SWAH

• Lorraine Adams – Audit

• Sheila Grimes – Stroke Nurse

• Sasi Pacha –PT

• Arlene Little – OT

• Anna Maguire - OT

• Sinead McNulty – SLT

• Ruth Corrigan - Ward Clerk

• Dr Jim Kelly

• Dr Breffni Keegan

Altnagelvin • Deirdre Kelly – Audit

• Jacquie McKee – Stroke Nurse

• Moira Tyrell – PT

• Annemarie Doherty – OT

• Grainne Kelly –OT

• Sinead Deery – SLT

• Tracy Donnell – Ward Clerk

• Dr John Corrigan

• Dr Stephen Todd

Thank you Tyrone County Hospital

• Anne McFarland – Ward Manager

• Sinead Eccles– Stroke Nurse

• Joy Hillen–PT

• Ann McLaughlin – OT

• Tanya Cuddy – SLT

ESD

• Susan McBarron – PT

• Suzanne Lynch– OT

• Sinead McNulty – SLT