1. If the patient is discharged from the service before 6 months, can we discharge the patient on SSNAP or wait for 6 months?
The patient should be discharged on the webtool once they are discharged from the service or at 6 months after stroke, whichever is first.
If a patient is still receiving care at your team 6 months after their stroke, you should enter a discharge date for the patient so that their 6 month assessment can be completed. Community rehabilitation teams can select "Completed their SSNAP record at 6 months but continues to receive/treatment from this team" as the discharge destination in Q3.1.
2. If the standardised cognitive, mood and visual screens have recently occurred on the stroke unit prior to ESD pick-up, are we able to enter these assessment dates on the data tool?
No, prior dates should not be recorded as these would be recorded by the team(s) performing the screen(s). It is expected that a patient has a reassessment for mood in the community. For cognition, "Not clinically required" should be chosen if screening/assessment has already been completed and due consideration has been given regarding the value of repeating screens (as per national clinical guidelines). For vision screen, "Screened by previous team" should be chosen if the patient has been previously screened for visual impairment by a previous team.
3. Can initial assessments by non-registered members of staff, including students, be recorded as the first assessment?
Initial assessments can be completed by a student or apprentice (and collected as assistant as per help notes), under the supervision of a qualified member of staff as part of their training. Initial assessments should not otherwise be undertaken by unregistered staff.
4. Are the four week blocks unique to the patients (i.e. measured from when they start with the community team) or is it based on monthly blocks?
The four week blocks are unique to each patient. Once the first assessment date and time have been entered, the start and end dates for each of the blocks will auto-populate for that patient on the webtool.
5. If a patient receives no therapy in a given week, do we document this as zero or leave this blank?
If the patient was considered to require therapy and did not receive any therapy, this would be documented as 0 days and 0 minutes. Therapy/care is recorded in blocks of 28 days and so any other therapy received in the 28 day period should be recorded. If no therapy was received in the 28 day period, then this would be recorded as 0.
6. We do the initial assessment and will identify the need for Occupational therapy, but there may a be a 6-7 week wait for that patient to see an Occupational therapist. Do we document on SSNAP that for these 7 weeks there was zero input?
Please record 0 days for any blocks the patient did not receive any therapy and record any therapy they do receive in the next block(s). The blocks have been designed to help us understand and explain where gaps are.
7. Which version of Barthel should be used for SSNAP?
The 10-item version with total score ranging from 0 to 20 (Collin and Wade, 1988) should be used. A version produced by Greater Manchester is available here: https://gmnisdn.org.uk/wp-content/uploads/2024/02/Barthel-Index.pdf.
8. Regarding patient consent for inclusion in SSNAP, are there any resources to use in the initial assessment pack to go through with patients?
Patient information sheets are available here: Information sheets.
9. What should be entered if there is not an up-to-date Modified Rankin Scale (mRS) on discharge?
Although every effort should be made to record this accurately, if the mRS is not known then a best estimate should be entered based on clinical judgement. However mRS should be available for all patients and therefore a "not known" option is unavailable. mRS on discharge gives incredibly important data on outcomes.
10. As 4 weekly recording is from the first face-to-face contact rather than admission, will the new dataset record admission to ESD/CRT teams and how will response times be recorded?
This has not changed with the new dataset. The clock will start for community services from the date and time of first face-to-face assessment. Response times remain important and a key feature of early supported discharge is being able to pick up within 24 hours and we have standards around non-ESD patients being seen promptly. These will continue to be reported.
11. If the patient has been discharged at 6 months on SSNAP for the purposes of the 6 month assessment, what do we record for the outcome measures from the community?
The outcome measures can be the same as those collected and recorded for the 6 month assessment. The discharge destination in Q3.1 should be recorded as "Competed their SSNAP record at 6 months but continues to receive care/treatment from this team".
12. How do we record those patients that never have a face-to-face assessment? We triage patients with a holistic assessment over the phone and some patients will decline therapy, not require therapy or only require a high level rehabilitation programme that does not require face-to-face intervention.
All patients should be assessed. If a patient has not been assessed and there is no assessment date and time, then these patients should not be recorded on SSNAP. If the record has been transferred to your team on SSNAP, please revoke the record back to the acute team and ask them to amend the discharge destination. Hospital and community teams should liaise to ensure a coordinated transfer of care and ensure only appropriate records are transferred on the SSNAP webtool.
The first assessment on SSNAP needs to be a face-to-face assessment. This has been maintained in SSNAP to reflect best practice and evidence. There are some examples where the patient may be appropriate to have an initial video consultation that is recorded on SSNAP, but this should only be an option if it is categorically known that no environmental or physical issues exist. In the event of video assessment being completed, the clinician must be satisfied that the definition of a comprehensive assessment has been completed for this to be used as first assessment.
If a patient has not received a face-to-face assessment or in exceptional cases an initial comprehensive video assessment, the patient should not be recorded on SSNAP.
It remains that only those patients with a confirmed stroke diagnosis should be added to the SSNAP dataset.
13. How should patients be recorded if they only have an initial assessment and then have no goals and are discharged?
Patients who are assessed and subsequently decline therapy or do not require therapy should be added to SSNAP. The dataset can then be completed. The therapy or care a patient is considered to require can be recorded in Q2.5, and any therapy/care not considered can be recorded as “No”.
It remains that only those patients with a confirmed stroke diagnosis should be added to the SSNAP dataset.
14. Our community rehabilitation service also completes the 6 month review, and we are registered as one service on SSNAP. If a patient either requires no therapy or has been discharged before 6 months, do we need to keep the record open to complete the 6 month review?
No. The 6 month assessment will be completed using the 6 month look-up tool for all patients and so completed separately to the rest of the record. If a patient has been discharged from the service before 6 months, then this should be recorded as such on SSNAP and the record locked to discharge. The above advice (Qs 12 and 13) should be followed for patients that did not receive an assessment or did not require any therapy. The 6 month assessment can then be completed at 6 months.
Guidance on using the 6 month look-up tool will be available in 2025.