Maintaining quality

The fifth edition of the National Clinical Guideline for Stroke was published in October 2016. The guideline covers:

  • organisation of stroke services
  • acute care
  • recovery and rehabilitation
  • long-term management
  • secondary prevention
  • commissioning of stroke services.

The State of the Nation: Stroke statistics guide was published by the Stroke Association in 2016 and provides a helpful summary of data about stroke epidemiology, risk factors, prevention and treatment.

The Sentinel National Stroke Audit Programme (SSNAP) based at King’s College London has been integral to improving stroke care. All hospitals that admit stroke patients in England, Wales and Northern Ireland contribute data about all stroke patients to this prospective audit. SSNAP produces detailed reports every 3 months and annually which describe the overall quality of stroke care in each trust/service (graded A–E). Performance in the following ten domains is also reported on:

  • scanning
  • stroke units
  • thrombolysis
  • specialist assessments
  • occupational therapy
  • physiotherapy
  • speech and language therapy
  • multidisciplinary team work
  • standards by discharge
  • discharge processes.

Results are available for each trust, clinical commissioning group (CCG), region and nation (England, Wales and Northern Ireland). These results, which are publicly available, enable services to review the quality of care they provide. The acute organisational audit provides a biennial snapshot of the quality of stroke service organisation in acute settings. The post-acute audit is a more recent development which looks at the stroke services which have been commissioned and how they are provided.

There are also regular reports about the organisation of acute services and post-acute care. SSNAP reports are available at hospital level, regionally, nationally or by CCG/local health board/local commissioning group. There are also public reports and easy access versions.

The national Commissioning for Quality and Innovation (CQUINs) are based on the National Clinical Guideline Audit for Stroke.

The following NICE guidance is relevant to the care of stroke patients: