1. A therapy assistant performs an initial, limited assessment and then a qualified therapist completes the remainder of the initial assessment later. Would both assessments be recorded under "Other" or would the initial assessment be recorded under "Other" and the later assessment be split under the appropriate domains?
All minutes for any initial comprehensive, holistic assessment should be included under "Other". Any further domain-specific assessments should go under their relevant therapy/care type, i.e. cognition assessment should go under psychological function.
In this scenario, both assessments are part of the initial assessment and should be recorded under "Other".
2. If a full initial assessment takes a full hour and includes mood and cognition assessment, and a stairs assessment, should we split the time between domains, e.g. 30 minutes into "Other", 20 minutes into "Psychological" and 10 into "Motor"?
See answer to question 1. In this scenario, the whole initial assessment should be recorded under "Other".
3. Do all initial screens by therapists go under "Other" even if it is performed by one therapist?
See answer to question 1. If the initial assessment by one therapist is a comprehensive, holistic assessment, this should be included under "Other". If the assessment is domain-specific, this should be included under the appropriate domain.
4. If therapy programmes have been taught to family members, can we include these minutes?
Only include time spent in treatment or rehabilitation under the supervision of a healthcare professional, either one-to-one or in a group session. Therapy on SSNAP does include training patients and carers around issues related to a specific patient (i.e. not general training). Therapy on SSNAP does not include independent practice by the patient on their own or without a healthcare professional present.
5. How would we record a supported communication education session with a family member, with the patient not present?
There are a small number of cases where information around training relevant to an individual patient can be included. If you have delivered a tailored, specific to that patient therapy session training a communication partner around the patient, this can be included. These would be included under the "Communication/Swallowing" domain. A general training session to all relatives on the ward around communication would not be included.
6. At inpatient services, if nurses provide input toward goals, would we be recording their minutes spent on that input and which domain does it go under?
The recorded treatment minutes can be provided by any clinician, assistant, support worker or student without supervision, with stroke specific knowledge and skills pertinent to the rehabilitation being undertaken, the underlying impairment and treatment modality. The input provided should form part of delivery of a documented evidence-based therapy treatment plan; be informed by assessment and patient specific goals; be progressive in nature, with capability for concurrent (re-) assessment and grading where appropriate. Delivery of routine care, such as providing personal care, toileting or transfers should not be included as rehabilitation. Please attribute minutes to the category that best describes the main focus of that therapeutic session, or part of a session.
Minutes can include team members employed by different organisations if they are working intrinsically with the stroke team, have stroke specialist knowledge and skills and are working to a goal based part of the stroke team's treatment programme.
Further details about broader contribution to rehabilitation can be found in the help notes appendix and here: https://www.youtube.com/watch?v=jovAnK64CcU.
7. Can we include Dietitian or Orthoptist input in the therapy minutes?
See answer to question 6.
8. If a cognitive/mood assessment is carried out and no concerns are raised and therefore psychological function therapy is not required, do we select "No" for requiring psychological function therapy and still put the minutes in psychological function?
If the patient does not require psychological function then "No" should be selected for Q4.4.2 (Was the patient considered to require this care or treatment at any point in this admission? Psychological function). Once "No" is selected, no days or minutes of therapy should be recorded.
9. Regarding multiple therapies inputting data for the 4 rehabilitation domains, will there be a function to record different disciplines separately?
The SSNAP dataset has moved away from who has provided the rehabilitation and toward what rehabilitation the patient has received. There will not be an option to record who delivered the therapy.
10. Historically chest physiotherapy was not included in SSNAP minutes, if and where can this be recorded on the new SSNAP dataset?
If the chest physiotherapy is part of the stroke management plan, such as the patient has aspirated and requires chest physiotherapy as a result, this can be recorded. Chest physiotherapy minutes should be recorded under "Other". If the patient has a respiratory condition not related to stroke, such as COPD or Cystic Fibrosis, and the chest physiotherapy is provided as part of normal management, this should not be included.
11. If a patient is considered to require care under multiple domains, is there a way to record when a patient no longer required rehabilitation for a specific domain? It feels the patient will fail the 3 hour motor therapy target but they do not require it.
There is no way on SSNAP to record when a patient no longer requires rehabilitation for a specific domain. Services can record in Q7.3.1 when the patient was considered to no longer require inpatient care, and this can be before the discharge/transfer date/time recorded in Q7.3.
Key indicators 6.1 (Percentage of patients receiving 3 hours of motor therapy per day motor therapy received), 6.3 (Percentage of patients receiving 45 minutes of psychological therapy per day psychological therapy received) and 6.5 (Percentage of patients receiving 45 minutes of communication/swallowing therapy per day communication/swallowing therapy received) look at the number of minutes of the respective therapies received over the number of days the respective therapy was actually received. Guidance on key indicator calculations is available in the Simplified Technical Guidance.
12. A patient is assessed and recorded as requiring motor therapy. The patient is then discharged the same day to ESD and so no motor therapy is received. How should this be recorded?
The patient should be recorded as considered to require motor therapy in Q4.4.1 (Was the patient considered to require this care or treatment at any point in this admission? Motor function) and 0 days of motor therapy recorded in Q4.5 (On how many days did the patient receive this care/treatment across their total stay in this hospital/team? Motor function).
The key indicator and domain levels used to calculate SSNAP scores account for cases such as this. Guidance on the scoring process is available in the Scoring Summary.
13. If a patient has received their initial assessments but does not require any ongoing therapy, how is this recorded?
The patient should be recorded as considered to require "Other" and the initial assessment minutes should be recorded under "Other". The patient should then be recorded as not considered to require Motor, Psychological and Communication/Swallowing therapy.
14. If a patient is on ICU, can the first contact from an ICU therapist count as the initial assessment or does this need to be first contact on a stroke unit?
If the initial assessment is stroke or neuro-specific, then this can count toward the initial assessment. If the initial assessment is not stroke or neuro-specific, then this would not count.
15. If a session is joint between a Psychologist and a Speech and Language Therapist, should this be recorded as 45 minutes of each if they are giving equal input?
The number of minutes a patient received should be recorded and not the number of staff in a session. The 45 minutes should not be double-counted.
Where there is more than one focus to a single session then minutes would be apportioned for each part and added up under each category appropriately. Please do not count the same minutes under more than one category, and do not double-count within the same category.
16. Who is applicable for therapy?
If a patient is assessed and requires further therapy at any point during their total stay under the care of your team, then the patient should be recorded as applicable for therapy, regardless of how much therapy the patient requires or receives.
17. Is the total number of therapy minutes that a patient received during their stay the amount of therapy they received while in the care of my team or across their stroke pathway?
The stay refers to the team answering the question on the audit. You should enter the total amount of therapy they received while in your care. The unit of measurement is minutes. The number of minutes must be a whole number.
18. Should the total therapy minutes provided by rehabilitation assistants include time when they are working alongside a therapist? Most of our assistants provide therapy sessions alongside therapists. How would we break this down into individual minutes for the purpose of recording?
Where a session has required two members of staff and one is qualified and one is an assistant, assume the session has been led by the qualified therapist. Record all minutes under qualified and do not record any minutes as assistant provided (i.e. do not split split minutes across staff groups) and do not double-count the minutes.
19. If rehabilitation is delivered by a rehabilitation assistant in a group session, do we count the minutes in both categories?
Yes, please count the minutes in both categories. The minutes should only be counted once in the total minutes, however they can then be recorded as being delivered by both a rehabilitation assistant and in a group session, as these will not need to total the total minutes.
20. If the patient has an initial assessment from a single profession and that professional feels the patient needs no further therapy input from other professions, do the other professions need to perform their initial assessments?
“Patient had no relevant deficit” should be answered if the patient was not considered to have any problems requiring Occupational therapy (Q3.5), Physiotherapy (Q3.6), or Speech and Language therapy (Q3.7) input.
If it is determined in the initial assessment by a single profession that the patient has no relevant deficit for another discipline, then “Patient had no relevant deficit” can be recorded. The date/time of the initial assessment should not be recorded as the date/time the patient was first assessed by the other professions.