Mind the gap!

The Third SSNAP Annual Report

Using SSNAP data to improve stroke services

The following case study was submitted by Dr Andrew Hill, Stroke Consultant at Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust.
Being admitted with a suspected stroke can be stressful and bewildering for stroke patients and their families. A simple way to alleviate this and provide high quality stroke care is to try to ensure that patients who have had a suspected stroke are admitted to a specialist ward, and are introduced to and assessed by all the members of the specialist team on the same day that they are admitted. This means that the patient and family can get a timely and well-informed idea of who is providing their care, information about their diagnosis, prognosis, and their initial plan of care.
At St Helens and Knowsley, we realised that SSNAP data is not just useful for examining national performance, but if we used the information real-time we could have a greater understanding of how our service works, and use that information to drive continuous improvement.
We began by looking at our bed capacity: a stroke unit must have an adequate number of beds and policies in place to make sure that when a stroke patient arrives to an Emergency Department that a bed on a specialist stroke unit can be made available immediately. We used information about when stroke patients arrive to hospital, and how long they stayed in hospital, both collected by the audit, to build a model of our unit and work out how big it needed to be in order to do this.
We were next able to use the data to study how long it took everyone in the team to see a patient from their time of arrival. This taught us a lot about barriers to care that we perhaps hadn’t considered: promoting very rapid admission to our Hyperacute stroke unit allowed the whole team to work more effectively together and significantly shortened the time to be seen by our team.
We also adjusted both the organisation of the team, and the working hours of our therapy team so that we were better aligned with when the patients arrived (most of our patients present to hospital with their stroke in the late morning or in the early afternoon). For patients and relatives this means that they get an earlier assessment, and a clearer idea of their plan of care. For severe strokes this may mean earlier assessments of swallowing and looking for potential complications such as pneumonia; for mild strokes this may mean plans for discharge being made a day earlier than they may otherwise have been.
We also introduced a review process into every patient’s care where our SSNAP data suggested we had not delivered one or more measure of their care, or it was done more slowly than we would like. In that review, we tease out any common themes, brainstorm and quickly implement changes to try to overcome them. This has meant clearer structured documentation, better quality discharge letters, or introducing checking systems. This has meant delivering sustainable changes, and the ability to identify new problems if they occur quite quickly (for example with changes to personnel or other things within or outside the service).
These changes have seen us improve massively on our SSNAP performance from when the audit first began, and we are now consistently amongst the top performing Trusts on the SSNAP audit.
We are very proud to have seen the improvements in our service – feedback from our patients and relatives suggests they are extremely pleased with the service we give, and we are confident we can prove we consistently and efficiently deliver the standards of care set out in NICE and RCP guidance.

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