1. What if a patient has a second stroke?
There are different scenarios that could apply to a patient suffering a second stroke:
1. Patient suffering a second stroke: If a patient suffers a second stroke, the initial record should be locked to discharge and a new record created for the second stroke event. The last team to see the patient (for the first stroke) would discharge the patient to "somewhere else" at the point they had their second stroke. The second record can be transferred on as normal and the community team can enter their data. When it comes to the 6-month assessment, the following advice should be followed: If a patient suffers another stroke before their 6 month assessment is due, which stroke record on SSNAP should the 6 month assessment information be entered for?
2. Patient suffering two strokes on the same day: If a patient suffers a second stroke on the same day, please add only the second stroke onto SSNAP.
3. Patient suffering two inpatient strokes: When an inpatient strokes more than once during their stay, both occurrences of stroke (providing the strokes are separate events) should be recorded. The dataset will not allow two records to be created for the same person with the same date and time of arrival, this is to ensure duplicate records are not created. In order to capture both events, you should therefore enter the date of arrival for the second stroke as the day after arrival. Time of arrival should remain the same.
2. Definition of a stroke unit
A stroke unit is defined as: a multi-disciplinary team including specialist nursing staff based in a discrete ward which is geographically defined and has been designated for stroke patients.
For the full criteria for what is necessary for a unit to be considered one which gives specialist stroke care, please refer to the National Clinical Guideline for Stroke:
- Page 15: 'Recommendations' (section 2.4.1)
- Page xiv: 'Resources' (2.4.1B, 2.4.1D, 2.4.1K)
If the recommendations/criteria are met for the patient then please enter stroke unit, if not please enter other/the ward which most fits with the staff and services unavailable.
3. When does the "clock" start for questions regarding the first 72 hours of care?
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 is already in hospital at the time of their stroke.
4. Why is there no "Not known" option for the diameter of the intracerebral haematoma (Q2.17)?
We have a reasonable expectation that the size of a haemoatoma in diameter is a measure that will always be known, either in an x-ray report or in the medical record, and we are trying to report a culture change where this is always reliably documented. However, as with all new dataset items, we understand that when rolled out to the whole of the clinical community, there are variations in practice and data recording that we had not anticipated when piloting. Bearing that in mind, we will continue to monitor feedback about this question in the event that it needs to be reviewed.
5. Who is applicable on SSNAP to have an ASPECTs score recorded?
This question is available to be entered for all ischaemic strokes that had a plain non-contrast CT. The expectation is that all of these patients would have an ASPECTs score recorded, however there is a "Not Known" option for the ASPECTs score which can be used if the score is not known.
6. Brain imaging modality
You can now select all scans that were performed during the patient's first visit to the clinical imaging/radiology department. If multiple scans were carried out during the patient's first visit to the radiology department/scanner, select all scans carried out during this visit. For example if a patient had a plain CT followed by a CT angiogram (CTA) followed by a CT perfusion (CTP) on the same visit to the scanner, select 'Plain/non-contrast CT', 'CT intracranial angiogram' and 'CT perfusion' for this question. You are not able to select both MRI and CT imaging options for this question, please choose the scan type the patient received first.
7. Following the change in standards for OT and PT assessment from “within 72hrs” to “within 24hrs”, if patients are not seen within the first 24 hours due to some circumstance (e.g. Patient Clinically Unwell) but ARE seen within the first 72 hours, there is no place in the webtool for us to input that. Will this affect our scores and how should we mitigate this?
It would not be feasible to restructure the webtool purely to accommodate the shift in standards for initial OT and PT assessment from ‘within 72 hours’ to ‘within 24 hours’, as the webtool must, in every other respect, still reflect and record the initial period of hyperacute care up to the 72-hour locking point. So, we must continue to work within the webtool structure as originally divided into pre- and post-72 hours.
The focus remains on delivering PT and OT assessments as soon as possible – in line with the guideline recommendations. There will always be reasons why for some patients that is not possible, including being medically unwell, but we would not expect that proportion to vary between sites – indeed if an unusually high proportion of patients were being recorded at any site as too unwell to be assessed, that should be the trigger for local audit to answer the question as to why that might be.
A threshold for an ‘A’ rating of 90% of patients assessed within 24 hours reflects an expectation that about 10% of patients will be medically unwell (or, in very few cases, refuse an assessment) and thereby unsuitable for assessment, but that in a high-performing service, everyone else would be. If a patient cannot be assessed within 24 hours for organisational reasons (e.g. staffing levels or staffing rotas prevent this) then this will affect the reported proportion hitting the 24-hour target and may result in them being recorded as not assessed within 72 hours for organisational reasons. Both measures interpreted together will give an indication of the service’s capability to assess patients in a timely fashion.
So, without a complex restructuring of the webtool, this represents the best compromise to accommodate the new guideline recommendations of PT and OT assessment within 24 hours.