8.8 Percentage of applicable patients who are assessed by a nurse within 24h AND at least one therapist within 24h AND all the relevant therapists within 72h AND have rehabilitation goals agreed wi...

This Key Indicator can be broken down into four components

1. assessment by a nurse within 24h
2. at least one therapist within 24h
3. all the relevant therapists within 72h
4. have rehabilitation goals agreed within 5 days

 
Patients included if eligible for all four components:

1. as in Key Indicator 4.3
2. all patients are included except those who are either medically unwell, refused to be assessed or had no relevant deficit
3. all patients are included except those who are either medically unwell, refused to be assessed or had no relevant deficit
4. as in Key Indicator 8.7

Patients must be eligible for all four parts to be deemed eligible for this Key Indicator.

Excluded:

1. no patients are excluded
2. patients who either refused, are medically unwell, or had no relevant deficit for all three therapies
3. patients who either refused, are medically unwell, or had no relevant deficit for all three therapies
4. patients who refused, have no impairments or are medically unwell for the entire admission are excluded. Patients considered to have no rehabilitation potential for all teams the patient is seen by within the first 5 days of clock start and where it has been decided either in the first 72 hours or by discharge that the patient is for palliative care are also excluded.

 
Numerator = the number of patients who achieve all 4 components of the indicator.
Denominator = all the applicable patients in the cohort. Patients who are applicable for all four components but did not achieve all four components are included in the denominator.
 
To calculate whether a patient is included in the numerator:
 
Part 1)
For newly arrived patients, the difference between the date and time first assessed by nurse trained in stroke management (Q 3.2) and the date of arrival (Q 1.13) must be greater than 0 minutes and less than or equal to 1440 minutes.
 
For patients already in hospital at the time of their stroke (Q 1.10 is ‘Yes’), the difference between date and time first assessed by nurse trained in stroke management (Q 3.2) and the date of symptom onset (Q 1.11) must be greater than 0 minutes and less than or equal to 1440 minutes.
 
AND
 
 
 
Part 2)
For newly arrived patients, the difference between the date and time first assessed by at least one of: an occupational therapist, a physiotherapist, communication assessed by speech and language therapist (Q 3.5, 3.6, 3.7), and the date of arrival (Q 1.13) must be greater than 0 minutes and less than or equal to 1440 minutes.
 
For patients already in hospital at the time of their stroke (Q 1.10 is ‘Yes’), the difference between the date and time first assessed by at least one of: an occupational therapist, a physiotherapist, communication assessed by speech and language therapist (Q 3.5, 3.6, 3.7), and the date of symptom onset (Q 1.11) must be greater than 0 minutes and less than or equal to 1440 minutes.
 
AND
 
Part 3)
For newly arrived patients, the difference between the date and time between receiving all required therapies (Q 3.5, 3.6, 3.7) and the date of arrival (Q 1.13) must be greater than 0 minutes and less than or equal to 4320 minutes.
 
For patients already in hospital at the time of their stroke (Q 1.10 is ‘Yes’), difference between the date and time between receiving all required therapies (Q 3.5, 3.6, 3.7) and the date of symptom onset (Q 1.11) must be greater than 0 minutes and less than or equal to 4320 minutes.
 
AND
 
Part 4)
For newly arrived patients, the difference between the first date rehabilitation goals agreed (Q 6.10) and the date of arrival (Q 1.13) must be greater than or equal to 0 days and less than or equal to 5 days.
 
For patients already in hospital at the time of their stroke (Q 1.10 is ‘Yes’), the difference between first date rehabilitation goals agreed (Q 6.10) and the date of symptom onset (Q 1.11) must be greater or equal to 0 days and less than or equal to 5 days.
 
Cohort percentage:
 

For team-centred	For patient-centred
N/A	All patients eligible in the patient-centred 72h cohort

 
Example
Part 1)
Patient X arrived (clock start) at hospital at 15:00 on Tuesday. They were assessed by a stroke nurse at 10:00 the following day. Patient X has achieved Part 1 of the indicator because 10:00 Wednesday – 15:00 Tuesday = 1140 minutes (19 hours).
Patient Y arrived (clock start) at hospital at 12:15 on Saturday. They were assessed by a stroke nurse at 11:15 the following Monday. Patient Y has not achieved Part 1 of the indicator because 11:15 Monday – 12:15 Saturday = 2820 minutes (47 hours).
Patient Z arrived (clock start) at hospital at 20:08 on Thursday. They were not assessed by a stroke nurse so has not achieved Part 1 of the indicator.
Therefore only Patient X has achieved Part 1.
 
Part 2)
Patient X arrived (clock start) at hospital at 15:00 on Tuesday. They were assessed by a physiotherapist at 10:00 on Wednesday. Patient X has achieved Part 2 of the indicator because Tuesday 15:00 – Wednesday 16:30 = 1140 minutes (19 hours).
Patient Y arrived (clock start) at hospital at 12:15 on Saturday. They were assessed by a physiotherapist, occupational therapist and speech and language therapist on Monday at 12:15. Patient Y has not achieved Part 2 of the indicator because Saturday 12:15 – Monday 12:15 = 2280 minutes (48 hours) and therefore they were not assessed by any therapist within 24 hours.
Patient Z arrived (clock start) at hospital at 20:08 on Thursday. Patient Z was applicable for an assessment but not assessed by an occupational therapist or a speech and language therapist.  They were applicable for physiotherapy assessment but not assessed by a physiotherapist so have not achieved Part 2 of the indicator.
Therefore only Patient X has achieved Part 2.
 
Part 3)
Patient X arrived (clock start) at hospital at 15:00 on Tuesday. They were assessed by a physiotherapist, occupational therapist and speech and language therapist at 10:00 on Wednesday. Patient X has achieved Part 3 of the indicator because Tuesday 15:00 – Wednesday 16:30 = 1140 minutes (19 hours).
Patient Y arrived (clock start) at hospital at 12:15 on Saturday. They were assessed by a physiotherapist, occupational therapist and speech and language therapist on Monday at 12:15. Patient Y has achieved Part 3 of the indicator because Saturday 12:15 – Monday 12:15 = 2880 minutes (48 hours).
Patient Z arrived (clock start) at hospital at 20:08 on Thursday. They were applicable but not assessed by a physiotherapist, occupational therapist or speech and language therapist so have not achieved Part 3 of the indicator.
Therefore Patient X and Patient Y have achieved Part 3.
 
Part 4)
Patient X arrived (clock start) at hospital on 1^st January. They had rehabilitation goals agreed on by 4^th January. Patient X has achieved Part 4 of the indicator because 1^st January – 4^th January = 3 days.
Patient Y arrived (clock start) at hospital on 2^nd January. They did not have rehabilitation goals set because the patient refused. Patient Y therefore is excluded from the indicator.
Patient Z arrived (clock start) at hospital on 3^rd January. They had rehabilitation goals agreed on by 5^th January. Patient Z has achieved Part 4 of the indicator as 2^nd January – 5^th January = 3 days.
Therefore Patient X and Patient Z have achieved Part 4, and Patient Y is excluded.
 
The only patient to achieve all four components is Patient X.
 
The percentage applicable patients who are assessed by a nurse within 24h AND at least one therapist within 24h AND all the relevant therapists within 72h AND have rehabilitation goals agreed within 5 days =