Clinical Audit Terminology

Key term	Definition
‘Locked’ data	Only ‘locked’ data are included in SSNAP analysis. The process of locking ensures high data quality and signifies that the data have been signed off by the lead clinician and are ready for central analysis. SSNAP records can be locked at three levels depending on their level of completion: ‘Locked to 72 hours’ for patients who have received their acute care provision. Sections 1-3 in the proforma are locked. ‘Locked to discharge’ for patients who have been discharged from one or more care provider. Sections 1-7 in the proforma are locked. ‘Locked to six months/all’ for patients for patients for whom 6 month assessment status has been recorded. Sections 1-8 in the proforma are locked.
Unlock	If a user needs to edit a record, it can be unlocked. Guidance on how to unlock a record is provided here.
Delete	Deletion refers to the complete patient record being removed from SSNAP, i.e. all data entered for that patient is deleted across all teams. Guidance on how to delete a record is provided here.
Revoke	This refers to revoking the transfer of a patient record from one team to another. Reasons for this include: Team A has transferred a record to Team B on the webtool, but Team B have not actually seen the patient. The transfer can be revoked from Team B to Team A. Team C transfer the record to Team D but then Team C need to edit the record. The transfer can be revoked from Team D to Team C. Any data entered by Team D will be deleted when the transfer is revoked. Guidance on how to revoke a record is provided here.
Key indicators	44 key indicators have been chosen by the Intercollegiate Stroke Working Party (ICSWP) as representative of high-quality care. These include data items included in the CCG Outcomes Indicator Set and NICE Quality Standards (covering England only). Examples include ‘Percentage of patients that were scanned within 1 hour of clock start’ and ‘Median time between clock start and thrombolysis’. The 44 SSNAP key indicators can be viewed and downloaded here.
Domains	The key indicators are grouped into 10 domains covering key aspects of the process of stroke case. Examples include ‘Stroke unit’ and ‘Discharge processes’. The 10 SSNAP domains can be viewed and downloaded here.
Six month assessment	This is a follow-up assessment for stroke patients due between 4 and 8 months after stroke. Six-month assessment data includes information on anticoagulation, further stroke and serious illness and mood and cognition, as well as modified Rankin Scale and mortality. Consent must be sought from the patient before six-month assessment data is uploaded onto SSNAP. The SSNAP six-month assessment leaflet and consent form can be viewed and downloaded here.
Case ascertainment	Measure of the coverage of all stroke patients. The aim is to have a patient record created on SSNAP for each new stroke admission. This Helpdesk article provides further information on how case ascertainment is calculated.    Case ascertainment and audit compliance overview
Audit compliance	Includes measures of completeness of items where it is possible to answer “not known” as all questions are mandatory. It also measures processes involved in the audit such as timely data entry and transfer of records between participating teams. This Helpdesk article provides further information on how audit compliance is calculated.    Case ascertainment and audit compliance overview
Team code	This is a unique identifier for each SSNAP team. It is 3 digits for inpatient teams, e.g. 000 and 4 characters beginning with a C for non-inpatient teams, e.g. C000.
Registration code	This is a unique code assigned to each SSNAP team and acts as an additional security measure for new user registration. This can be provided by the Lead Contact and the Second Lead Contact for each team (found in the ‘User Profile’ area of the webtool). This registration code is 6 characters long.
SSNAP reports on the processes of care and patient outcomes in two ways: ‘patient centred’ and ‘team centred’
Patient-centred results	‘Patient centred’ attribute the results to every team which treated the patient at any point in their care. A team’s patient-centred results demonstrate the quality of care that their patients received across the whole inpatient care pathway, regardless of how many teams each patient went to, or which of the teams provided each aspect of care.
Team-centred results	‘Team centred’ attribute the results to the team considered to be most appropriate to assign the responsibility for the measure to.
Types of teams on SSNAP
Routinely admitting team	Routinely admitting acute teams: teams which admit stroke patients directly for acute stroke care
Non-routinely admitting team	Non-routinely admitting acute teams: teams which do not generally admit stroke patients directly but continue to provide care in an acute setting when patients have been transferred from place of initial treatment
Non-acute inpatient teams	Non-acute inpatient teams: teams which provide inpatient rehabilitation in a post-acute setting e.g. community hospitals
Post-acute non-inpatient team	Post-acute non inpatient teams: these teams include early supported discharge and community rehabilitation teams
Specialist Community Rehabilitation Team (CRT)	A specialist community rehabilitation team refers to a stroke specific service delivered by specialist professionals within a multi-disciplinary team working in the community delivering rehabilitation services within a patient’s home. A community rehabilitation team (CRT) will cater for patients following inpatient rehabilitation or transfer from Early Supported Discharge (ESD).
Early Supported Discharge team (ESD)	An Early Supported Discharge team refers a stroke specific service delivered by specialist professionals within a multi-disciplinary team to provide rehabilitation and support in a community setting with the aim of reducing the duration of hospital care for stroke patients and enabling them to return home quicker.
Domiciliary service (not ESD/CRT)	Teams which provide post-acute rehabilitation at a patient’s home but excludes Early Supported Discharge (ESD) or Community Rehabilitation Teams (CRT).
Six month assessment providers	Six month assessment providers: community based teams that provide six month reviews
Tiers of analysis
Hospital or ‘Team’ level analysis	This includes aggregate level patient data at individual service or ‘team’ level for the relevant reporting period.
Regional level analysis	This includes aggregate level patient data at service level with teams being grouped according to the region in which they are based. Services in England are regionalised by the strategic clinical network (SCN) to which they belong. Wales and Northern Ireland are also reported as separate regions.
National level analysis	This includes all patient data for England, Wales and Northern Ireland aggregated together to provide national level results.
Population or 'CCG/LHB' level analysis	This includes aggregate level patient data but rather than assigning patients to the stroke service where they were treated, they are assigned to the clinical commissioning group (CCG) or local health board (LHB) in which they belong. This is achieved by linking patients’ home postcodes to that of the relevant CCG or LHB. In this way specific population level reporting of stroke care is possible.