This section contains technical information regarding the scoring algorithm.
For examples on how to achieve an A-E score for each domain please see article "Domain Scoring Examples" https://ssnap.zendesk.com/hc/en-us/articles/13576813408285-Domain-scoring-examples
Clock Start:
The term "Clock Start" is used throughout SSNAP reporting to refer to the date and time of arrival at first hospital for newly arrived patients, or to the date and time of symptom onset if patient already in hospital at the time of their stroke.
Ie. The date and time of first arrival at hospital (Q1.13) for newly arrived patients (Q1.10 is "No"), or the date and time of onset/awareness of symptoms (Q1.11) if patient was already an inpatient at the time of stroke (Q1.10 is "Yes").
Domains for SSNAP Key Indicators scoring:
Domain 1: Scanning
Domain 2: Stroke unit
Domain 3: Thrombolysis
Domain 4: Specialist assessments
Domain 5: Occupational therapy
Domain 6: Physiotherapy
Domain 7: Speech and language therapy
Domain 8: Multidisciplinary team working
Domain 9: Standards by discharge
Domain 10: Discharge processes
Teams can be excluded from receiving results for each section for a variety of reasons:
"""Not included in scoring"" = Teams are excluded from all scoring if the team does not have EITHER team-centred 72h scores or team-centred post-72h scores. Please see full portfolio of results for patient-centred results.
""Insufficient records"" = Teams which did not meet their minimum case ascertainment target for inclusion in a particular cohort do not receive results for that cohort.
""Too few to report"" = Teams with less than 20 patients in a particular cohort do not receive results for that cohort.
""None entered/No records"" = Team which did not submit any records in a particular cohort do not receive results for that cohort."
Domain Scores:
Domain scores are typically the average percentage of the Key Indicators within the domain. However, for some of the Key Indicators this was not appropriate. For these Key Indicators, a score was attributed based on the performance in the Key Indicator:
Domain 1
1.1 Percentage of patients scanned within 1 hour of clock start
The score for this indicator is the percentage scanned within 1 hour multiplied by 2, and capped at a score of 100 (ie. Scanning 50% of patients within 1 hour achieves the top score for this indicator)
1.2 Percentage of patients scanned within 12 hours of clock start
The score for this indicator is allocated depending on the percentage scanned within 12 hours:
A score of 100 is obtained if 95% or more of patients are scanned within 12 hours
A score of 90 is obtained if 90% to <95% of patients are scanned within 12 hours
A score of 80 is obtained if 85% to <90% of patients are scanned within 12 hours
A score of 70 is obtained if 80% to <85% of patients are scanned within 12 hours
A score of 60 is obtained if 75% to <80% of patients are scanned within 12 hours
A score of 50 is obtained if 70% to <75% of patients are scanned within 12 hours
A score of 40 is obtained if 65% to <70% of patients are scanned within 12 hours
A score of 30 is obtained if 60% to <65% of patients are scanned within 12 hours
A score of 20 is obtained if 55% to <60% of patients are scanned within 12 hours
A score of 10 is obtained if 50% to <55% of patients are scanned within 12 hours
A score of 0 is obtained if less than 50% of patients are scanned within 12 hours
1.3 Median time between clock start and scan
The score for this indicator is allocated depending on your team's median clock start to scan time:
A score of 100 is obtained if the median time is less than 45 minutes
A score of 90 is obtained if the median time is between 45 to <60 minutes
A score of 80 is obtained if the median time is between 60 to <75 minutes
A score of 70 is obtained if the median time is between 75 to <90 minutes
A score of 60 is obtained if the median time is between 1.5 to <2 hours
A score of 50 is obtained if the median time is between 2 to <3 hours
A score of 40 is obtained if the median time is between 3 to <4 hours
A score of 30 is obtained if the median time is between 4 to <5 hours
A score of 20 is obtained if the median time is between 5 to <6 hours
A score of 10 is obtained if the median time is between 6 to <8 hours
A score of 0 is obtained if the median time is 8 hours or longer
Domain 2
2.1 Percentage of patients directly admitted to a stroke unit within 4 hours of clock start
The score for this indicator is the percentage attained.
2.2 Median time between clock start and arrival on stroke unit
The score for this indicator is allocated depending on your team's median clock start to arrival on stroke unit time:
A score of 100 is obtained if the median time is less than 60 minutes
A score of 90 is obtained if the median time is between 1 to <2 hours
A score of 80 is obtained if the median time is between 2 to <3 hours
A score of 70 is obtained if the median time is between 3 to <4 hours
A score of 60 is obtained if the median time is between 4 to <4.5 hours
A score of 50 is obtained if the median time is between 4.5 to <5 hours
A score of 40 is obtained if the median time is between 5 to <5.5 hours
A score of 30 is obtained if the median time is between 5.5 to <6 hours
A score of 20 is obtained if the median time is between 6 to <7 hours
A score of 10 is obtained if the median time is between 7 to <8 hours
A score of 0 is obtained if the median time is 8 hours or longer
2.3 Percentage of patients who spent at least 90% of their stay on stroke unit
The score for this indicator is the percentage attained.
Domain 3
Teams do not receive a team centred domain 3 score if no patients were eligible using the minimum RCP criteria nor were any patients thrombolysed
3.1 Percentage of all stroke patients given thrombolysis (all stroke types)
The score for this indicator is the percentage of all patients given thrombolysis multiplied by 5, and capped at a score of 100 (ie. Thrombolysing 20% of patients achieves the top score for this indicator)
3.2 Percentage of eligible patients (according to the RCP guideline minimum threshold) given thrombolysis
The score for this indicator is the percentage attained.
3.3 Percentage of patients who were thrombolysed within 1 hour of clock start
The score for this indicator is the percentage attained.
3.4 Percentage of applicable patients directly admitted to a stroke unit within 4 hours of clock start AND who either receive thrombolysis or have a pre-specified justifiable reason ('no but') for why it could not be given
The score for this indicator is the percentage attained.
3.5 Median time between clock start and thrombolysis
The score for this indicator is allocated depending on your team's median clock start to thrombolysis time:
A score of 100 is obtained if the median time is less than 30 minutes
A score of 90 is obtained if the median time is between 30 to <40 minutes
A score of 80 is obtained if the median time is between 40 to <50 minutes
A score of 70 is obtained if the median time is between 50 to <60 minutes
A score of 60 is obtained if the median time is between 60 to <70 minutes
A score of 50 is obtained if the median time is between 70 to <80 minutes
A score of 40 is obtained if the median time is between 80 to <90 minutes
A score of 30 is obtained if the median time is between 90 to <100 minutes
A score of 20 is obtained if the median time is between 100 to <110 minutes
A score of 10 is obtained if the median time is between 110 to <120 minutes
A score of 0 is obtained if the median time is 120 minutes or longer
Domain 4
4.1 Percentage of patients assessed by a stroke specialist consultant physician within 24h of clock start
The score for this indicator is the percentage attained.
4.2 Median time between clock start and being assessed by stroke consultant
The score for this indicator is allocated depending on your team's median clock start to assessment by stroke consultant time:
A score of 100 is obtained if the median time is less than 3 hours
A score of 90 is obtained if the median time is between 3 to <6 hours
A score of 80 is obtained if the median time is between 6 to <9 hours
A score of 70 is obtained if the median time is between 9 to <12 hours
A score of 60 is obtained if the median time is between 12 to <15 hours
A score of 50 is obtained if the median time is between 15 to <18 hours
A score of 40 is obtained if the median time is between 18 to <21 hours
A score of 30 is obtained if the median time is between 21 to <24 hours
A score of 20 is obtained if the median time is between 24 to <36 hours
A score of 10 is obtained if the median time is between 36 to <48 hours
A score of 0 is obtained if the median time is 48 hours or longer
4.3 Percentage of patients who were assessed by a nurse trained in stroke management within 24h of clock start
The score for this indicator is the percentage attained.
4.4 Median time between clock start and being assessed by stroke nurse
The score for this indicator is allocated depending on your team's median clock start to assessment by stroke nurse time:
A score of 100 is obtained if the median time is less than 30 minutes
A score of 90 is obtained if the median time is between 30 to <60 minutes
A score of 80 is obtained if the median time is between 1 to <2 hours
A score of 70 is obtained if the median time is between 2 to <3 hours
A score of 60 is obtained if the median time is between 3 to <6 hours
A score of 50 is obtained if the median time is between 6 to <9 hours
A score of 40 is obtained if the median time is between 9 to <12 hours
A score of 30 is obtained if the median time is between 12 to <15 hours
A score of 20 is obtained if the median time is between 15 to <18 hours
A score of 10 is obtained if the median time is between 18 to <21 hours
A score of 0 is obtained if the median time is 21 hours or longer
4.5 Percentage of applicable patients who were given a swallow screen within 4h of clock start
The score for this indicator is the percentage attained.
4.6 Percentage of applicable patients who were given a formal swallow assessment within 72h of clock start
The score for this indicator is the percentage attained.
Domain 5
5.1 Percentage of patients reported as requiring occupational therapy
The score for this indicator is the percentage attained.
5.2 Median number of minutes per day on which occupational therapy is received
The score for this indicator is allocated depending on your team's median number of minutes of OT received by patients per day on which OT is received:
A score of 100 is obtained if the median is more than 40 minutes per day
A score of 90 is obtained if the median is more than 32 and up to 40 minutes per day
A score of 80 is obtained if the median is more than 28 and up to 32 minutes per day
A score of 70 is obtained if the median is more than 24 and up to 28 minutes per day
A score of 60 is obtained if the median is more than 20 and up to 24 minutes per day
A score of 50 is obtained if the median is more than 16 and up to 20 minutes per day
A score of 40 is obtained if the median is more than 12 and up to 16 minutes per day
A score of 30 is obtained if the median is more than 8 and up to 12 minutes per day
A score of 20 is obtained if the median is more than 4 and up to 8 minutes per day
A score of 10 is obtained if the median is more than 0 and up to 4 minutes per day
A score of 0 is obtained if the median time is 0 minutes per day
5.3 Median % of days as an inpatient on which occupational therapy is received
The score for this indicator is the percentage attained.
5.4 Compliance (%) against the therapy target of an average of 25.7 minutes of occupational therapy across all patients (Target = 45 minutes x (5/7) x 0.8 which is 45 minutes of occupational therapy x 5 out of 7 days per week x 80% of patients)
The score for this indicator is the percentage attained.
Domain 6
6.1 Percentage of patients reported as requiring physiotherapy
The score for this indicator is the percentage attained.
6.2 Median number of minutes per day on which physiotherapy is received
The score for this indicator is allocated depending on your team's median number of minutes of PT received by patients per day on which PT is received:
A score of 100 is obtained if the median is more than 40 minutes per day
A score of 90 is obtained if the median is more than 32 and up to 40 minutes per day
A score of 80 is obtained if the median is more than 28 and up to 32 minutes per day
A score of 70 is obtained if the median is more than 24 and up to 28 minutes per day
A score of 60 is obtained if the median is more than 20 and up to 24 minutes per day
A score of 50 is obtained if the median is more than 16 and up to 20 minutes per day
A score of 40 is obtained if the median is more than 12 and up to 16 minutes per day
A score of 30 is obtained if the median is more than 8 and up to 12 minutes per day
A score of 20 is obtained if the median is more than 4 and up to 8 minutes per day
A score of 10 is obtained if the median is more than 0 and up to 4 minutes per day
A score of 0 is obtained if the median time is 0 minutes per day
6.3 Median % of days as an inpatient on which physiotherapy is received
The score for this indicator is the percentage attained.
6.4 Compliance (%) against the therapy target of an average of 27.1 minutes of physiotherapy across all patients (Target = 45 minutes x (5/7) x 0.85 which is 45 minutes of physiotherapy x 5 out of 7 days per week x 85% of patients)
The score for this indicator is the percentage attained.
Domain 7
7.1 Percentage of patients reported as requiring speech and language therapy
The score for this indicator is the percentage attained.
7.2 Median number of minutes per day on which speech and language therapy is received
The score for this indicator is allocated depending on your team's median number of minutes of SALT received by patients per day on which SALT is received:
A score of 100 is obtained if the median is more than 40 minutes per day
A score of 90 is obtained if the median is more than 32 and up to 40 minutes per day
A score of 80 is obtained if the median is more than 28 and up to 32 minutes per day
A score of 70 is obtained if the median is more than 24 and up to 28 minutes per day
A score of 60 is obtained if the median is more than 20 and up to 24 minutes per day
A score of 50 is obtained if the median is more than 16 and up to 20 minutes per day
A score of 40 is obtained if the median is more than 12 and up to 16 minutes per day
A score of 30 is obtained if the median is more than 8 and up to 12 minutes per day
A score of 20 is obtained if the median is more than 4 and up to 8 minutes per day
A score of 10 is obtained if the median is more than 0 and up to 4 minutes per day
A score of 0 is obtained if the median time is 0 minutes per day
7.3 Median % of days as an inpatient on which speech and language therapy is received
The score for this indicator is the percentage attained.
7.4 Compliance (%) against the therapy target of an average of 16.1 minutes of speech and language therapy across all patients (Target = 45 minutes x (5/7) x 0.5 which is 45 minutes of speech and language therapy x 5 out of 7 days per week x 50% of patients)
The score for this indicator is the percentage attained.
Domain 8
8.1 Percentage of applicable patients who were assessed by an occupational therapist within 72h of clock start
The score for this indicator is the percentage attained.
8.2 Median time between clock start and being assessed by occupational therapist (hours:mins)
The score for this indicator is allocated depending on your team's median clock start to assessment by occupational therapist time:
A score of 100 is obtained if the median time is less than 6 hours
A score of 90 is obtained if the median time is between 6 to <12 hours
A score of 80 is obtained if the median time is between 12 to <18 hours
A score of 70 is obtained if the median time is between 18 to <24 hours
A score of 60 is obtained if the median time is between 24 to <30 hours
A score of 50 is obtained if the median time is between 30 to <36 hours
A score of 40 is obtained if the median time is between 36 to <42 hours
A score of 30 is obtained if the median time is between 42 to <48 hours
A score of 20 is obtained if the median time is between 48 to <54 hours
A score of 10 is obtained if the median time is between 54 to <60 hours
A score of 0 is obtained if the median time is 60 hours or longer
8.3 Percentage of applicable patients who were assessed by a physiotherapist within 72h of clock start
The score for this indicator is the percentage attained.
8.4 Median time between clock start and being assessed by physiotherapist (hours:mins)
The score for this indicator is allocated depending on your team's median clock start to assessment by physiotherapist time:
A score of 100 is obtained if the median time is less than 6 hours
A score of 90 is obtained if the median time is between 6 to <12 hours
A score of 80 is obtained if the median time is between 12 to <18 hours
A score of 70 is obtained if the median time is between 18 to <24 hours
A score of 60 is obtained if the median time is between 24 to <30 hours
A score of 50 is obtained if the median time is between 30 to <36 hours
A score of 40 is obtained if the median time is between 36 to <42 hours
A score of 30 is obtained if the median time is between 42 to <48 hours
A score of 20 is obtained if the median time is between 48 to <54 hours
A score of 10 is obtained if the median time is between 54 to <60 hours
A score of 0 is obtained if the median time is 60 hours or longer
8.5 Percentage of applicable patients who were assessed by a speech and language therapist within 72h of clock start
The score for this indicator is the percentage attained.
8.6 Median time between clock start and being assessed by speech and language therapist (hours:mins)
The score for this indicator is allocated depending on your team's median clock start to assessment by speech and language therapist time:
A score of 100 is obtained if the median time is less than 6 hours
A score of 90 is obtained if the median time is between 6 to <12 hours
A score of 80 is obtained if the median time is between 12 to <18 hours
A score of 70 is obtained if the median time is between 18 to <24 hours
A score of 60 is obtained if the median time is between 24 to <30 hours
A score of 50 is obtained if the median time is between 30 to <36 hours
A score of 40 is obtained if the median time is between 36 to <42 hours
A score of 30 is obtained if the median time is between 42 to <48 hours
A score of 20 is obtained if the median time is between 48 to <54 hours
A score of 10 is obtained if the median time is between 54 to <60 hours
A score of 0 is obtained if the median time is 60 hours or longer
8.7 Percentage of applicable patients who have rehabilitation goals agreed within 5 days of clock start
The score for this indicator is the percentage attained.
8.8 Percentage of applicable patients who are assessed by a nurse within 24h AND at least one therapist within 24h AND all relevant therapists within 72h AND have rehab goals agreed within 5 days
The score for this indicator is the percentage attained.
Domain 9
9.1 Percentage of applicable patients screened for nutrition and seen by a dietitian by discharge
The score for this indicator is the percentage attained.
9.2 Percentage of applicable patients who have a continence plan drawn up within 3 weeks of clock start
The score for this indicator is the percentage attained.
9.3 Percentage of applicable patients who have mood and cognition screening by discharge
The score for this indicator is the percentage attained.
Domain 10
10.1 Percentage of applicable patients receiving a joint health and social care plan on discharge
The score for this indicator is the percentage attained.
10.2 Percentage of patients treated by a stroke skilled Early Supported Discharge team
The score for this indicator is the percentage treated by stroke skilled ESD multiplied by 2.5, and capped at a score of 100 (ie. Treating 40% of patients with ESD achieves the top score for this indicator)
10.3 Percentage of applicable patients in atrial fibrillation on discharge who are discharged on anticoagulants or with a plan to start anticoagulation
The score for this indicator is the percentage attained.
10.4 Percentage of those patients who are discharged alive who are given a named person to contact after discharge
The score for this indicator is the percentage attained.
1) Algorithm for calculating domain scores and levels:
Once the score for each individual Key Indicator is known, the patient-centred domain score is calculated by adding together all the patient-centred key indicator scores in the domain and dividing by the number of applicable patient-centred key indicators.
eg. Patient-centred Domain 1 score = ( KI1.1A + KI1.2A + KI1.3A ) / 3
Similarly, the team-centred domain score is calculated by adding together all the team-centred key indicator scores in the domain and dividing by the number of applicable team-centred key indicators.
Each domain score is then categorised into levels A to E. The score required to achieve each level is outlined in each domain section and we plan to keep these levels static for at least a few reporting periods so that they can be a fixed point of reference for each team to measure improvement.
Note: Where a team does not have a particular key indicator score (eg. Teams which do not routinely admit patients would not have a team-centred % scanned with 1 hour score) that key indicator would not count towards the domain score. The domain score would be calculated out of the relevant key indicators within the domain.
2) Algorithm for combining domain levels into a Total Key Indicator level:
Once the level for each of the domains has been determined each level is assigned a number of points (A=100, B=80, C=60, D=40, E=20). For example, an average score of 78% for patient-centred Domain 10 would be a Level C performance. Level C would be worth 60 points towards the patient-centred Total Key Indicator score.
The patient-centred Total Key Indicator score is calculated by adding together all of the patient-centred domain points and dividing by the number of applicable patient-centred domains. This score is then assigned a patient-centred Total Key Indicator level:
"A= over 80
B= between 70 and <80
C= between 60 and <70
D= between 40 and <60
E= less than 40"
Similarly, the team-centred Total Key Indicator score is calculated by adding together the team-centred domain points and dividing by the number of applicable team-centred domains. Then a level is assigned as above.
Note: If a domain (either patient-centred or team-centred) is wholly not applicable (eg. The whole of domain 1 would be not applicable for team who do not directly admit patients) then the patient-centred (or team-centred) total KI score would be calculated out of the relevant domains.
Teams with no patients eligible for thrombolysis are excluded from team centred domain 3 scoring.
3) Adjustments for case ascertainment and audit compliance to produce the final SSNAP Score:
In order to adjust for case ascertainment and audit compliance, the Combined Total Key Indicator score is created by averaging the patient-centred and team-centred Total Key Indicator scores. This Combined Total Key Indicator score is then adjusted for case ascertainment and audit compliance. Please see the "Technical Information" in the SSNAP Portfolio for this reporting period for more detailed information about how case ascertainment and audit compliance levels are calculated.
Adjusting for case ascertainment and audit compliance:
Low case ascertainment or audit compliance will result in a team receiving an adjustment. The size of the adjustment varies depending on how low the case ascertainment or audit compliance band is:
Adjustment 1:
Case ascertainment adjustments:
Band A = Case ascertainment is 90% or higher, no adjustment is made to the score (100% of the score is maintained)
Band B = Case ascertainment is between 80 to <90%, an adjustment resulting in 95% of the score is made
Band C = Case ascertainment is between 70 to <80%, an adjustment resulting in 85% of the score is made
Band D = Case ascertainment is between 60 to <70%, an adjustment resulting in 70% of the score is made
Band E = Case ascertainment is less than 60%, an adjustment resulting in 50% of the score is made
Adjustment 2:
Audit compliance adjustments:
Band A = Audit compliance is 90 or higher, no adjustment is made to the score (100% of the remaining score following Adjustment 1 is maintained)
Band B = Audit compliance is between 80 to <90, an adjustment resulting in 95% of the remaining score following Adjustment 1 is made
Band C = Audit compliance is between 70 to <80, an adjustment resulting in 90% of the remaining score following Adjustment 1 is made
Band D = Audit compliance is between 50 to <70, an adjustment resulting in 85% of the remaining score following Adjustment 1 is made
Band E = Audit compliance is less than 50, an adjustment resulting in 80% of the remaining score following Adjustment 1 is made
For example, a team with 70-79% case ascertainment would keep 85% of their original score in Adjustment 1. If that team had 80-89 audit compliance, the team would occur a second adjustment, keeping 95% of their remaining score.
SSNAP Score and Level:
Less than optimal case ascertainment or audit compliance will result in a team receiving downwards adjustments. The size of the adjustments vary depending on how low the case ascertainment or audit compliance band is. The resulting adjusted SSNAP score is then assigned a level:
"A= over 80
B= between 70 and <80
C= between 60 and <70
D= between 40 and <60
E= less than 40"
4) Patient-centred and team-centred SSNAP scores:
The same process as above is used to calculate the patient-centred and team-centred SSNAP scores, except the specific Total Key Indicator scores are used rather than the Combined Total Key Indicator score.