Entering SSNAP data during the COVID-19 period FAQs

Below are the answers to some COVID-19-related queries received by our helpdesk. Please continue to keep us updated on the issues and barriers to data entry due to COVID-19-related circumstances or changing policies within your trust as this will help inform any decisions.

Can we record COVID status on SSNAP?

Additional questions regarding confirmed or suspected COVID status have been added to section 9. Please remember to complete these questions for every patient:

• Was COVID confirmed at any time during the stroke illness or after death? 

‘Yes’ should be selected if there is documented evidence that a COVID-19 diagnosis was confirmed.

• If COVID not confirmed was it suspected clinically? 

Although a COVID-19 diagnosis was not confirmed, is there documented evidence that it was suspected by your clinicians.

On the current webtool (www.strokeaudit.org) section 9 is not mandatory, however we would advise teams to answer those questions if they continue to enter data via the full dataset. It is a useful question that will allow teams to keep a record of stroke patients impacted by COVID.

Are there any plans to return to the minimum dataset?

There are currently no immediate plans to re-open the minimum dataset for collection, however as the situation evolves and based on feedback from our funders (NHS England and the Welsh Government) and from SSNAP teams, we will continuously assess all options for data entry going forward and will keep teams updated with any changes.

Patients are no longer being transferred to our team because of COVID-19, will our team still get a report?

To get a report, inpatient teams must enter and lock at least 20 records, as well as achieve 75% case ascertainment. For April-June 2020 and July-September 2020, the expected cases for all routinely admitting teams were reduced to account for the reported reduction in stroke admissions. We will continue to review this going forward.

For non-routinely admitting teams and non-acute inpatient teams, case ascertainment is calculated by comparing the number of patients arriving at a team with the number of patients leaving the team in a reporting period, essentially it is all patients discharged/transferred from the team, divided by those transferred to/admitted to the team. Due to the way this is calculated, there is unfortunately not much we can do to ensure the team gets a report if the thresholds aren’t met and we encourage teams to run the data through the DIY analysis tool for any periods they do not get a report.

Please let us know if you don’t think your team will reach these thresholds in a given reporting period.

Our stroke unit is now closed, can we still answer ‘stroke unit’ if the stroke team are managing stroke patients in other areas of the hospital?

 To answer stroke unit, the area in which the patient is seen must meet all the usual criteria for 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 Guidelines for stroke:

• Page 16: '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 available. 

We have stopped collecting data during the pandemic, how should we deal with records that are still being transferred to our team?

These records will need to be revoked back to the previous team. Please contact the previous team (contact information for SSNAP teams can be found here) and ask that they revoke the records. Let the team who transferred the records know that you are not completing SSNAP records at the moment, so that they can discharge those records to "Team not participating on SSNAP" in Section 7.

Should we include patients who have been quarantined on SSNAP?

 Yes, all patients with a primary diagnosis of stroke coded as I-61, I-63, I-64 should be submitted to SSNAP, please include patients who have been quarantined.

We are experiencing delays in getting the records for quarantined patients, will this affect our audit compliance score?

For the previous 3 reporting periods we have not included scoring in our reports in part because case ascertainment and audit compliance have been affected during the COVID period.

A decision has not been made about scoring or audit compliance for October-December 2020, and this will be reviewed closer to the deadline in February 2021. As the situation evolves and based on feedback from our funders (NHS England and the Welsh Government) and from SSNAP teams, we will continuously assess all options for data entry and reporting going forward and will keep teams updated with any changes. Please continue to keep us updated on the issues/barriers to data entry due to COVID-related circumstances or changing policies within your trust as this will help inform SSNAP decisions.

How should we enter data for COVID-19 positive patients who will arrive on the stroke unit after 14 days of isolation (not in the first 72h)?

 If an isolation ward or special COVID unit was the first ward the patient went to then for Q1.14 (on the main webtool) you can choose ITU/CCU/HDU (specifically for HDU).

For 1.15 you can then put the date and time the patient first arrived on a stroke unit.

If you are the team starting the record, then 4.2 and 4.3 will be populated with the selections for 1.14 and 1.15.

We are struggling to enter data because of staff sickness and redeployment, and so will not be able to enter data this quarter.

We understand that stroke services are under a lot of pressure currently, including those entering the data and that this has impacted SSNAP data entry. This is why we have not made SSNAP scoring, including audit compliance and case ascertainment, publicly available since January 2020. For the previous two reporting periods we have also reduced the number of expected cases for routinely admitting teams to reflect a decrease in stroke admissions. A decision has not been made about scoring or case ascertainment for October-December 2020, and this will be reviewed closer to the deadline in February 2021.

The stance from NHSE and the Welsh Government is still that data collection can be suspended by teams if needed, and so you are not under obligation to enter data onto SSNAP, and we will make a note of this for our records. However, if you do enter data and this meets the threshold to get a report (e.g. 75% case ascertainment and at least 20 records) we are under obligation to publish this data in the public domain.

Please continue to keep us updated on the issues/barriers to data entry due to COVID-related circumstances, we are continuously assessing all options for data entry going forward and will keep teams updated with any changes.