National Report on Stroke Services in Scottish Hospitals ... · • Support management decision making by: • providing data to allow better service planning; • providing data

National Report on Stroke Services in Scottish Hospitals

2005/2006 Scottish Stroke Care Audit

Prepared by Martin Dennis, Robin Flaig, Mike McDowall, Jennifer Bishop, Alyson

McDonald and Laura Kelso.

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1 Acknowledgements

This report could not have been written without the help of a great many people: the

audit, clinical, IT and Managed Clinical Network staff at all units participating in the

audit who ran their local data collection, provided local reports and commented on

drafts of this national report; the Steering Committee, Information and Statistics

Division Scotland and NHS Quality Improvement Scotland who provided invaluable

support and guidance; Chest Heart and Stroke Scotland; the Royal College of

Physicians Edinburgh; the Scottish Executive through NHS Quality Improvement

Scotland and the CHD & Stroke Strategy who provided funding for the Scottish

Stroke Care Audit.

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Table of Contents

1 Acknowledgements 2

2 Introduction 5 2.1 Stroke in Scotland 5 2.2 Background 5 2.3 This report 5

3 Scottish Stroke Care Audit (SSCA) – An Overview 6 3.1 Aims 6 3.2 Ethical requirements 6 3.3 Requirements for Data Protection 7 3.4 Tools for the audit 7 3.4.1 Data Sets 7 3.4.2 SSCAS Software 7 3.4.3 Audit Website 8 3.5 Funding, Staffing and Responsibilities 8 3.5.1 Central 8

3.5.1.1 Staff 8 3.5.1.2 Funding 8

3.5.2 Local 8 3.5.2.1 Staff 8 3.5.2.2 Funding 9

3.6 Key Stages of the Audit 9 3.6.1 Case Ascertainment 9 3.6.2 Data Collection 9 3.6.3 Data Entry 9 3.6.4 Data Validation 9 3.6.5 Reporting 9

4 Preparation of the report 10 4.1 Period of Data Collection 10 4.2 Methods of analysis 10 4.3 Interpretation of data 11

4.3.1 General 11 4.3.2 Scotland wide figures 11 4.3.3 Service changes 11

4.4 Limitations of the data 11 4.4.1 Incomplete case ascertainment 12 4.4.2 Failure to track patients through to discharge 12 4.4.3 Inadequate input from clinicians 12 4.4.4 Incomplete or unclear recording of process in clinical notes 12 4.4.5 Deviation from minimum dataset 12 4.4.6 Failure to adhere to definitions and coding rules 12 4.4.7 Difficulties with audit staff 13

4.5 Data Completeness of SMR01 and SSCAS data 13 4.5.1 By Health Board - Table 1 13 4.5.2 By Hospital - Table 2 13 4.5.3 Possible missing cases - Table 3 14

5 Inpatient Tables 18 5.1 Inpatient Table Definitions: 18 5.2 Scotland wide - Table 4 21 5.3 Ayrshire and Arran - Table 5 23 5.4 Argyll and Clyde - Table 6 25 5.5 Borders - Table 7 27 5.6 Dumfries and Galloway - Table 8 29 5.7 Fife - Table 9 31 5.8 Forth Valley - Table 10 33 5.9 Highlands - Table 11 35 5.10 Lanarkshire - Table 12 37

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5.11 Greater Glasgow, North - Table 13 39 5.12 Greater Glasgow, South - Table 14 41 5.13 Grampian - Table 15 43 5.14 Lothian - Table 16 45 5.15 Tayside - Table 17 47 5.16 Islands - Table 18 49

6 Outpatient Tables 51 6.1 Outpatient Definitions 51 6.2 Scotland Wide - Table 19 53 6.3 Ayrshire and Arran - Table 20 54 6.4 Argyll and Clyde - Table 21 55 6.5 Dumfries and Galloway - Table 22 56 6.6 Fife - Table 23 57 6.7 Highlands - Table 24 58 6.8 Lanarkshire - Table 25 59 6.9 Grampian - Table 26 60 6.10 Lothian - Table 27 61 6.11 Tayside - Table 28 62

7 ISD Linkage Data (Inpatients only) 63 7.1 Casemix Comparisons 63 7.1.1 Mean age by Health Board - Chart 1 63 7.1.2 Mean age by Hospital - Chart 2 64 7.1.3 % Independent in Activities of Daily Living pre-stroke, by Health Board - Chart 3 65 7.1.4 % Independent in Activities of Daily Living pre-stroke, by Hospital - Chart 4 66 7.1.5 % Living Alone pre-stroke, by Health Board - Chart 5 67 7.1.6 % Living Alone pre-stroke, by Hospital - Chart 6 68 7.1.7 % Able to lift arms on admission, by Health Board - Chart 7 69 7.1.8 % Able to lift arms on admission, by Hospital - Chart 8 70 7.1.9 % Able to walk independently on admission, by Health Board - Chart 9 71 7.1.10 % Able to walk independently on admission, by Hospital - Chart 10 72 7.1.11 % Able to talk and not confused on admission, by Health Board - Chart 11 73 7.1.12 % Able to talk and not confused on admission, by Hospital - Chart 12 74 7.2 Survival Analyses 75 7.2.1 % Cases successfully linked and included for survival analyses 75

7.2.1.1 By Health Board - Table 29 75 7.2.1.2 By Hospital - Table 30 76

7.2.2 Six Month Survival After Stroke Admission by Health Board of Treatment 77 7.2.2.1 Crude Analysis - Table 31 77 7.2.2.2 Casemix Adjusted - Table 32 78 7.2.3 Six Month Survival After Stroke adjusted for casemix - Admission by Health

Board: W scores with 95% Confidence Intervals - Chart 13 79 7.2.4 Six Month Survival After Stroke Admission by Hospital of Treatment 80

7.2.4.1 Crude Analysis - Table 33 80 7.2.4.2 Casemix adjusted - Table 34 81 7.2.5 Six Month Survival After Stroke Admission by Hospital of Treatment: W scores

with 95% Confidence Intervals - Chart 14 83 7.2.6 Cox regression results for death at 6 months - Table 35 84

8 Future developments 86

9 Contacts 86

List of References 87

List of Appendices

Appendix A Minimum Dataset Definitions 88

Appendix B Comments on presented data from Health Boards 94

Appendix C Steering Committee Membership 98

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2 Introduction

2.1 Stroke in Scotland

Stroke is the third commonest cause of death in Scotland and the most common cause

of severe physical disability amongst adults. It is estimated that about 15,000 people

in Scotland have a stroke each year. Hospital care for these patients accounts for 7%

of all NHS beds and 5% of the entire NHS budget. Not surprisingly the Scottish

Executive has identified stroke as a priority.1

There is now strong evidence that the way patients with stroke are managed affects

their outcome, in terms of survival, functional status and risk of recurrence. Organised

stroke care delivered through a stroke unit and certain specific medical interventions

have been shown to improve outcome. The Scottish Intercollegiate Guidelines

Network (SIGN) have produced four guidelines2,3,4,5

which take account of this

evidence, much of which has been collated by members of the Cochrane

Collaboration Stroke Review Group, which is funded by the Chief Scientist’s Office

(CSO) and based in Scotland.

2.2 Background

The Scottish Stroke Care Audit was established in 2002. By 2005 all hospitals

admitting patients with acute stroke were participating. The first National Report of

data collected in the audit was published in 2005. This included data describing the

numbers of patients enrolled in each hospital and their process of care. It provided

stroke services in Scotland with the opportunity to compare their performance with

others.

NHS QIS published the Clinical Standards for Stroke Services: Care of the Patient in

the Acute Setting in March 20046, and carried out peer review visits across Scotland to

assess performance against the standards during Sept 2004 – May 2005. The audit

provided Managed Clinical Networks (MCN) with the data to complete their self-

assessment questionnaires for NHS QIS. Stroke services participating in the audit can

monitor their progress against the standards set by NHS QIS and those they have set

for themselves in their Quality Assessment Frameworks.

2.3 This report

This report provides updated information about the performance of each Health Board

and acute hospital in Scotland with respect to their stroke care. This year’s report

includes:

1. Data describing important aspects of the process of care (access to stroke unit

care, brain imaging, swallowing assessments, early administration of aspirin

and secondary prevention) for each acute hospital and each Health Board

Stroke MCN – similar to the data presented in last year’s report. However, this

year we have presented data for different time periods to indicate how the

process of care might be changing over time. Where available, we have

provided data for three periods, the first is the same as the 2005 National

Report, with two following time periods of six months.

2. Results of a data linkage between SSCAS data and ISD’s Scottish Morbidity

Record Type 01(SMR01). These provide some indication of the case

ascertainment achieved in each hospital and the accuracy of routine coding.

3. Case fatality (proportion dying by 6 months from data of admission). For

patients admitted with acute stroke to each hospital adjusted for casemix

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variables available through the audit. These data are comparable with those

produced routinely by ISD but the additional data collected by SSCAS allows

the case fatality to be more fully adjusted for variation in casemix between

services.

4. An analysis of those factors which are associated with lower case fatality after

acute stroke across Scotland.

3 Scottish Stroke Care Audit (SSCA) – An Overview

3.1 Aims

The Scottish Stroke Care Audit aims to:

• Drive improvements in the organisation and delivery of stroke care by

encouraging:

• sharing of good practice;

• adherence to best evidence; and

• better recording of patient care.

• Routinely monitor the performance of Scottish Hospitals to:

• improve accuracy and clinical usefulness of routinely collected data;

• measure against nationally agreed standards for stroke care, such as the stroke

components of the Scottish Executive’s Strategy for CHD and Stroke;

• facilitate an ongoing programme of national time-limited audits of specific

aspects of stroke care directed by the SSCA steering group, which forms a

subgroup of the National Advisory Committee for Stroke; and

• facilitate benchmarking and permit comparisons between units by encouraging

all Health Boards to use a common data set (with explicit definitions) collected

using standard methods.

• Support management decision making by:

• providing data to allow better service planning;

• providing data for consultant appraisal to reflect an individual clinician’s

performance; while

• being flexible enough to meet the information needs of individual users to help

address particular weaknesses in local clinical care.

• Bridge the gap between the routine data collection systems currently available

(mainly through ISD’s SMR01) and the expected future Clinical IT systems,

which will allow data for audit to be captured as part of routine care.

3.2 Ethical requirements

Patient consent is not required for a hospital audit. Patients should be informed of

potential use of their clinical records for audit purposes. All hospitals are aware that

each Health Board should have an information leaflet for patients about the Data

Protection Act and it should include a discussion of how the Health Board uses audit

data.

The Multi-Centre Research Ethics Committee has reviewed the SSCA in regards to

compliance with the Adults with Incapacity Act and has agreed that it is in compliance

with the Act. Participating hospitals do not need to obtain Local Research Ethics

Committee (LREC) approval for collecting and using the minimum dataset or extra

data collected during the hospital stay to reflect the performance of the stroke service.

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Nonetheless all participating hospitals should notify their LRECs that they are

participating in the audit.

If researchers at participating hospitals decide to collect additional data for research

purposes in addition to the audit, then they must obtain LREC approval and informed

patient consent is usually required.

3.3 Requirements for Data Protection

Data collected for the Audit must be kept in compliance with the Data Protection Act

(1998).

• Data use - access to identifiable data should be limited to staff with a real “need to

know” working under proper supervision and control.

• Paper records - all hospital notes and forms with patient identifiable information

should be locked up when left unattended. This includes any printouts with

identifiable data from the system and reports.

• Electronic data – must be kept on password protected systems. Networks must be

protected against un-authorized access. All back-up disks should also be locked

up.

• Audit system provisions - access to SSCAS requires a separate password and

patient names and addresses are stored in an encrypted format.

3.4 Tools for the audit

3.4.1 Data Sets

The audit collects a mandatory core data set for each episode which has led a patient

to be referred to a hospital. These are the data that must be collected on an individual

patient in order to be able to enter them into the database. They include identifiers,

simple demographics, information about their interaction with the health service and a

diagnosis.

A minimum dataset has been defined which has the mandatory core data at its centre

but which aims to provide information to reflect the quality of the stroke service. We

have defined these variables to help make data from different hospitals comparable

(Appendix A). This minimum dataset provides information on:

• patient demographics;

• the process of care and its appropriateness; and

• the performance of services in relation to National Standards.

This dataset includes six variables which describe casemix and allow correction of

case fatality. These are: age; whether patient was independent in everyday activities

prior to the stroke; whether the patient lived alone prior to the stroke; whether on an

assessment after admission to hospital they could talk AND were not confused, they

could lift both arms off the bed and could walk without help from another person.

These variables have been validated as casemix adjuster in several datasets7,8,9

3.4.2 SSCAS Software

One of the key aims of the collaboration has been to develop a software system which

supports the National Audits. The current software has been developed using Visual

FoxPro (version 5.0) which runs on PCs and improvements are ongoing. Detailed

analyses, beyond routine reporting, are facilitated by an export function in a standard

format that can be interpreted by many widely used programmes (e.g. Excel™,

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SPSS™, MINITAB™, SAS™). SSCAS has been designed to import information

from PAS systems and outcomes information from ISD/GRO. The export system is

designed for aggregate monitoring and audit. SSCAS has been designed so data items

can be easily added or subtracted. The system generates data entry screens

automatically. This makes SSCAS easily adaptable to local users needs. Indeed, every

centre has identified items additional to the minimum dataset which they aim to

collect for local use.

The MCN in Lanarkshire is using a web based system to support the Stroke Audit and

this has been used to provide their data for this report.

3.4.3 Audit Website

ISD has developed a website for the audit as a part of its Managed Clinical Networks

on the Web program. The URL is: http://www.strokeaudit.scot.nhs.uk/

The website has general information about the audit for people who are unfamiliar

with it, including a guide to the audit, draft forms and the previous National Report

available for download.

The website provides a resources for hospitals currently participating in SSCA. This

includes:

• User documentation

• Programme updates

• Discussion forum

3.5 Funding, Staffing and Responsibilities

3.5.1 Central

3.5.1.1 Staff

Martin Dennis is the national clinical lead for the audit, Robin Flaig is the national

audit co-ordinator, and Mike McDowall is the IT specialist. Martin Dennis gives

clinical guidance, in particular practical implementation of clinical guidelines and

standards. Robin Flaig is responsible for support of the local audit staff and compiling

the National Report. Mike McDowall is responsible for developing and maintaining

the software and developing datasets for local needs. From March 2004 to October

2005 the audit had a quality assurance co-ordinator, Christene Leiper, who was

responsible for visiting participating centres and assisting them with implementing

good practice for the audit.

3.5.1.2 Funding

NHS QIS took up funding of the audit on November 1st 2002 for co-ordination of this

audit. This funding finished on July 31st 2006. The Scottish Executive Health

Department through the CHD and Stroke Strategy, has provided funding to continue

the central co-ordination of the audit from August 1st 2006 until March 31

st 2007 in

the first instance.

3.5.2 Local

3.5.2.1 Staff

Audit staff are employed at each centre with funding made available through the CHD

and Stroke Strategy. Typically, a medium or large acute hospital will have one audit

co-ordinator with support from their MCN. In practice, staffing varies widely between

hospitals. Audit co-ordinators’ responsibilities include case ascertainment, data

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collection, completion of forms, data entry and provision of reports for both local and

national use. Local centres are responsible for ensuring the quality of their data and no

routine central validation of data is carried out.

3.5.2.2 Funding

Ring fenced funding was provided by the CHD and Stroke Strategy from April 1st

2003 till March 31st 2006. The Scottish Executive has indicated that the ring fenced

funding provided to each Health Board to support local data collection should be

continued until at least March 31st 2007. This extension will allow us to monitor

changes occurring in stroke services as a result of the Strategy and other national

developments. In addition, the audit will be able to evolve to take advantage of

developing IT systems.

3.6 Key Stages of the Audit

3.6.1 Case Ascertainment

The value of the audit is greater, and the results more easily interpreted if all, or at

least a large enough majority of, patients admitted (or assessed) at the participating

hospitals are included in the register to avoid significant bias. Thus a robust system to

identify eligible cases needs to be in place. The best method, or more likely

combination of methods, will vary depending on local circumstances and are

described in each centre's Standard Operating Procedure (SOP) for the audit.

Each institution has decided whether it will include just those patients who are

admitted to the hospital (i.e. stay overnight) or in addition those attending outpatient

clinics and/or the Accident and Emergency department. Different systems of

ascertainment are required for each.

3.6.2 Data Collection

In developing SSCAS we have tried to minimise the amount of data needed and also

focussed on those data which are easily and reliably collected. Data can be extracted

from unstructured case records, clerking proformas, integrated care pathways and

structured discharge summaries.

3.6.3 Data Entry

All centres are using manual entry. A few also download demographic data through

their patient administration systems (PAS).

3.6.4 Data Validation

It is important to ensure that the data are as complete and accurate as possible. Data

validation occurs at several stages. Data entry forms are checked before data entry.

Although most of this work can be done by administrative staff, an interested and

knowledgeable clinician must be involved to answer specific clinical questions and

ensure the validity of clinical data. SSCAS data entry screens incorporate range and

consistency checks. SSCAS contains tools for checking the completeness of the data.

Each centre is responsible for the completeness and accuracy of their data, but this

does not guarantee that resources were sufficient to guarantee 100% completeness and

accuracy.

3.6.5 Reporting

The SSCA system incorporates a reporting facility. Amongst other functions this

allows generation of simple reports summarising the hospital’s performance against

national standards. These reports are designed to allow the user to monitor their stroke

care services on an ongoing basis. The reporting system allows the user to produce

performance indicators for a specified time period for: the hospital as a whole; a

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stroke unit; or individual clinicians. The data presented in this National Report were

produced by pooling the reports produced by each participating centre. However, in

addition we have collected patient specific data centrally to facilitate the linkage with

data from ISD. We received approval from ISD’s Privacy Advisory Committee to use

data held by ISD. We obtained approval from all MCNs involved in SSCA for the use

of the data held in their hospitals.

4 Preparation of the report

4.1 Period of Data Collection

The data presented in the first part of the report relate to patients admitted to hospital

or assessed in an outpatient clinic in the participating hospitals between 31 May 2003

and 30 July 2005. The exact periods of data collection vary because some hospitals

only started collecting data during 2004 and they are not all equally up to date with

their data entry. The periods of data collection for each centre are shown in the first

two rows of each Health Board table. The data for the linkage with ISD goes from the

beginning of the audit at each centre, the earliest data is from July 2000, to the end of

December 2005.

4.2 Methods of analysis

For the first set of tables, the majority of centres simply generated a standard report

from SSCAS for the defined periods of data collection. Certain centres were unable to

run the standard report because they have not collected the full minimum dataset. We

have included data from these centres wherever possible and indicated where they

were not available based on the standard method.

Most of the process of care data are represented by counts and proportions of patients

fulfilling particular standards. However, to ensure comparable reports across centres it

was very important to define exactly which patients were included in the numerator

and denominator for each performance indicator. These are defined in the general

tables that start each grouping of tables, Inpatients and Outpatients.

Where we have compared six month case fatality between Stroke Services we have

provided crude, unadjusted case fatality but also adjusted for variation in casemix.

Using Logistic regression we have adjusted for six variables which have been

validated for this purpose 7,8,9

.

We have presented these case fatalities using a W score (with 95% confidence

intervals). The W score method provides a measure of outcome in absolute terms. The

W score measures the difference between the observed and predicted number of

survivors per 100 patients treated within each hospital or Health Board. In the crude

analyses the predicted number was derived from the Scottish average whilst in the

casemix adjusted analyses the predicted number was derived from a logistic

regression including the casemix variables. For example, a W score of 5 for a hospital

indicates that this hospital had 5 more survivors than predicted per 100 patients (i.e. a

5% lower case fatality). On the charts positive W scores above the line have better

than expected outcomes and negative ones lie below the line.

Cox regression (or proportional hazards regression) was used to identify factors, and

in particular aspects of management, which are associated with survival. This method

allows one to take account of interactions between factors and the effect of several

variables upon the time a specified event (in our case death) takes to happen.

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4.3 Interpretation of data

4.3.1 General

Variations in performance indicators between hospitals and within hospitals over time

are inevitable. These will occur by chance and apparent fluctuations in performance

will be greater where the proportions are based on small numbers of patients.

Therefore whilst the performance with respect to proportion admitted to a stroke unit

may be quite stable in a hospital admitting 400 patients a year (if the service does not

change) it is likely to vary more in a hospital admitting 100 or less. Also, measures

based on subsets of patients, such as those with ischaemic stroke and atrial fibrillation

will be prone to greater random variation. Performance measured over a longer period

of time, which is based on more patients, is bound to be more stable. However, there

is inevitably a balance to be struck in obtaining recent enough data to reflect current

practice and collecting data on enough patients to provide a precise estimate of

performance.

To help the reader judge the precision of any estimate of performance we have

presented proportions with 95% confidence intervals, calculated using a method

derived by Altman10,

although these are only indicative statistics. If one was to

measure performance 100 times one’s confidence interval would be expected to

include the true proportion 95 out of these 100 times.

Differences in performance may reflect real differences in the process of care but also

differences in the way these data were collected between hospitals or over time.

Although we have attempted to standardise the methods of case ascertainment, data

extraction, definition of variables, data entry and analysis, inevitably individuals

responsible for aspects of the audit were not able to adhere strictly to the standards

often for very practical reasons (see Section 5). Therefore in this report we have not

referred to, or commented, on the performance of any centre. It is for the centres to

compare their data with that provided by others and for them to try to identify the

reasons for any large differences. However, we have provided each Health Board

Stroke MCN with the opportunity to insert a brief narrative to explain their results

(see Appendix B).

4.3.2 Scotland wide figures

The Scotland wide figures were calculated based on the three periods of data sent by

each centre. However, because the third time period for several hospitals is

incomplete there are not three periods for the Scotland wide figures. In addition, the

actual time periods for each hospital do not match for a variety of reasons, so that is

why the there is not a start and stop date for each one. Therefore, period one is an

aggregate of each centre’s data for the first time point and period two is the

combination of the second and third periods of data for each centre.

4.3.3 Service changes

The analyses do not take in to account gross changes to the overall structure of stroke

services within units. For example, centralising acute care may lead to large changes

in the numbers of patients cared for in different units.

4.4 Limitations of the data

Some examples of how the rigour with which the audit is carried out can influence

estimates of performance are:

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4.4.1 Incomplete case ascertainment

If the methods of identifying all patients admitted with stroke, or having a stroke

whilst in hospital, are not applied rigorously then the total number of cases identified

may be lower than expected. It is likely that stroke patients admitted to a stroke unit

will be more easily identified for the audit than those admitted elsewhere or having a

stroke on another ward. This might inflate the proportion admitted to a stroke unit and

also the proportion having certain aspects of stroke care such as swallowing

assessments and appropriate secondary prevention. Thus apparently good

performance with respect to stroke care may actually reflect less good stroke care

disguised by poor adherence to audit standards.

Incomplete case ascertainment may be indicated by a large discrepancy between the

numbers identified in the audit and the numbers identified from SMR01 or the

expected number of cases in that hospital. However, a large discrepancy may result

from patients being allocated incorrect diagnostic codes on the SMR01, perhaps

because of poor quality discharge summaries or inexperienced coding staff. In many

hospitals there are long delays between patients’ discharge and notification of SMR01

data to ISD. This may lead to significant under estimates of numbers of patients

admitted based on routine data if the audit period ends recently.

4.4.2 Failure to track patients through to discharge

Patients for whom discharge date (or date of death if died in hospital) is not recorded

are not included in these analyses. This is perfectly valid where the patient has really

not been discharged. Failure to collect date of discharge for patients who have

actually been discharged (or died) could lead to patients been incorrectly excluded

from these analyses. This is most likely to affect long stay patients. It is also more

likely to affect patients who are not in a stroke unit at the time of discharge. This may

introduce a small bias into the figures for the proportions receiving discharge

medications.

4.4.3 Inadequate input from clinicians

It is often difficult to decide from the clinical notes whether a patient has had a stroke

or not. If the audit co-ordinator does not have adequate support from a senior clinician

they may either inappropriately include or exclude patients. Since such patients may

be managed differently from those with more definite stroke this may influence

overall estimates of performance.

4.4.4 Incomplete or unclear recording of process in clinical notes

Most participating hospitals rely on audit co-ordinators to extract these data items

from the clinical notes. If the notes do not reflect the process of care then neither will

the audit. Also, if the process is recorded but the notes are poorly organised the

auditor is more likely to overlook the record. This may lead to an overly pessimistic

view of care. In centres that use structured notes and proformas, which reflect the

needs of the audit, this is less likely to happen.

4.4.5 Deviation from minimum dataset

A few centres did not collect all of the standard data items or did not use the standard

format. This means that calculations of performance derived from these data items

was not possible.

4.4.6 Failure to adhere to definitions and coding rules

Inevitably if the definitions shown in Appendix A were not adhered to, or the items

were not coded in SSCAS as indicated then this could distort the estimates of

performance.

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4.4.7 Difficulties with audit staff

There were a variety staffing issues that affected the completeness and quality of data.

In some instances sickness, maternity leave, holidays and replacing departing staff can

leave gaps in the data collection that make it difficult to interpret the data.

4.5 Data Completeness of SMR01 and SSCAS data

A comparison was made between patients with a stroke code (I61, I63 or I64) on

SMR01 and patients with a stroke diagnosis in SSCAS. The comparison with SMR01

records has been restricted to SMR01 emergency admissions covering the same time

period as SSCAS. In this table "Any diagnoses" means a stroke code "in any

diagnostic position". SMR01 has a primary diagnosis and 5 other secondary

diagnostic positions (no order of priority for the 5). Transfer and elective episodes

were excluded from the analyses and continuous inpatient stays were assigned to the

hospital of the first admission.

4.5.1 By Health Board - Table 1

SMR01 data

Stroke I61, I63, I64

Health Board SSCAS strokes Main diagnosis

Any diagnoses

Ayrshire and Arran 1450 1221 1431

Argyll and Clyde 1401 1730 2041

Borders 388 428 464

Dumfries and Galloway 780 667 768

Fife 1032 1069 1326

Forth Valley 1226 981 1201

Highland 621 746 849

Lanarkshire 2353 2314 2748

Greater Glasgow 2147 2314 2754

Grampian 2016 3310 3888

Lothian 4180 4989 5615

Tayside 1022 1646 2029

Orkney 31 26 39

Shetland 20 20 24

Western Isles 114 114 176

4.5.2 By Hospital - Table 2

SMR01 data

Stroke I61, I63, I64

Hospital SSCAS main

diagnosis any

diagnoses

Ayr Hospital 622 635 727

Crosshouse Hospital 828 586 704

Inverclyde Royal Hospital 563 539 652

Lorn & Islands 71 106 115

Royal Alexandra Hospital 702 855 1008

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Vale of Leven 65 230 266

Borders General Hospital 388 428 464

Dumfries & Galloway Royal Infirmary 780 667 768

Queen Margaret Hospital 437 400 462

Victoria Hospital, Kirkaldy 595 669 864

Falkirk Royal Infirmary 564 507 592

Stirling Royal Infirmary 662 474 609

Belford 28 28 35

Caithness 38 91 99

Raigmore 555 627 715

Hairmyres Hospital 640 744 852

Monklands Hospital 797 797 986

Wishaw Hospital 916 773 910

Glasgow Royal Infirmary 324 563 667

Southern General Hospital 726 450 529

Stobhill Hospital 148 273 380

Victoria Infirmary, Glasgow 397 370 452

Western Infirmary /Gartnaval 552 658 726

Aberdeen Royal Infirmary 1949 2906 3353

Edinburgh Royal Infirmary 868 1024 1146

New Edinburgh Royal Infirmary 819 1203 1359

St John's Hospital 851 1150 1281

Western General Hospital 1589 1591 1801

Perth Royal Infirmary 615 567 779

Ninewells Hospital 407 1079 1250

Balfour 31 26 39

Gilbert Bain 20 20 24

Uist & Barra 10 6 7

Western Isles 104 108 169

4.5.3 Possible missing cases - Table 3

Patients admitted as an emergency with a main diagnosis of stroke (I61, I63 and I64)

were extracted from the SMR01 linked database and a comparison made between

these patients and patients on the SSCAS database. We did not include all the ICD10

cerebrovascular disease codes (i.e. I61 – I69) because these include diagnoses other

than stroke. However, some patients included in SSCAS may have been assigned one

of these other codes on SMR01 and appear as a “missed” case on SMR01. A total of

18,463 patients were identified on the SSCAS data extract. 20,487 patients were

identified on the SMR01 database. These patients were restricted to those whose

admission dates were within the range of admission dates for each hospital as

recorded on SSCAS.

Table 3 is a 2 x 2 table. Across Scotland 12859 admissions were recorded as being

due to stroke on both SSCAS and SMR01. However 5764 were identified as stroke by

SSCAS but not on SMR01 and 7795 were identified as strokes by SMR01 but not

included in SSCAS. These discrepancies are likely to be due to different factors in

different hospitals. It would be sensible for hospitals to examine a sample of

15

admissions where they were not included in both SSCAS and SMR01 to establish

whether there are problems with case ascertainment in SSCAS or incorrect coding of

SMR01. One would expect some discrepancies simply because the SMR01 codes

used were not all those which might be used for stroke patients. ISD can provide a list

of patients who were not in both SSCAS and SMR01 to facilitate an audit of case

ascertainment and coding. Please contact Robin Flaig if you are interested in receiving

a copy of the list for your centre.

SSCAS

SMR01

No stroke diagnosis

stroke diagnosis

Total

All Hospitals No stroke diagnosis n/a 5764 5764

stroke diagnosis 7795 12859

20654

Total 7795 18623 26418

Ayr Hospital No stroke diagnosis n/a 183 183

stroke diagnosis 187 414 601

Total 187 597 784

Crosshouse Hospital No stroke diagnosis n/a 314 314


Total 92 785 877

Inverclyde Royal Infirmary No stroke diagnosis n/a 161 161


Total 126 548 674

Lorn & Islands No stroke diagnosis n/a 24 24


Total 66 60 126

Royal Alexandra Hospital No stroke diagnosis n/a 221 221


Total 332 681 1013

Vale of Leven No stroke diagnosis n/a 12 12


Total 172 61 233

Borders General Hospital No stroke diagnosis n/a 34 34


Total 67 380 447

Dumfries & Galloway Royal Infirmary No stroke diagnosis n/a 267 267


Total 171 739 910

Queen Margaret Hospital No stroke diagnosis n/a 102 102


Total 67 425 492

Victoria Hospital, No stroke diagnosis n/a 140 140

Totals are higher than overall patients due to some patients having more than one admission to different hospitals in the time period

16

SSCAS

SMR01

No stroke diagnosis

stroke diagnosis

Total

Kirkaldy


Total 198 570 768

Falkirk Royal Infirmary No stroke diagnosis n/a 172 172


Total 121 536 657

Stirling Royal Infirmary No stroke diagnosis n/a 339 339


Total 169 626 795

Belford No stroke diagnosis n/a 10 10


Total 11 27 38

Caithness No stroke diagnosis n/a 5 5


Total 58 37 95

Raigmore No stroke diagnosis n/a 139 139


Total 204 532 736

Hairmyres Hospital No stroke diagnosis n/a 105 105


Total 202 596 798

Monklands Hospital No stroke diagnosis n/a 249 249


Total 248 751 999

Wishaw Hospital No stroke diagnosis n/a 243 243


Total 136 850 986

Glasgow Royal Infirmary No stroke diagnosis n/a 97 97


Total 323 316 639

Southern General Hospital No stroke diagnosis n/a 409 409


Total 159 695 854

Stobhill Hospital No stroke diagnosis n/a 50 50


Total 171 139 310

Victoria Infirmary, Glasgow No stroke diagnosis n/a 143 143


Total 120 390 510

17

SSCAS

SMR01

No stroke diagnosis

stroke diagnosis

Total

Western Infirmary /Gartnaval No stroke diagnosis n/a 194 194


Total 286 543 829

Aberdeen Royal Infirmary No stroke diagnosis n/a 539 539


Total 1024 2278 3302

Edinburgh Royal Infirmary No stroke diagnosis n/a 197 197


Total 345 849 1194

New Edinburgh Royal Infirmary No stroke diagnosis n/a 177 177


Total 517 830 1347

St John's Hospital No stroke diagnosis n/a 210 210


Total 487 813 1300

Western General Hospital No stroke diagnosis n/a 458 458


Total 454 1515 1969

Perth Royal Infirmary No stroke diagnosis n/a 210 210


Total 174 591 765

Ninewells Hospital No stroke diagnosis n/a 110 110


Total 757 396 1153

Balfour No stroke diagnosis n/a 11 11


Total 7 30 37

Gilbert Bain No stroke diagnosis n/a 9 9


Total 9 20 29

Uist & Barra No stroke diagnosis n/a 6 6


Total 2 10 12

Western Isles No stroke diagnosis n/a 47 47


Total 48 99 147

18

5 Inpatient Tables

5.1 Inpatient Table Definitions:

NHS QIS Standards included where appropriate. Lines highlighted in grey are the denominators for the calculations immediately below.

Inpatient Data Definition

Audit Period Start and End Dates (based on date of admission)

All admissions between these dates are included in the audit.

Number of days This is the number of days between start date and end date (inclusive).

Total Number of patients entered This is the total number of Inpatients entered into SSCAS for this period.

Total number of Stroke patients Patients with a Final Diagnosis of stroke (definite or probable).

Estimated no. of stroke pts per year Total number of stroke patients, divided by the Number of days, and then multiplied by 365.

No. of Stroke Patients Patients with a Final Diagnosis of stroke (definite or probable).

No. Admitted to the SU within 1 day of admission

This is the number of patients admitted to hospital who are recorded as having entered any kind of stroke unit on the same date or the day after they were admitted.

% Admitted to the SU within 1 day of admission Percentage Admitted to SU in <= 1 day: This is the percentage of patients admitted to hospital who are recorded as having entered any kind of stroke unit on the same date or the day after they were admitted.

NHS QIS Standard 1.4: 70% of all patients admitted to hospital with a diagnosis of stroke are admitted to the stroke unit within 24 hours of presentation at hospital, and remain in specialist stroke care until in-hospital rehabilitation is complete.

Confidence Interval The 95% Confidence Intervals of the percentage admitted to stroke unit within 1 day of admission

No. Admitted to a SU during admission This is the number of patients admitted to hospital who are recorded as receiving any Acute Stroke Unit management, Integrated Stroke Unit management or Rehab Stroke Unit Management.

% Admitted to a Stroke Unit during admission This is the percentage of patients admitted to hospital who are recorded as receiving any of Acute Stroke Unit management, Integrated Stroke Unit management or Rehab Stroke Unit Management.

Confidence Interval The 95% Confidence Intervals on the percentage of patients admitted to hospital who are recorded as receiving any of Acute Stroke Unit management, Integrated Stroke Unit management or Rehab Stroke Unit Management.

No. Scanned within 2 days of admission This is the number of stroke patients who had either CT or MR brain scan on the date of admission or either of the following 2 days, i.e. the next date, or the next date again.

% Scanned within 2 days of admission This is the percentage of all stroke patients who had either CT or MR brain scan on the date of admission or either of the following 2 days, i.e. the next date, or the next date again.

NHS QIS Standard 2.2: 80% of patients have CT/MRI imaging within 48 hours of admission, unless there is a documented contraindication.

19


Confidence Interval The 95% Confidence Intervals on the percentage of stroke patients scanned within 2 days of admission.

No. Scanned within 7 days of admission This is the number of stroke patients who had either CT or MR brain scan on the date of admission or any of the following 7 days.

% Scanned within 7 days of admission This is the percentage of all stroke patients who had either CT or MR brain scan on the date of admission or any of the following 7 days.

Confidence Interval The 95% Confidence Intervals on the percentage of all stroke patients who had either CT or MR brain scan on the date of admission or any of the following 7 days.

No. Scanned during admission This is the number stroke patients who are recorded as having had either CT or MR brain scan at any time following their event.

% Scanned during admission This is the percentage of all stroke patients who are recorded as having had either CT or MR brain scan at any time following their event.

Confidence Interval The 95% Confidence Intervals on the percentage of all stroke patients scanned during admission.

No. Swallow screen within 1 day of admission This is the number of stroke patients who had a Swallow screen recorded on the date of admission or the following day.

% Swallow screen within 1 day of admission This is the percentage of all stroke patients who had a Swallow screen recorded on the date of admission or the following day.

Confidence Interval The 95% Confidence Intervals on the percentage of stroke patients who had a Swallow screen recorded on the date of admission or the following day.

No. Swallow screen during admission This is the number of stroke patients who had a Swallow screen recorded at any time during their hospital stay.

% Swallow screen during admission This is the percentage of all stroke patients who had a Swallow screen recorded at any time during their hospital stay.

Confidence Interval The 95% Confidence Intervals on the percentage of stroke patients who had a Swallow screen recorded at any time during their hospital stay.

No. Patients with Definite Ischaemic event Patients who do not have Final Diagnosis of sub-arachnoid haemorrhage and either: have a Final Diagnosis of stroke and who have had CT or MR scan or post-mortem and none of these show haemorrhage

or patients who do not have Final Diagnosis of stroke but do have a Final Diagnosis of cerebral TIA or a Final diagnosis of Transient Monocular Blindness or a Final Diagnosis of Retinal Artery Occlusion.

No. Started Aspirin within 2 days of admission This is the number of patients with ischaemic events given aspirin on the date of admission or either of the following 2 days.

20


% Started Aspirin within 2 days of admission This is the percentage of patients with ischaemic events given aspirin on the date of admission or either of the following 2 days.

NHS QIS Standard 2.3: Aspirin treatment is initiated within 48 hours of admission for all patients in whom a haemorrhagic stroke, or other contraindication, has been excluded.

Confidence Interval The 95% Confidence Intervals on those with ischaemic events given aspirin in hospital within 2 days.

No. Received Aspirin in hospital This is the number of patients with ischaemic events recorded as being given aspirin in hospital.

% Received Aspirin in hospital This is the percentage of patients with ischaemic events recorded as being given aspirin in hospital.

Confidence Interval The 95% Confidence Intervals on the percentage of patients with ischaemic events recorded as being given aspirin in hospital.

No. Patients with Definite Ischaemic event - Alive at Discharge

Patients with definite ischaemic events as above who are still alive at discharge.

No. Discharged on Antiplatelet or Warfarin This is the number of patients with definite ischaemic events recorded as prescribed Antiplatelet or Warfarin at discharge.

% Discharged on Antiplatelet or Warfarin This is the percentage of patients with definite ischaemic events recorded as prescribed Antiplatelet or Warfarin at discharge.

Confidence Interval The 95% Confidence Intervals on the percentage of patients with definite ischaemic events recorded as prescribed Antiplatelet or Warfarin at discharge.

No. Discharged on Statin This is the number of patients with ischaemic events recorded as prescribed Statin at discharge.

% Discharged on Statin This is the percentage of patients with ischaemic events recorded as prescribed Statin at discharge.

Confidence Interval The 95% Confidence Intervals on the percentage of patients with ischaemic events recorded as prescribed Statin at discharge

No. Discharged on antihypertensive This is the number of patients with definite ischaemic events recorded as prescribed Ace inhibitor, diuretic, or another anti-hypertensive at discharge.

% Discharged on antihypertensive This is the percentage of patients with definite ischaemic events recorded as prescribed Ace inhibitor, diuretic, or another anti-hypertensive at discharge.

Confidence Interval The 95% Confidence Intervals on the percentage of patients with definite ischaemic events recorded as prescribed Ace inhibitor, diuretic, or another anti-hypertensive at discharge.

No. Patients with Definite ischaemic event in AF - Alive at Discharge

Patients with definite ischaemic events as above who also have Atrial Fibrillation confirmed on ECG since the event.

No. Discharged on Warfarin This is the number of patients with definite ischaemic events in AF recorded as prescribed Warfarin at discharge.

% Discharged on Warfarin This is the percentage of patients with definite ischaemic events in AF recorded as prescribed Warfarin at discharge.

Confidence Interval The 95% Confidence Intervals on the percentage of patients with definite ischaemic events in AF recorded as prescribed Warfarin at discharge.

21

5.2 Scotland wide - Table 4

Scotland Period 1:

2003/2004

Scotland Periods 2 & 3 Combined: 2004/2005

Total Number of patients entered 7594 8379

No. of Stroke Patients 6312 7077

No. Admitted to the SU within 1 day of admission 2541 3329

% Admitted to the SU within 1 day of admission 40 47

Confidence Interval 39 to 42 46 to 48

No. Admitted to a SU during admission 3993 4969

% Admitted to a Stroke Unit during admission 63 70


No. Scanned within 2 days of admission 4508 5427

% Scanned within 2 days of admission 71 76


No. Scanned within 7 days of admission 5469 6379

% Scanned within 7 days of admission 87 90


No. Scanned during admission 5655 6662

% Scanned during admission 90 94


No. Swallow screen within 1 day of admission 2095 4037

% Swallow screen within 1 day of admission 33 57


No. Swallow screen during admission 2349 4525

% Swallow screen during admission 37 64


22

Scotland Period 1:

2003/2004

Scotland Periods 2 & 3 Combined: 2004/2005

No. Patients with Definite Ischaemic event 5804 6674

No. Started Aspirin within 2 days of admission 2480 3682

% Started Aspirin within 2 days of admission 43 55


No. Received Aspirin in hospital 3631 5155

% Received Aspirin in hospital 63 77


No. Patients with Definite Ischaemic event - Alive at Discharge 5013 5786

No. Discharged on Antiplatelet or Warfarin 4218 5221

% Discharged on Antiplatelet or Warfarin 84 90


No. Discharged on Statin 3454 4455

% Discharged on Statin 69 77


No. Discharged on antihypertensive 3081 3209

% Discharged on antihypertensive 61 56


No. Patients with Definite ischaemic event in AF - Alive at Discharge 882 993

No. Discharged on Warfarin 280 326

% Discharged on Warfarin 32 33


23

5.3 Ayrshire and Arran - Table 5

Ayr Hospital Crosshouse Hospital Audit Period Start Date (based on date of admission) 01/01/04 01/11/04 01/05/05 01/03/04 01/11/04 01/05/05

Audit Period End Date 31/10/04 30/04/05 31/10/05 31/10/04 30/04/05 31/10/05

Number of days 305 181 184 245 181 184

Total Number of patients entered 324 208 195 334 224 225

Total number of Stroke patients 265 170 160 291 206 204

Estimated no. of stroke pts per year 317.6 343.3 317.8 434.1 416.0 405.2

No. of Stroke Patients 265 170 160 291 206 204

No. Admitted to the SU within 1 day of admission 204 110 135 172 91 106

% Admitted to the SU within 1 day of admission 77 65 84 59 44 52

Confidence Interval 72 to 82 57 to 71 78 to 89 53 to 65 38 to 51 45 to 59

No. Admitted to a SU during admission 254 141 150 249 184 173

% Admitted to a Stroke Unit during admission 96 83 94 86 89 85


No. Scanned within 2 days of admission 142 115 128 159 124 147

% Scanned within 2 days of admission 54 68 80 55 60 72





No. Scanned during admission 259 158 154 279 202 197

% Scanned during admission 98 93 96 96 98 97


No. Swallow screen within 1 day of admission 146 119 133 255 190 196

% Swallow screen within 1 day of admission 55 70 83 88 92 96


No. Swallow screen during admission 181 145 148 274 202 198

% Swallow screen during admission 69 85 93 94 98 97


24

Ayr Hospital Crosshouse Hospital No. Patients with Definite Ischaemic event 282 173 174 258 193 185

No. Started Aspirin within 2 days of admission 49 52 54 96 81 95

% Started Aspirin within 2 days of admission 17 30 31 37 42 51


No. Received Aspirin in hospital 167 110 110 235 177 161

% Received Aspirin in hospital 59 64 63 91 92 87


No. Patients with Definite Ischaemic event - Alive at Discharge 248 143 156 223 169 164

No. Discharged on Antiplatelet or Warfarin 223 132 141 219 164 159

% Discharged on Antiplatelet or Warfarin 90 92 90 98 97 97


No. Discharged on Statin 169 110 130 195 147 134

% Discharged on Statin 68 77 83 87 87 82


No. Discharged on antihypertensive 152 82 84 127 92 94

% Discharged on antihypertensive 61 57 54 57 54 57


No. Patients with Definite ischaemic event in AF - Alive at Discharge 34 23 26 27 18 28

No. Discharged on Warfarin 18 10 7 14 12 16

% Discharged on Warfarin 53 43 27 52 67 57


25

5.4 Argyll and Clyde - Table 6

Inverclyde Royal Hospital Royal Alexandra Hospital Audit Period Start Date (based on date of admission) 01/09/03 01/09/04 01/03/05 01/09/03 01/09/04 01/03/05


Number of days 367 181 184 366 181 184




















No. Swallow screen within 1 day of admission 70 81 n/a n/a n/a n/a

% Swallow screen within 1 day of admission 29 75 n/a n/a n/a n/a

Confidence Interval 24 to 35 66 to 82 n/a n/a n/a n/a

No. Swallow screen during admission 88 106 n/a n/a n/a n/a

% Swallow screen during admission 37 98 n/a n/a n/a n/a

Confidence Interval 31 to 43 93 to 99 n/a n/a n/a n/a

26

Inverclyde Royal Hospital Royal Alexandra Hospital No. Patients with Definite Ischaemic event 225 106 115 204 127 107





















27

5.5 Borders - Table 7

Borders General Hospital Audit Period Start Date (based on date of admission) 01/01/04 01/01/05 01/07/05

Audit Period End Date 31/12/04 30/06/05 31/12/05

Number of days 366 181 184

Total Number of patients entered 176 118 101

Total number of Stroke patients 176 118 101

Estimated no. of stroke pts per year 175.8 238.3 200.6

No. of Stroke Patients 176 118 101

No. Admitted to the SU within 1 day of admission 132 89 83

% Admitted to the SU within 1 day of admission 75 75 82

Confidence Interval 68 to 81 67 to 82 74 to 88

No. Admitted to a SU during admission 150 104 90

% Admitted to a Stroke Unit during admission 85 88 89


No. Scanned within 2 days of admission 145 100 96

% Scanned within 2 days of admission 82 85 95





No. Scanned during admission 166 112 101

% Scanned during admission 94 95 100


No. Swallow screen within 1 day of admission 120 91 78

% Swallow screen within 1 day of admission 68 77 77


No. Swallow screen during admission 126 95 82

% Swallow screen during admission 72 81 81


28

Borders General Hospital No. Patients with Definite Ischaemic event 141 98 82

No. Started Aspirin within 2 days of admission 90 66 55

% Started Aspirin within 2 days of admission 64 67 67


No. Received Aspirin in hospital 122 84 67

% Received Aspirin in hospital 87 86 82


No. Patients with Definite Ischaemic event - Alive at Discharge 120 80 60

No. Discharged on Antiplatelet or Warfarin 108 75 56

% Discharged on Antiplatelet or Warfarin 90 91 93


No. Discharged on Statin 85 63 41

% Discharged on Statin 71 77 68


No. Discharged on antihypertensive 44 24 27

% Discharged on antihypertensive 37 29 45


No. Patients with Definite ischaemic event in AF - Alive at Discharge 31 16 13

No. Discharged on Warfarin 7 6 4

% Discharged on Warfarin 39 46 44


29

5.6 Dumfries and Galloway - Table 8

Dumfries and Galloway Royal Infirmary Audit Period Start Date (based on date of admission) 01/07/03 01/07/04 01/01/05






















No. Swallow screen within 1 day of admission n/a 75 84

% Swallow screen within 1 day of admission n/a 58 71

Confidence Interval n/a 49 to 66 62 to 78

No. Swallow screen during admission n/a 81 90

% Swallow screen during admission n/a 62 76

Confidence Interval n/a 54 to 70 67 to 82

30

Dumfries and Galloway Royal Infirmary No. Patients with Definite Ischaemic event 268 119 113





















31

5.7 Fife - Table 9

Victoria Hospital, Kirkcaldy Queen Margaret Hospital Audit Period Start Date (based on date of admission) 08/12/03 08/06/04 08/12/04 08/12/03 08/06/04 08/12/04


Number of days 183 183 182 183 183 182


























32

Victoria Hospital, Kirkcaldy Queen Margaret Hospital No. Patients with Definite Ischaemic event 173 133 142 117 109 98





















33

5.8 Forth Valley - Table 10

Forth Valley Audit Period Start Date (based on date of admission) 01/01/04 01/01/05 01/07/05






















No. Swallow screen within 1 day of admission 253 148 116

% Swallow screen within 1 day of admission 55 58 54


No. Swallow screen during admission 287 151 124

% Swallow screen during admission 62 59 58


34

Forth Valley No. Patients with Definite Ischaemic event 360 202 149





















35

5.9 Highlands - Table 11

Stroke Unit opened at Raigmore 01/01/2005, Belford and Caithness do not have stroke units.

Raigmore Belford Caithness Audit Period Start Date (based on date of admission) 01/07/03 01/07/04 01/01/05 01/03/04 01/09/2003

Audit Period End Date 30/06/04 31/12/04 30/06/05 01/05/06 01/05/2006

Number of days 366 184 181 792 974

Total Number of patients entered 275 234 182 38 39

Total number of Stroke patients 200 177 146 28 37

Estimated no. of stroke pts per year 199.7 351.6 294.8 12.9 13.9

No. of Stroke Patients 200 177 146 28 37

No. Admitted to the SU within 1 day of admission n/a n/a 20 n/a n/a

% Admitted to the SU within 1 day of admission n/a n/a 14 n/a n/a

Confidence Interval n/a n/a 9 to 20 n/a n/a

No. Admitted to a SU during admission n/a n/a 51 n/a n/a

% Admitted to a Stroke Unit during admission n/a n/a 35 n/a n/a

Confidence Interval n/a n/a 28 to 43 n/a n/a

No. Scanned within 2 days of admission 82 83 70 19 0

% Scanned within 2 days of admission 42 47 48 68 0

Confidence Interval 35 to 49 40 to 55 40 to 56 49 to 82 0 to 9

No. Scanned within 7 days of admission 144 144 119 21 29

% Scanned within 7 days of admission 73 82 82 75 78


No. Scanned during admission 161 153 131 22 31

% Scanned during admission 82 87 90 79 84


No. Swallow screen within 1 day of admission n/a 52 35 14 5

% Swallow screen within 1 day of admission n/a 30 24 50 14

Confidence Interval n/a 23 to 37 18 to 32 33 to 67 6 to 28

No. Swallow screen during admission n/a 65 50 15 6

% Swallow screen during admission n/a 37 34 54 16

Confidence Interval n/a 30 to 44 27 to 43 36 to 70 8 to 31

36

Raigmore Belford Caithness No. Patients with Definite Ischaemic event 199 176 144 24 32

No. Started Aspirin within 2 days of admission 92 82 69 10 15

% Started Aspirin within 2 days of admission 46 47 48 42 47


No. Received Aspirin in hospital 149 131 107 18 26

% Received Aspirin in hospital 75 74 74 75 81


No. Patients with Definite Ischaemic event - Alive at Discharge 171 159 124 21 28

No. Discharged on Antiplatelet or Warfarin 156 147 112 21 23

% Discharged on Antiplatelet or Warfarin 91 92 90 100 82


No. Discharged on Statin 123 114 89 16 21

% Discharged on Statin 72 72 72 76 75


No. Discharged on antihypertensive 105 111 95 11 22

% Discharged on antihypertensive 61 70 77 52 79


No. Patients with Definite ischaemic event in AF - Alive at Discharge 33 35 31 1 7

No. Discharged on Warfarin 14 14 8 0 0

% Discharged on Warfarin 42 40 26 0 0


37

5.10 Lanarkshire - Table 12

Hairmyres Hospital Monklands Hospital Wishaw General Hospital Audit Period Start Date (based on date of admission) 01/11/03 01/11/04 01/05/05 01/11/03 01/11/04 01/05/05 01/11/03 01/11/04 01/05/05

Audit Period End Date 31/10/04 30/04/05 31/10/05 31/10/04 30/04/05 31/10/05 31/10/04 30/04/05 31/10/05

Number of days 366 181 184 366 181 184 366 181 184

Total Number of patients entered 325 172 136 355 156 160 396 213 182

Total number of Stroke patients 260 147 108 337 144 137 342 197 167

Estimated no. of stroke pts per year 259.6 296.8 214.5 336.5 290.8 272.1 341.5 397.8 331.7

No. of Stroke Patients 260 147 108 337 144 137 342 197 167

No. Admitted to the SU within 1 day of admission 108 92 72 225 108 102 67 71 116

% Admitted to the SU within 1 day of admission 42 63 67 67 75 74 20 36 69

Confidence Interval 36 to 48 54 to 70 57 to 75 62 to 72 67 to 82 66 to 82 16 to 24 29 to 43 62 to 76

No. Admitted to a SU during admission 207 122 97 302 139 130 204 152 141

% Admitted to a Stroke Unit during admission 80 83 90 90 97 95 60 77 84


No. Scanned within 2 days of admission 226 132 75 247 95 87 310 174 142

% Scanned within 2 days of admission 87 90 69 74 66 64 91 84 85





No. Scanned during admission 252 145 105 327 139 133 329 190 154

% Scanned during admission 97 99 97 98 97 97 96 96 92


No. Swallow screen within 1 day of admission 112 94 71 287 88 89 310 182 158

% Swallow screen within 1 day of admission 43 64 66 86 61 65 91 92 95


No. Swallow screen during admission 172 112 88 319 116 118 336 194 166

% Swallow screen during admission 66 76 81 95 81 86 98 98 99


38

Hairmyres Hospital Monklands Hospital Wishaw General Hospital No. Patients with Definite Ischaemic event 267 133 94 302 124 121 344 183 154

No. Started Aspirin within 2 days of admission 158 95 48 n/a 69 65 n/a 128 105

% Started Aspirin within 2 days of admission 59 71 51 n/a 56 54 n/a 70 68

Confidence Interval 53 to 65 63 to 79 41 to 62 n/a 46 to 65 44 to 63 n/a 63 to 76 60 to 75

No. Received Aspirin in hospital 196 114 79 n/a 121 113 n/a 160 133

% Received Aspirin in hospital 73 86 84 n/a 98 93 n/a 87 87

Confidence Interval 68 to 78 79 to 91 75 to 91 n/a 93 to 96 87 to 97 82 to 92 80 to 91

No. Patients with Definite Ischaemic event - Alive at Discharge 235 113 84 243 117 110 292 160 131

No. Discharged on Antiplatelet or Warfarin 212 105 74 239 115 107 283 153 117

% Discharged on Antiplatelet or Warfarin 90 93 84 98 98 97 97 96 89


No. Discharged on Statin 161 86 74 226 108 102 258 135 126

% Discharged on Statin 69 76 88 93 92 93 88 84 96


No. Discharged on antihypertensive 177 81 46 200 88 71 212 113 97

% Discharged on antihypertensive 75 72 55 82 75 65 73 71 74


No. Patients with Definite ischaemic event in AF - Alive at Discharge 32 12 3 43 12 22 52 27 27

No. Discharged on Warfarin 7 3 1 15 1 3 21 11 7

% Discharged on Warfarin 22 25 33 35 8 14 40 41 26


39

5.11 Greater Glasgow, North - Table 13

Royal Infirmary Glasgow Stobhill Hospital Western Infirmary Glasgow Audit Period Start Date (based on date of admission) 01/09/04 01/03/2005 01/09/05 01/09/04 01/03/05 01/09/05 01/09/04 01/03/05 01/09/05


Number of days 181 184 181 181 184 181 181 184 181




















No. Swallow screen within 1 day of admission 125 79 64 43 27 29 175 210 61

% Swallow screen within 1 day of admission 91 83 80 81 55 56 98 93 92


No. Swallow screen during admission 135 82 71 48 35 31 177 212 62

% Swallow screen during admission 99 86 89 91 71 60 99 94 94


40

Royal Infirmary Glasgow Stobhill Hospital Western Infirmary Glasgow No. Patients with Definite Ischaemic event 146 97 76 60 51 52 201 233 85

No. Started Aspirin within 2 days of admission 50 27 36 30 19 28 129 165 61

% Started Aspirin within 2 days of admission 34 28 47 50 37 54 64 71 72


No. Received Aspirin in hospital 115 67 55 60 40 49 147 178 67

% Received Aspirin in hospital 79 69 72 70 78 94 73 76 79
















41

5.12 Greater Glasgow, South - Table 14

Southern General Victoria Infirmary Glasgow Audit Period Start Date (based on date of admission) 05/04/04 06/10/04 06/04/05 05/04/04 06/10/04 06/04/05


Number of days 184 182 183 184 182 183


























42

Southern General Victoria Infirmary Glasgow No. Patients with Definite Ischaemic event 131 200 243 189 117 53





















43

5.13 Grampian - Table 15

Aberdeen Royal Infirmary Audit Period Start Date (based on date of admission) 01/10/03 01/10/04 01/04/05






















No. Swallow screen within 1 day of admission n/a n/a 69

% Swallow screen within 1 day of admission n/a n/a 44

Confidence Interval n/a n/a 36 to 51

No. Swallow screen during admission n/a n/a 105

% Swallow screen during admission n/a n/a 66


44

Aberdeen Royal Infirmary No. Patients with Definite Ischaemic event 468 206 154








No. Discharged on Antiplatelet or Warfarin n/a n/a 113

% Discharged on Antiplatelet or Warfarin n/a n/a 82


No. Discharged on Statin n/a n/a 102

% Discharged on Statin n/a n/a 74


No. Discharged on antihypertensive n/a n/a 88

% Discharged on antihypertensive n/a n/a 64






45

5.14 Lothian - Table 16

Royal Infirmary Edinburgh Western General Hospital St Johns Hospital Audit Period Start Date (based on date of admission) 01/08/03 01/08/04 01/02/05 01/09/03 01/09/04 01/03/05 01/01/04 01/01/05 01/07/05


Number of days 366 184 181 366 181 184 366 181 184




















No. Swallow screen within 1 day of admission n/a 71 68 n/a 94 97 n/a 69 69

% Swallow screen within 1 day of admission n/a 46 44 n/a 59 60 n/a 51 56

Confidence Interval n/a 38 to 54 37 to 52 n/a 52 to 67 53 to 67 n/a 43 to 59 47 to 64

No. Swallow screen during admission n/a 84 77 n/a 125 123 n/a 70 71

% Swallow screen during admission n/a 55 50 n/a 79 76 n/a 52 57

Confidence Interval n/a 47 to 62 42 to 58 n/a 72 to 85 69 to 82 n/a 43 to 60 48 to 66

46

Royal Infirmary Edinburgh Western General Hospital St Johns Hospital No. Patients with Definite Ischaemic event 361 145 126 351 159 166 145 176 114

No. Started Aspirin within 2 days of admission 181 76 70 245 119 117 105 117 76

% Started Aspirin within 2 days of admission 50 52 56 70 75 70 72 66 67


No. Received Aspirin in hospital 249 100 97 289 138 136 127 139 93

% Received Aspirin in hospital 69 69 77 82 87 82 88 79 82
















47

5.15 Tayside - Table 17

Ninewells Perth Royal Infirmary Audit Period Start Date (based on date of admission) 01/06/04 01/01/05 01/07/05 01/01/04 01/01/05 01/07/05


Number of days 214 181 184 366 181 184




















No. Swallow screen within 1 day of admission 94 78 71 n/a 72 55

% Swallow screen within 1 day of admission 33 53 53 n/a 51 45

Confidence Interval 28 to 39 45 to 61 45 to 61 n/a 43 to 59 36 to 54

No. Swallow screen during admission 115 89 84 n/a 75 62

% Swallow screen during admission 40 61 63 n/a 53 50

Confidence Interval 35 to 46 53 to 68 54 to 70 n/a 45 to 61 42 to 59

48

Ninewells Perth Royal Infirmary No. Patients with Definite Ischaemic event 285 152 143 224 123 120





















49

5.16 Islands - Table 18

Orkney and Shetland do not have stroke units.

Orkney Shetland Western Isles Audit Period Start Date (based on date of admission) 01/01/04 01/01/05 01/01/04 01/01/05 10/10/04 01/08/2005

Audit Period End Date 31/12/04 31/12/05 31/12/04 31/12/05 31-Jul-05 31/03/2006

Number of days 366 365 366 365 295 243





No. Admitted to the SU within 1 day of admission n/a n/a n/a n/a 18 5

% Admitted to the SU within 1 day of admission n/a n/a n/a n/a 55 17

Confidence Interval n/a n/a n/a n/a 38 to 70 8 to 35

No. Admitted to a SU during admission n/a n/a n/a n/a 25 10

% Admitted to a Stroke Unit during admission n/a n/a n/a n/a 76 34

Confidence Interval n/a n/a n/a n/a 59 to 87 20 to 53






Confidence Interval 11 to 42 43 to 82 22 to 61 14 to 48 n/a n/a




No. Swallow screen within 1 day of admission 12 7 6 n/a n/a n/a

% Swallow screen within 1 day of admission 46 35 30 n/a n/a n/a

Confidence Interval 29 to 65 18 to 57 15 to 52 n/a n/a n/a

No. Swallow screen during admission 12 9 8 n/a n/a n/a

% Swallow screen during admission 46 45 40 n/a n/a n/a

Confidence Interval 29 to 65 26 to 66 22 to 61 n/a n/a n/a

50

Orkney Shetland Western Isles No. Patients with Definite Ischaemic event 9 14 10 7 30 26











No. Discharged on Statin 8 9 6 9 18









Confidence Interval 21 to 100 n/a 9 to 91 21 to 100 0 to 79 10 to 70

51

6 Outpatient Tables

6.1 Outpatient Definitions

NHS QIS Standards included where appropriate. Lines highlighted in grey are the denominators for the calculations immediately below.

Outpatient Data Definition

Audit Period Start Date and End Date (based on date of admission)

All patients assessed in a neurovascular clinic between these dates are included in the audit.

Number of days This is the number of days between start date and end date (inclusive).

Total Number of patients entered This is the total number of Outpatients entered into SSCAS for this period.

Estimated annual no. Total number of patients assessed, divided by the Number of days, and then multiplied by 365.

No. Diagnosis: Stroke Number of patients assessed with Final Diagnosis of stroke.

% Diagnosis: Stroke % of patients assessed with Final Diagnosis of stroke

No. Diagnosis: TIA Number of patients assessed with Final Diagnosis of Cerebral TIA.

% Diagnosis: TIA % of patients assessed with Final Diagnosis of Cerebral TIA.

No. Diagnosis: Eye Number of patients assessed with Final Diagnosis of Transient Monocular Blindness or Retinal Artery Occlusion.

% Diagnosis: Eye % of patients assessed with Final Diagnosis of Transient Monocular Blindness or Retinal Artery Occlusion.

No. Diagnosis: Other Number of patients assessed with no. definite Cerebrovascular Final Diagnosis (Stroke, TIA, TMB or RAO), recorded as either Possible Cerebrovascular Disease or Definite Non-cerebrovascular Disease and patients with no. recorded diagnosis.

% Diagnosis: Other % of patients assessed with no. definite Cerebrovascular Final Diagnosis (Stroke, TIA, TMB or RAO), recorded as either Possible Cerebrovascular Disease or Definite Non-cerebrovascular Disease and patients with no. recorded diagnosis.

Number having surgery All patients who had secondary preventative surgery (Carotid Endarterectomy).

Mean delay from Last event to surgery (days) This is the median number of days between event and surgery for all patients who had surgery for secondary prevention (CEA).

No. of patients with Definite cerebro-vascular diagnosis

Patients who do not have a Final Diagnosis of sub-arachnoid haemorrhage and with a Final Diagnosis of stroke or a Final Diagnosis of Cerebral TIA or a Final diagnosis of Transient Monocular Blindness or a Final Diagnosis of Retinal Artery Occlusion.

No. seen within 7 days of receipt of referral This is the number of patients who had their Initial Assessment in the neurovascular clinic within 7 days of receipt of referral.

52

Outpatient Data Definition

% seen within 7 days of receipt of referral This is the percentage of patients who had their Initial Assessment in the neurovascular clinic within 7 days of receipt of referral.

NHS QIS Standard 1.8: 80% of new patients are seen within 7 days of receipt of referral to the neurovascular clinic

Confidence Interval The 95% Confidence Intervals on the percentage of patients who had their Initial Assessment in the neurovascular clinic within 7 days of receipt of referral.

No. seen within 14 days of receipt of referral This is the number of patients who had their Initial Assessment in the neurovascular clinic within 14 days of receipt of referral.

% seen within 14 days of receipt of referral This is the percentage of patients who had their Initial Assessment in the neurovascular clinic within 14 days of receipt of referral.

NHS QIS Standard 1.7: 80% of new patients are seen within 14 days of receipt of referral to the neurovascular clinic.

Confidence Interval The 95% Confidence Intervals on the percentage of patients who had their Initial Assessment in the neurovascular clinic within 14 days of receipt of referral.

Delay from Assessment to Duplex: Mean and Median

These are the mean and median number of days between assessment and the first carotid doppler for all patients assessed who had a carotid Doppler.

All patients with stroke Percent of patients assessed with Final Diagnosis of stroke.

Delay from Assessment to Brain scan: Mean and Median

These are the mean and median number of days between assessment and the first scan for all Stroke patients assessed who had a scan.

Cerebral TIA or stroke Patients who do not have Final Diagnosis of sub-arachnoid haemorrhage and who have a Final Diagnosis of stroke or a Final Diagnosis of cerebral TIA.

Delay from Assessment to Echo: Mean and Median

These are the mean and median number of days between assessment and the first Echocardiogram for all Cerebral TIA or Stroke patients assessed who had an Echocardiogram.

53

6.2 Scotland Wide - Table 19

Scotland Period 1:

2003/2004 Scotland Periods 2 & 3 Combined: 2004/2005

Total Number of patients entered 3046 4061

No. Diagnosis: Stroke 941 1205

% Diagnosis: Stroke 31 30

No. Diagnosis: TIA 921 1209

% Diagnosis: TIA 30 30

No. Diagnosis: Eye 134 237

% Diagnosis: Eye 4 6

No. Diagnosis: Other 1066 1345

% Diagnosis: Other 35 33

Number having surgery 61 64

No. of patients with Definite cerebro-vascular diagnosis 2005 2631

No. seen within 7 days of receipt of referral 428 502

% seen within 7 days of receipt of referral 21 19

Confidence Interval

880 1140

No. seen within 14 days of receipt of referral 44 43

% seen within 14 days of receipt of referral 3046 4061

Confidence Interval 941 1205

54

6.3 Ayrshire and Arran - Table 20

Ayr Hospital Crosshouse Hospital Audit Period Start Date (based on date of assessment) 01/01/04 01/11/04 01/05/05 01/03/04 01/11/04 01/05/05


Number of days 305 181 184 245 181 184


Estimated annual no. 186.9 169.6 133.1 276.0 226.2 252.3

No. Diagnosis: Stroke 51 25 13 76 54 67

% Diagnosis: Stroke 33 30 19 41 48 53

No. Diagnosis: TIA 85 48 52 58 52 52

% Diagnosis: TIA 54 57 78 31 46 41

No. Diagnosis: Eye 2 4 2 8 4 7

% Diagnosis: Eye 1 5 3 4 4 6

No. Diagnosis: Other 18 7 0 51 10 2

% Diagnosis: Other 12 8 0 28 9 2

Number having surgery 0 1 0 9 5 2

Mean delay from Last event to surgery (days) n/a 211 n/a 212.1 150.3 140.5

No. of patients with Definite cerebro-vascular diagnosis 138 77 67 140 110 126

No. seen within 7 days of receipt of referral 11 3 10 11 7 23

% seen within 7 days of receipt of referral 8 4 15 8 6 18





Delay from Assessment to Duplex: Mean 0.4 0.2 0.5 1.5 0.7 1.1

Delay from Assessment to Duplex: Median 0.0 0.0 0.0 0.0 0.0 0.0

All patients with stroke 51 25 13 76 54 67

Delay from Assessment to Brain scan: Mean 2.3 0.9 1.8 0.0 3.7 1.7

Delay from Assessment to Brain scan: Median 0.0 0.0 0.0 0.0 0.0 0.0

Cerebral TIA or stroke 136 73 65 133 106 119

Delay from Assessment to Echo: Mean 28.4 20.7 70.8 36.1 85.9 54.1

Delay from Assessment to Echo: Median 27.0 17.0 67.5 30.5 78.0 46.0

55

6.4 Argyll and Clyde - Table 21

Inverclyde Royal Hospital Royal Alexandra Hospital Audit Period Start Date (based on date of assessment) 01/09/03 09/01/04 01/03/05 01/09/03 01/09/04 01/03/05


Number of days 367 181 184 366 181 184





No. Diagnosis: TIA 84 59 78 55 14 9

% Diagnosis: TIA 60 67 72 34 20 16




% Diagnosis: Other 1 0 0 41 64 60


Mean delay from Last event to surgery (days) n/a 39 97 75 106 78.5








Delay from Assessment to Duplex: Mean 0.2 0 0 27.9 22.2 26.3

Delay from Assessment to Duplex: Median 0.0 0 0 28.5 21.5 21.5


Delay from Assessment to Brain scan: Mean 15.0 n/a n/a 20.3 18.0 51.5

Delay from Assessment to Brain scan: Median 22.0 n/a n/a 20.0 17.5 26.5


Delay from Assessment to Echo: Mean 0.2 0 0 51.7 n/a 35.0

Delay from Assessment to Echo: Median 0.0 0 0 50.5 n/a 25.0

56

6.5 Dumfries and Galloway - Table 22

Dumfries and Galloway Royal Infirmary Audit Period Start Date (based on date of assessment) 01/01/04 01/01/05 01/07/05




Estimated annual no. 217.7 246.4 246.3

No. Diagnosis: Stroke 93 41 47

% Diagnosis: Stroke 43 34 38

No. Diagnosis: TIA 43 15 30

% Diagnosis: TIA 20 12 24

No. Diagnosis: Eye 5 2 0

% Diagnosis: Eye 2 2 0

No. Diagnosis: Other 83 66 48

% Diagnosis: Other 38 54 39

Number having surgery 5 0 1

Mean delay from Last event to surgery (days) 75.7 n/a 79

No. of patients with Definite cerebro-vascular diagnosis 135 56 76

No. seen within 7 days of receipt of referral 40 16 22

% seen within 7 days of receipt of referral 30 29 29


No. seen within 14 days of receipt of referral 101 44 54

% seen within 14 days of receipt of referral 75 79 71


Delay from Assessment to Duplex: Mean 0.9 0.6 0.8

Delay from Assessment to Duplex: Median 0.0 0 0.0

All patients with stroke 93 41 47

Delay from Assessment to Brain scan: Mean 0 0.5 0

Delay from Assessment to Brain scan: Median 0 0 0

Cerebral TIA or stroke 131 54 76

Delay from Assessment to Echo: Mean 67.5 67.2 58.7

Delay from Assessment to Echo: Median 66.0 49.0 50.0

57

6.6 Fife - Table 23

Victoria Hospital, Kirkcaldy Queen Margaret Hospital Audit Period Start Date (based on date of assessment) 08/12/03 08/06/04 08/12/04 08/12/03 08/06/04 08/12/04


Number of days 183 183 182 183 183 182





No. Diagnosis: TIA 40 30 34 38 25 29

% Diagnosis: TIA 38 35 30 31 24 32




% Diagnosis: Other 30 24 30 34 35 42


Mean delay from Last event to surgery (days) n/a 71 66.5 32 40 n/a








Delay from Assessment to Duplex: Mean 0.2 0.0 0.0 0.7 0.6 0.0

Delay from Assessment to Duplex: Median 0.0 0.0 0.0 0.0 0.0 0.0


Delay from Assessment to Brain scan: Mean 3.6 0.0 0.0 0.0 1.5 0.2

Delay from Assessment to Brain scan: Median 0.0 0.0 0.0 0.0 0.0 0.0


Delay from Assessment to Echo: Mean 33.3 40.0 69.0 16.0 33.0 38.0

Delay from Assessment to Echo: Median 35.0 40.0 69.0 16.0 23.0 38.0

58

6.7 Highlands - Table 24

Raigmore Hospital Audit Period Start Date (based on date of assessment) 03/02/05

Audit Period End Date 02/02/06

Number of days 365

Total Number of patients entered 269

Estimated annual no. 269.4

No. Diagnosis: Stroke 113

% Diagnosis: Stroke 42

No. Diagnosis: TIA 56

% Diagnosis: TIA 21

No. Diagnosis: Eye 7

% Diagnosis: Eye 3

No. Diagnosis: Other 76

% Diagnosis: Other 28

Number having surgery 2

Mean delay from Last event to surgery (days) 35

No. of patients with Definite cerebro-vascular diagnosis 173

No. seen within 7 days of receipt of referral 67

% seen within 7 days of receipt of referral 39

Confidence Interval 32 to 46




Delay from Assessment to Duplex: Mean 0.7

Delay from Assessment to Duplex: Median 0.0

All patients with stroke 113

Delay from Assessment to Brain scan: Mean 16.1

Delay from Assessment to Brain scan: Median 3.5

Cerebral TIA or stroke 169

Delay from Assessment to Echo: Mean 2.8

Delay from Assessment to Echo: Median 0.0

59

6.8 Lanarkshire - Table 25

Hairmyres Audit Period Start Date (based on date of assessment) 01/11/03 01/11/04 01/05/05




Estimated annual no. 142.8 298.9 260.2

No. Diagnosis: Stroke 48 37 29

% Diagnosis: Stroke 35 25 22

No. Diagnosis: TIA 32 37 32

% Diagnosis: TIA 23 25 24

No. Diagnosis: Eye 2 6 8

% Diagnosis: Eye 1 4 6

No. Diagnosis: Other 61 68 67

% Diagnosis: Other 43 46 51

Number having surgery 0 0 0

Mean delay from Last event to surgery (days) n/a n/a n/a

No. of patients with Definite cerebro-vascular diagnosis 82 80 67

No. seen within 7 days of receipt of referral n/a n/a n/a

% seen within 7 days of receipt of referral n/a n/a n/a

Confidence Interval n/a n/a n/a

No. seen within 14 days of receipt of referral n/a n/a n/a

% seen within 14 days of receipt of referral n/a n/a n/a

Confidence Interval n/a n/a n/a

Delay from Assessment to Duplex: Mean 36.0 35.4 21.4

Delay from Assessment to Duplex: Median 28.0 29.0 6.0

All patients with stroke 48 37 29

Delay from Assessment to Brain scan: Mean 13.6 15.8 14.0

Delay from Assessment to Brain scan: Median 6.0 9.0 6.0

Cerebral TIA or stroke 80 74 61

Delay from Assessment to Echo: Mean 28.7 53.0 44.6

Delay from Assessment to Echo: Median 30.0 13.0 42.0

60

6.9 Grampian - Table 26

Aberdeen Royal Infimary Audit Period Start Date (based on date of assessment) 01/04/2005

Audit Period End Date 31/03/2006

Number of days 365

Total Number of patients entered 451

Calculated annual no. 451.62

No. Diagnosis: Stroke 116

% Diagnosis: Stroke 26

No. Diagnosis: TIA 112

% Diagnosis: TIA 25

No. Diagnosis: Eye 5

% Diagnosis: Eye 1

No. Diagnosis: Other 125

% Diagnosis: Other 28

Number having surgery not tracked

Mean delays from Last event to surgery (days) n/a

No. of patients with Definite cerebro-vascular diagnosis 232







Delays from Assessment to Duplex: Mean 1.7

Delays from Assessment to Duplex: Median 0.0

All patients with stroke 116

Delays from Assessment to Brain scan: Mean 3.9

Delays from Assessment to Brain scan: Median 0.0

Cerebral TIA or stroke 228

Delays from Assessment to Echo: Mean 77.5

Delays from Assessment to Echo: Median 77.5

61

6.10 Lothian - Table 27

The Royal Infirmary Edinburgh does not have a rapid access Neurovascular Clinic.

Royal Infirmary Edinburgh Western General Hospital St Johns Hospital Audit Period Start Date (based on date of assessment) 31/05/03 02/06/04 01/01/05 01/09/03 01/09/04 01/03/05 01/01/04 01/01/05 01/07/05


Number of days 368 213 181 366 181 184 366 181 184


Estimated annual no. 106.3 115.0 86.8 930.7 935.0 852.2 298.6 347.3 313.9

No. Diagnosis: Stroke 52 34 27 275 141 119 83 45 45

% Diagnosis: Stroke 49 51 63 30 30 28 28 26 28

No. Diagnosis: TIA 37 22 10 202 113 107 87 51 44

% Diagnosis: TIA 35 33 23 22 24 25 29 30 28

No. Diagnosis: Eye 0 1 2 47 41 44 26 21 16

% Diagnosis: Eye 0 1 5 5 9 10 9 12 10

No. Diagnosis: Other 13 11 9 405 175 169 107 54 56

% Diagnosis: Other 12 16 21 43 38 39 36 31 35

Number having surgery n/a n/a n/a 30 15 11 6 3 4

Mean delay from Last event to surgery (days) n/a n/a n/a 80.7 71.4 80.1 66.7 115 54

No. of patients with Definite cerebro-vascular diagnosis 93 56 37 541 291 266 195 117 105

No. seen within 7 days of receipt of referral 1 5 2 97 24 32 60 29 5

% seen within 7 days of receipt of referral 1 9 5 18 8 12 31 25 5


No. seen within 14 days of receipt of referral 10 14 5 314 107 110 124 83 16

% seen within 14 days of receipt of referral 11 25 14 58 37 41 64 71 15


Delay from Assessment to Duplex: Mean 3.8 22.4 30.7 1.6 2.4 2.2 2.1 4.0 3.0

Delay from Assessment to Duplex: Median 2 18.0 35.0 0.0 0.0 0.0 0.0 0.0 0.0

All patients with stroke 52 34 27 275 141 119 83 45 45

Delay from Assessment to Brain scan: Mean n/a 1 9 7.3 2.1 1.9 1.3 6.5 3.6

Delay from Assessment to Brain scan: Median n/a 1 9 0.0 0.0 0.0 0 7.0 0.0

Cerebral TIA or stroke 93 50 36 477 253 224 170 96 89

Delay from Assessment to Echo: Mean 7.8 26 0 32.5 27.9 35.2 3 7.0 6.2

Delay from Assessment to Echo: Median 0 26 0 21.0 24.0 24.0 0 0.0 0.0

62

6.11 Tayside - Table 28

Perth Royal Infirmary Stracathro

Audit Period Start Date (based on date of assessment) 01/01/04 01/01/05 01/07/05 01/01/04 01/01/05 01/07/05


Number of days 366 181 184 366 181 184





No. Diagnosis: TIA 85 24 15 61 25 11

% Diagnosis: TIA 28 21 15 40 33 19




% Diagnosis: Other 47 60 56 29 37 63

Number having surgery 4 2 3 3 1 n/a

Mean delays from Last event to surgery (days) 103.3 127 114.3 37 34.6 n/a








Delays from Assessment to Duplex: Mean 3.6 3.0 4.3 2.4 2.1 0.6

Delays from Assessment to Duplex: Median 0.0 0.0 0.0 0 0 0


Delays from Assessment to Brain scan: Mean 19.8 15.9 17.6 4.5 0.8 2.1

Delays from Assessment to Brain scan: Median 15.0 15.0 17.0 0 0 0


Delays from Assessment to Echo: Mean 74.6 74.0 19.3 104.0 66.7 28.0

Delays from Assessment to Echo: Median 70.0 64.0 7.0 64 65 28

63

7 ISD Linkage Data (Inpatients only)

7.1 Casemix Comparisons

7.1.1 Mean age by Health Board - Chart 1

60

65

70

75

80

85

A&

A

A&

C

Bo

rde

rs

D&

G

Fife

FV

Hig

hla

nd

La

na

rk

GG

Gra

mp

ian

Lo

thia

n

Ta

ysid

e

Ork

ne

y

Sh

etla

nd

WI

lower CI

upper CI

Scotland

Health Board

64

7.1.2 Mean age by Hospital - Chart 2

60

65

70

75

80

85

90

Ayr

Cro

ssh

ou

se

Inve

rcly

de

Lo

rn

RA

H

Va

le L

eve

n

Bo

rde

rs

DG

RI

QM

H

VH

K

Fa

lkir

k R

I

Stirl

ing

RI

Be

lfo

rd

Ca

ith

ne

ss

Ra

igm

ore

Ha

irm

yre

s

Mo

nkla

nd

s

Wis

ha

w

GR

I

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uth

Ge

n

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ill

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AR

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St

Jo

hn

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H

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ew

ells

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Gilb

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Ba

in

Uis

t &

Ba

rra

We

st

Isle

s

Ag

e

lower CI

upper CI

Scotland

Hospital

65

7.1.3 % Independent in Activities of Daily Living pre-stroke, by Health Board - Chart 3

0

10

20

30

40

50

60

70

80

90

100

A&A

A&CBor

ders

D&G

Fife

FVH

ighl

and

Lana

rk.

GG

Gra

mp.

Loth

ian

Taysi

de

Ork

ney

Shetla

nd

W Is

les

% c

ases Health Board

lower CI

upper CI

Scotland

66

7.1.4 % Independent in Activities of Daily Living pre-stroke, by Hospital - Chart 4

0

20

40

60

80

100

AyrC

ross

hous

eIn

verc

lyde

Lorn

RAH

Vale

Leve

nBor

ders

DG

RI

QM

H

VHK

Falki

rk R

IStir

ling

RI

Belfo

rdC

aith

ness

Rai

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airm

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Mon

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GR

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th G

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tern

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t

AR

I

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IN

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RI

St J

ohn'

s

WG

HPer

th R

IN

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Balfo

urG

ilber

t Bai

nU

ist &

Bar

raW

est I

sles

% c

ases Hospital

lower CI

upper CI

Scotland

67

7.1.5 % Living Alone pre-stroke, by Health Board - Chart 5

0

10

20

30

40

50

60

70

80

90

100

A&A

A&CBor

ders

D&G

Fife

FVH

ighl

and

Lana

rk.

GG

Gra

mp.

Loth

ian

Taysi

de

Ork

ney

Shetla

nd

W Is

les

% c

ases Health Board

lower CI

upper CI

Scotland

68

7.1.6 % Living Alone pre-stroke, by Hospital - Chart 6

0

10

20

30

40

50

60

70

80

90

100

Ayr

Cro

ssho

use

Inve

rcly

de

Lorn

RAH

Val

e Le

ven

Bor

ders

DG

RI

QM

H

VH

KFal

kirk

RI

Stir

ling

RI

Bel

ford

Cai

thne

ssR

aigm

ore

Hai

rmyr

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ands

Wis

haw

GR

IS

outh

Gen

Sto

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tern

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t

AR

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IN

ew E

RI

St J

ohn'

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GH

Per

th R

IN

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Bal

four

Gilb

ert B

ain

Uis

t & B

arra

Wes

t Isl

es

% c

as

es Hospital

lower CI

upper CI

Scotland

69

7.1.7 % Able to lift arms on admission, by Health Board - Chart 7

0

10

20

30

40

50

60

70

80

90

A&A

A&CBor

ders

D&G

Fife

FVH

ighl

and

Lana

rk.

GG

Gra

mp.

Loth

ian

Taysi

de

Ork

ney

Shetla

nd

W Is

les

% c

ases Health Board

lower CI

upper CI

Scotland

70

7.1.8 % Able to lift arms on admission, by Hospital - Chart 8

0

20

40

60

80

100

Ayr

Cro

ssho

use

Inve

rcly

deLo

rnR

AHVal

e Le

ven

Borde

rsD

GR

IQ

MH

VHK

Falki

rk R

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ness

Rai

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Mon

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th G

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Vict I

nf

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tern

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t

ARI

ERI

New

ER

ISt J

ohn'

sW

GH

Perth

RI

Nin

ewel

lsBal

four

Gilb

ert B

ain

Uis

t & B

arra

Wes

t Isl

es

% c

as

es Hospital

lower CI

upper CI

Scotland

71

7.1.9 % Able to walk independently on admission, by Health Board - Chart 9

0

10

20

30

40

50

60

70

A&A

A&C

Borde

rs

D&G

Fife

FVH

ighl

and

Lana

rk.

GG

Gra

mp.

Loth

ian

Taysi

de

Ork

ney

Shetla

nd

W Is

les

% c

ases Health Board

lower CI

upper CI

Scotland

72

7.1.10 % Able to walk independently on admission, by Hospital - Chart 10

0

10

20

30

40

50

60

70

80

AyrC

ross

hous

eIn

verc

lyde

Lorn

RA

HVal

e Le

ven

Borde

rsD

GR

IQ

MH

VHK

Falki

rk R

IStir

ling

RI

Belfo

rdC

aith

ness

Rai

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airm

yres

Mon

klan

dsW

isha

w

GR

ISou

th G

enSto

bhill

Vict I

nf

Wes

tern

/Gar

t

ARI

ERI

New

ER

ISt J

ohn'

sW

GH

Perth

RI

Nin

ewel

lsBal

four

Gilb

ert B

ain

Uis

t & B

arra

Wes

t Isl

es

% c

as

es Hospital

lower CI

upper CI

Scotland

73

7.1.11 % Able to talk and not confused on admission, by Health Board - Chart 11

0

10

20

30

40

50

60

70

80

90

100

A&A

A&CBor

ders

D&G

Fife

FVH

ighl

and

Lana

rk.

GG

Gra

mp.

Loth

ian

Taysi

de

Ork

ney

Shetla

nd

W Is

les

% c

ases Health Board

lower CI

upper CI

Scotland

74

7.1.12 % Able to talk and not confused on admission, by Hospital - Chart 12

0

10

20

30

40

50

60

70

80

90

100

Ayr

Cro

ssho

use

Inve

rcly

de

Lorn

RAH

Val

e Le

ven

Bor

ders

DG

RI

QM

H

VH

KFal

kirk

RI

Stir

ling

RI

Bel

ford

Cai

thne

ssR

aigm

ore

Hai

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esM

onkl

ands

Wis

haw

GR

IS

outh

Gen

Sto

bhill

Vic

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Wes

tern

/Gar

t

AR

I

ER

IN

ew E

RI

St J

ohn'

sW

GH

Per

th R

IN

inew

ells

Bal

four

Gilb

ert B

ain

Uis

t & B

arra

Wes

t Isl

es

% c

as

es Hospital

lower CI

upper CI

Scotland

75

7.2 Survival Analyses

7.2.1 % Cases successfully linked and included for survival analyses

The proportion included in the analyses depends on the number of patients for whom all casemix variables were available.

7.2.1.1 By Health Board - Table 29

Health Board of Treatment

Total no. of cases entered

in SSCAS

SSCAS cases linked successfully to

Mortality/ SMR01 Data

Total no. of linked cases with Stroke

diagnosis

% of Total SSCAS cases included in survival analysis

Ayrshire & Arran 1688 1684 1448 62

Argyll & Clyde 1592 1571 1399 62

Borders 388 387 387 71

Dumfries & Galloway 885 874 772 73

Fife 1369 1357 1024 56

Forth Valley 1228 1211 1210 72

Highland 812 812 628 52

Lanarkshire 2761 2738 2337 60

Greater Glasgow 2654 2625 2151 58

Grampian 3512 3509 2700 39

Lothian 4961 4943 4175 65

Tayside 1557 1550 1019 46

Orkney 34 34 31 41

Shetland 27 26 20 52

Western Isles 134 133 113 56

Total 23602 23454 19414 58

76

7.2.1.2 By Hospital - Table 30

Hospital


in SSCAS




diagnosis


Ayr Hospital 766 764 620 62

Crosshouse Hospital 921 919 827 62

Inverclyde Royal Hospital 643 642 563 62

Lorn & Islands 84 75 63 70

Royal Alexandra Hospital 774 766 700 62

Vale of Leven 77 74 64 53

Borders General Hospital 388 387 385 71

Dumfries & Galloway Royal Infirmary 884 873 770 73

Queen Margaret Hospital 547 540 433 62

Victoria Hospital, Kirkaldy 822 817 591 52

Falkirk Royal Infirmary 564 561 561 87

Stirling Royal Infirmary 664 650 647 59

Belford 38 38 28 53

Caithness 42 42 39 48

Raigmore 726 726 557 52

Hairmyres Hospital 837 829 634 56

Monklands Hospital 892 886 791 60

Wishaw Hospital 1032 1023 909 62

Glasgow Royal Infirmary 455 450 347 52

Southern General Hospital 797 781 711 57

Stobhill Hospital 205 201 146 50

Victoria Infirmary, Glasgow 452 450 396 77

Western Infirmary /Gartnaval 745 743 551 55

Aberdeen Royal Infirmary 3163 3160 2401 42

Edinburgh Royal Infirmary 967 963 867 71

New Edinburgh Royal Infirmary 919 938 839 59

St John's Hospital 1168 1160 846 59

Western General Hospital 1850 1847 1587 69

Perth Royal Infirmary 1034 1028 610 43

Ninewells Hospital 522 521 406 51

77

Hospital


in SSCAS




diagnosis


Balfour 34 34 31 41

Gilbert Bain 27 26 20 52

Uist & Barra 10 10 10 60

Western Isles 124 123 102 56

7.2.2 Six Month Survival After Stroke Admission by Health Board of Treatment

7.2.2.1 Crude Analysis - Table 31

Number predicted is based on overall survival across all hospitals. A negative W score indicates a poorer than average survival. These analyses

do not take any account of casemix

Number alive at 6 months Excess number survived per 100 admissions

with 95% CI

Health Board of Treatment Admissions Observed Predicted W Score Lower Upper

Ayrshire & Arran 1039 761 780 -1.9 -4.5 0.7

Argyll & Clyde 988 738 742 -0.4 -3.1 2.3

Borders 275 206 207 -0.2 -5.3 4.9

Dumfries & Galloway 644 470 484 -2.1 -5.5 1.2

Fife 765 483 575 -12.0 -15.1 -8.9

Forth Valley 883 653 663 -1.2 -4.0 1.7

Highland 423 293 318 -5.8 -10.0 -1.7

Lanarkshire 1644 1261 1235 1.6 -0.5 3.7

Greater Glasgow 1549 1245 1163 5.3 3.1 7.4

Grampian 1355 1156 1018 10.2 7.9 12.5

Lothian 3211 2347 2412 -2.0 -3.5 -0.5

Tayside 709 523 532 -1.3 -4.5 1.8

Orkney 14 8 11 -18.0 -40.6 4.7

Shetland 14 10 11 -3.7 -26.3 18.9

Western Isles 75 51 56 -7.1 -16.9 2.7

78

7.2.2.2 Casemix Adjusted - Table 32

These analyses take casemix into account.


with 95% CI

Health Board of Treatment Admissions Observed Predicted W Score Lower Upper

Ayrshire & Arran 1039 761 765 -0.4 -2.6 1.9

Argyll & Clyde 988 738 761 -2.3 -4.5 0.0

Borders 275 206 206 0.0 -4.3 4.4

Dumfries & Galloway 644 470 428 6.5 3.3 9.7

Fife 765 483 507 -3.1 -6.0 -0.3

Forth Valley 883 653 659 -0.7 -3.2 1.8

Highland 423 293 306 -3.0 -6.7 0.6

Lanarkshire 1644 1261 1237 1.5 -0.3 3.2

Greater Glasgow 1549 1245 1242 0.2 -1.5 1.9

Grampian 1355 1156 1126 2.2 0.4 4.0

Lothian 3211 2347 2370 -0.7 -2.0 0.6

Tayside 709 523 532 -1.2 -3.9 1.5

Orkney 14 8 10 -11.0 -31.7 9.7

Shetland 14 10 10 1.5 -19.0 22.1

Western Isles 75 51 49 2.3 -6.7 11.3

79

7.2.3 Six Month Survival After Stroke adjusted for casemix - Admission by Health Board: W scores with 95% Confidence Intervals -

Chart 13

-40

-30

-20

-10

0

10

20

30

Ayrsh

ire &

Arra

nArg

yll &

Cly

de

Borde

rs

Dum

fries

& G

allo

way Fife

Forth

Val

ley

Hig

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d

Lana

rksh

ireG

reat

er G

lasg

ow

Gra

mpi

an

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ian

Taysi

de

Ork

ney

Shetla

ndW

este

rn Is

les

80

7.2.4 Six Month Survival After Stroke Admission by Hospital of Treatment

7.2.4.1 Crude Analysis - Table 33


with 95% CI

Hospital Board of Treatment Admissions Observed Predicted W Score Lower Upper

Ayr Hospital 471 344 354 -2.1 -6.0 1.8

Crosshouse Hospital 567 416 426 -1.7 -5.3 1.8

Inverclyde Royal Hospital 397 287 298 -2.8 -7.1 1.4

Lorn & Islands 59 44 44 -0.5 -11.6 10.5

Royal Alexandra Hospital 483 369 363 1.3 -2.6 5.2

Vale of Leven 41 31 31 0.5 -12.7 13.7

Borders General Hospital 275 206 207 -0.2 -5.3 4.9

Dumfries & Galloway Royal Infirmary 643 470 483 -2.0 -5.4 1.3

Queen Margaret Hospital 340 228 255 -8.0 -12.6 -3.4

Victoria Hospital, Kirkaldy 425 255 319 -15.1 -19.2 -11.0

Falkirk Royal Infirmary 493 368 370 -0.5 -4.3 3.4

Stirling Royal Infirmary 390 285 293 -2.0 -6.3 2.3

Belford 20 12 15 -15.1 -34.1 3.8

Caithness 20 15 15 -0.1 -19.1 18.8

Raigmore 380 263 285 -5.9 -10.2 -1.5

Hairmyres Hospital 465 371 349 4.7 0.8 8.6

Monklands Hospital 535 426 402 4.5 0.9 8.2

Wishaw Hospital 644 464 484 -3.1 -6.4 0.3

Glasgow Royal Infirmary 238 206 179 11.5 6.0 16.9

Southern General Hospital 455 377 342 7.8 3.8 11.7

Stobhill Hospital 103 84 77 6.5 -1.9 14.8

Victoria Infirmary, Glasgow 347 256 261 -1.3 -5.9 3.2

Western Infirmary /Gartnaval 406 322 305 4.2 0.0 8.4

Aberdeen Royal Infirmary 1321 1132 992 10.6 8.3 12.9

Edinburgh Royal Infirmary 683 459 513 -7.9 -11.1 -4.7

New Edinburgh Royal Infirmary 539 380 405 -4.6 -8.3 -1.0

St John's Hospital 692 488 520 -4.6 -7.8 -1.4

Western General Hospital 1271 995 955 3.2 0.8 5.6

Perth Royal Infirmary 444 323 333 -2.4 -6.4 1.7

Ninewells Hospital 264 199 198 0.3 -4.9 5.5

81


with 95% CI


Balfour 14 8 11 -18.0 -40.6 4.7

Gilbert Bain 14 10 11 -3.7 -26.3 19.0

Uist & Barra 6 5 5 8.2 -26.4 42.8

Western Isles 69 46 52 -8.4 -18.6 1.8

7.2.4.2 Casemix adjusted - Table 34


with 95% CI


Ayr Hospital 471 344 338 1.3 -2.1 4.6

Crosshouse Hospital 567 416 426 -1.8 -4.8 1.2

Inverclyde Royal Hospital 397 287 295 -2.1 -5.8 1.6

Lorn & Islands 59 44 39 9.2 -1.4 19.9

Royal Alexandra Hospital 483 369 388 -3.9 -7.0 -0.9

Vale of Leven 41 31 33 -4.7 -15.2 5.6

Borders General Hospital 275 206 206 0.1 -4.3 4.4

Dumfries & Galloway Royal Infirmary 643 470 427 6.6 3.4 9.8

Queen Margaret Hospital 340 228 229 -0.2 -4.4 4.0

Victoria Hospital, Kirkaldy 425 255 278 -5.4 -9.5 -1.6

Falkirk Royal Infirmary 493 368 364 0.8 -2.6 4.1

Stirling Royal Infirmary 390 285 295 -2.5 -6.2 1.3

Belford 20 12 13 -7.0 -24.9 11.0

Caithness 20 15 16 -3.4 -19.4 12.6

Raigmore 380 263 275 -3.1 -6.9 0.7

Hairmyres Hospital 465 371 350 4.6 1.3 7.9

Monklands Hospital 535 426 413 2.4 -0.6 5.4

Wishaw Hospital 644 464 474 -1.6 -4.5 1.3

Glasgow Royal Infirmary 238 206 207 -0.6 -4.4 3.2

Southern General Hospital 103 84 85 -1.3 -7.3 4.7

Stobhill Hospital 455 377 364 2.8 -0.4 6.0

Victoria Infirmary, Glasgow 347 256 263 -1.9 -5.7 1.9

Western Infirmary /Gartnaval 406 322 322 -0.1 -3.5 3.3

Aberdeen Royal Infirmary 1321 1132 1101 2.3 0.6 4.1

82


with 95% CI


Edinburgh Royal Infirmary 539 380 381 -0.2 -3.5 3.1

St John's Hospital 692 488 514 -3.7 -6.5 -0.9

Western General Hospital 1271 995 976 1.5 -0.5 3.5

Perth Royal Infirmary 264 199 208 -3.5 -7.7 0.8

Ninewells Hospital 444 323 322 0.1 -3.4 3.6

Balfour 14 8 10 -11.0 -31.7 9.7

Gilbert Bain 14 10 10 1.6 -19.0 22.1

Western Isles 69 46 45 1.2 -8.2 10.7

83

7.2.5 Six Month Survival After Stroke Admission by Hospital of Treatment: W scores with 95% Confidence Intervals - Chart 14

-40

-30

-20

-10

0

10

20

30

Ayr H

ospi

tal

Cro

ssho

use

Hos

pita

l

Inve

rcly

de R

oyal

Hos

pita

l

Lorn

& Is

land

s

Roy

al A

lexa

ndra

Hos

pita

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Vale

of L

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Borde

rs G

ener

al H

ospi

tal

Dum

fries

& G

allo

way

Roy

al In

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ary

Que

en M

arga

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Victo

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tal,

Kirkal

dy

Falki

rk R

oyal

Infir

mar

y

Stirlin

g R

oyal

Infir

mar

yBel

ford

Cai

thne

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ore

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rmyr

es H

ospi

tal

Mon

klan

ds H

ospi

tal

Wis

haw

Hos

pita

l

Gla

sgow

Roy

al In

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ary

South

ern

Gen

eral

Hos

pita

l

Stobh

ill H

ospi

tal

Victo

ria In

firm

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Gla

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tern

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mar

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Aberd

een

Roy

al In

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Edinb

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Roy

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St Joh

n's

Hos

pita

l

Wes

tern

Gen

eral

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84

7.2.6 Cox regression results for death at 6 months - Table 35

Table 35 shows a Cox regression analysis. This aims to show the relationship between aspects of a patient’s management and their likelihood of

dying within 6 months of admission to hospital. The analysis includes patients from all hospitals with complete casemix and treatment data. A

Hazard ratio of less than 1.0 indicates that being treated in that way is associated with a reduced risk of death. If the 95% confidence intervals of

the hazard ratio do not overlap 1.0 then the reduction in risk of death associated with that treatment is unlikely to have occurred by chance.

However, certain treatments are more or less likely to be given depending on the patients’ clinical state – thus the hazard ratios have been

adjusted to take account of the age, degree of frailty and the stroke severity. As an example having aspirin within 2 days of admission was

associated with a hazard ratio of 0.8 (i.e. a 20% reduction in hazard of death) and this was statistically significant with 95% confidence intervals

of 0.7-0.8. However having adjusted for stroke severity this association disappears (HR = 1.0). This may be because aspirin is more often given

to those with milder strokes – for example those with haemorrhagic stroke have a higher chance of dying (see haemorrhage on scan) but are

unlikely to receive aspirin. These sorts of analyses are not very reliable in determining the effectiveness of specific treatments. Large randomised

controlled trials have shown that aspirin and stroke unit care are associated with lower mortality – it is quite possible for Cox regression analyses

to miss such effects.

Unadjusted

Hazard Ratio 95% CI

Adjusted Hazard Ratio (adjusted

for case-mix variables) 95% CI

Aspirin within 2 days of Admission - -

no 1.0

yes 0.8 0.7 0.8 1.0 0.9 1.1

On Aspirin at Time of Stroke

no 1.0

yes 1.1 1.1 1.2 1.0 0.9 1.1

On Warfarin at time of Stroke

no 1.0

yes 1.4 1.2 1.6 1.5 1.3 1.7

Atrial Fibrillation

no 1.0

yes 2.1 1.9 2.3 1.4 1.3 1.5

Haemorrhage on Scan

no 1.0

yes 2.1 1.9 2.3 1.7 1.5 1.8

Stroke Unit within 1 day

no 1.0

yes 0.9 0.8 1.0 1.1 1.0 1.2

85

Unadjusted

Hazard Ratio 95% CI

Adjusted Hazard Ratio (adjusted

for case-mix variables) 95% CI

Stroke Unit care at any stage*

no 1.0

yes 0.7 0.7 0.8 0.7 0.6 0.7

CT Scan within 2 days

no 1.0

yes 0.9 0.8 0.9 1.0 0.9 1.1

Aspirin given in Hospital

no 1.0

yes 0.4 0.4 0.4 0.5 0.4 0.5

Swallow Screen carried out

no 1.0

yes 1.1 1.0 1.2 0.8 0.7 0.8

* Only cases where patient has survived at least 7 days included Cox regression using forward selection - final model; variables in equation

86

8 Future developments

An IT and audit subgroup of the National Advisory Committee for Stroke has been

established. The first meeting took place on June 19th

2006. Its role is to co-ordinate

several inter-related pieces of work which should facilitate the audit in the future.

These include:

• This audit

• Completion of the National Clinical Dataset Development Programme

(NCDDP) co-ordinated by Lorna Ramsay and Felicity Naughton at ISD.

Specifically their work developing standards for the recording of clinical data.

(http://www.clinicaldatasets.scot.nhs.uk/).

• The MCNs on the Web project co-ordinated by Karen Barrie at ISD.

• Building on work in Lanarkshire to develop a web based stroke audit system

which will make data entry and reporting easier.

• Bringing together teams who are developing Clinical IT systems to support

their service delivery and which might provide models for developing a

National Clinical Stroke System built using the Generic Clinical System

Toolkit.

The long term target is to capture the data for National Audit as a by-product of

routine care rather than collecting data specifically for audit. The primary role of a

National Clinical System will be to capture and share information about patients’

health across primary and secondary care. These clinical systems will streamline

production of discharge documentation etc.

We intend to link this system with a web based audit system so that reports can be

generated.

9 Contacts

Any questions about SSCA should be referred to the Co-ordinating Centre. Please

refer questions on this report to Robin Flaig. Please refer questions on the SSCA

system to Mike McDowall. For general questions about the Audit please contact

Martin Dennis, Chair of National Advisory Committee for Stroke.

Robin Flaig

Phone: 0131 537 3127

Email: [email protected]

Mike McDowall

Phone: 0131 537 2926


Martin Dennis

Phone: 0131 537 1719


Scottish Stroke Care Audit

University of Edinburgh,

Division of Clinical Neurosciences,

Clinical Trials Unit, Bramwell Dott Building

Western General Hospital, Crewe Road,

Edinburgh EH4 2XU

Scotland

Fax Number: 0131 332 5150

87

List of References

1. Scottish Executive, Coronary Heart Disease and Stroke: Strategy for Scotland,

2002. http://www.scotland.gov.uk/Resource/Doc/46997/0013955.pdf

2. Scottish Intercollegiate Guidelines Network (SIGN). Management of Patients

With Stroke, 1: Assessment, Investigation, Immediate Management and Secondary

Prevention. Edinburgh, Scotland: SIGN (No. 13); 1997.

http://www.sign.ac.uk/guidelines/published/#CHD

3. Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with

stroke part II: Management of carotid stenosis and carotid endarterectomy.

Edinburgh, Scotland: SIGN (No. 14); 1997.



stroke: rehabilitation, prevention and management of complications, and

discharge planning. Edinburgh, Scotland: SIGN (No. 64); 2005.



stroke: Identification and management of dysphagia. Edinburgh, Scotland: SIGN

(No. 78); 2004. http://www.sign.ac.uk/guidelines/published/#CHD

6. NHS Quality Improvement Scotland, Clinical Standards for Stroke Services: Care

of the Patient in the Acute Setting. Edinburgh, Scotland: NHS Quality

Improvement Scotland (NHS QIS); 2004.

http://www.nhshealthquality.org/nhsqis/files/Stroke%20Standards.doc

7. Weir N, Dennis M. Scottish Stroke Outcomes Group. Towards a National System

for Monitoring the Quality of hospital-Based Stroke Services. Stroke

2001;32:1415-1421.

8. Counsell C, Dennis M, McDowall M, Warlow C. Predicting outcome after acute

stroke: development and validation of new models. Stroke 2002;33:1041-1047.

9. The FOOD Trial Collaboration. Performance of a statistical model to predict

stroke outcome in the context of a large simple randomised controlled trial of

feeding. Stroke 2003;34:127-133.

10. Altman et al, Statistics with confidence - confidence intervals and statistical

guidelines, 2nd

edition, British Medical Journal Publishers; 2000.

88

Appendix A Minimum Dataset Definitions

Field Name Definition Patient identifier (CHI)

Community Health Index ('CHI') numbers are being introduced in Scotland, giving a patient a unique, national , reference number 'from the cradle to the grave'. We recommend using CHI numbers as patient reference numbers. Where CHI numbers are not immediately available users may use another number. When a CHI number becomes available, that can be used to replace the temporary number. Similar steps are being taken in other parts of the UK. In England, 'new NHS' numbers are being introduced to fulfil the same function as CHI numbers. These will be acceptable to the system which is designed to cope with patients from any origin required.

Case reference Current hospital (provider unit) case reference for patient. Surname From the COPPISH SMR Data Manual version 1.1; issued November

1995 p2-5: "The surname of a person represents that part of the name of a person which indicates the family group of which the person is part."

Forename From the COPPISH SMR Data Manual version 1.1; issued November 1995 p2-6: "The first forename of a person represents that part of the name of a person which, after the surname, is the principal identifier of a person." When recording names be aware of different conventions for order for parts of the name used in different cultures.

Sex Male or Female Date of birth Date the patient was born Date and Time of Initial assessment

Date and time of clinical examination from which baseline data for the system has been (mainly) drawn.

Responsible clinician This should be the consultant under whose care the patient was at the time of hospital discharge.

Unit where seen Identity of hospital or other provider unit where the patient was assessed.

Seen as In what context was the patient seen when initially examined. This can be in a hospital as either an Inpatient or as an Outpatient. It could also be at a GP clinic, at home (normal place of residence) or at some other place away from a hospital.

Never seen as an Outpatient should be used where a patient has been referred for an event or events, but has never been seen in relation to that event or events. Thus it can be used even if a patient has been seen for a separate event or events. This code is intended to allow a Unit to audit the number of referrals received, including those where the patient is never seen.

Date and Time of Admission

This should refer to date and time of arrival at the hospital rather than the date when the decision to admit was made or the date when the patient actually entered the ward. It is likely to be recorded in the Accident & Emergency department.

If the event concerned occurred when the patient was already in hospital for another condition, the date of the original admission should be given. Dates of admission prior to event can easily be identified at analysis.

89

Field Name Definition Admitted from Type of facility admitted from. Coded as per COPPISH codes.

The patient's place of residence is required. For instance, patients taken ill in the street should be coded as "admitted from home". COPPISH codes have commonly been mis-applied here (1). Patients taken ill in the street have been incorrectly coded as "admitted from other". Where a patient has a stroke when they are already in hospital for another condition, code the patient's place of residence when originally admitted to hospital.

Discharge date Date discharged from hospital (alive) if relevant. Discharged to Type of facility Discharged to. Coded as per COPPISH codes. Postcode sector Postcode sector is that part of the patient's postcode excluding the last

two characters (the 'Unit') from their usual address. Strictly the sector as described here comprises Area, District and Sector (see http://www.ex.ac.uk/cimt/resource/postcode.htm). Storage of sector alone is not considered to compromise patient confidentiality as it is too imprecise to be used to identify individuals. The sector can be used to establish Deprivation scores in Scotland using the Carstairs index.

Stroke Whether final diagnosis included stroke. (Further details may be recorded in the Disease Classification section).

Transient ischaemic attack

Whether final diagnosis included Transient Ischaemic Attack. (Further details may be recorded in the Disease Classification section).

Sub-arachnoid haemorrhage

Whether final diagnosis included SubArachnoid Haemorrhage. (Further details may be recorded in the Disease Classification section).

Retinal artery occlusion

Whether final diagnosis included Retinal Artery Occlusion. (Further details may be recorded in the Disease Classification section).

Transient monocular blindness

Whether final diagnosis included Amaurosis Fugax. (Further details may be recorded in the Disease Classification section). Amaurosis Fugax refers to any episode of monocular visual loss (complete or partial) lasting less than 24 hours and which is presumed to be due to retinal ischaemia (not venous occlusions). Retinal venous occlusions should be coded as non-cerebrovascular disease.

Possible cerebrovascular

Whether final diagnosis included Possible cerebrovascular disease. Use if presentation could have cerebrovascular cause but < 50% certain and give details (e.g. lone vertigo).

Possible cerebrovascular Details

Whether final diagnosis included possible cerebrovascular diagnosis. Further details may be recorded in the text box alongside. In addition, the Disease Classification section can be set up to record specific details to suit your requirements.

Definite non-cerebrovascular

Whether final diagnosis included other, non-cerebrovascular diagnosis. Further details may be recorded in the text box alongside. In addition, the Disease Classification section can be set up to record specific details to suit your requirements.

Definite non-cerebrovascular: Details

When final diagnosis includes other, non-cerebrovascular diagnosis, further details may be recorded here.

Date of Onset This is the best estimate of the date of onset of the patient’s focal cerebral symptoms based on all available information. If patients do not have focal cerebral symptoms (e.g. just headache with subarachnoid or intracerebral haemorrhage) the onset of the predominant symptom should be recorded. If a patient has non-focal symptoms prior to development of focal cerebral symptoms or deficits do not code the date of onset of these as the date of stroke onset.

90

Field Name Definition Was the patient independent in ADL before event

Patients should be independent (i.e. not need help from any person) in activites which would normally be performed everyday i.e. walking (at least around their house), washing, dressing, feeding (not meal preparation) and toileting. For the purposes of this classification we do not include activites which are carried out less frequently and where dependency is highly dependent on the environment (e.g. bathing vs showering, shopping depends on distance from shops, stairs depends on type of living accommodation). This will hopefully lead to better agreement than leaving it up to the individual rater to decide what 'everyday activities' means.

Was the patient living alone at the time of event

If they are living away from their normal place of residence temporarily - e.g. on holiday or in hospital - please be sure to code their NORMAL place of residence, not their temporary place of residence. If the patient is living in a residential or nursing home they should not be coded as living alone. If they live alone in a warden controlled apartment then this can be coded as living alone.

Can the patient talk Is the patient able to talk? Should the patient be unassessable for any reason code 'NO' (abnormal).

Are they orientated in time, place and person

Can the patient tell you their name, the place and time correctly (Y or N)? This question is based on the verbal component of the Glasgow Coma Scale, where: 5 = orientated 4 = confused 3 = inappropriate words 2 = groans 1 = none If 5 record as 'Yes' (orientated), otherwise record as 'No' (including patients who are unassessable for any reason).

Can the patient lift both arms off the bed

We do not stipulate that they should be able to keep them off the bed for any specific period or lift them to the horizontal. Should the patient be unassessable for any reason code 'NO' (abnormal). Should the unaffected arm be completely missing, code the affected arm only. Should the affected arm be completely missing, code on the affected leg instead, if possible, otherwise code 'NO'.

Able to walk without help from another person

Is the patient able to walk without the aid of another person (Y or N)? They may use any other aid.

Current AF confirmed on ECG

Refers to atrial fibrillation (AF) which is proven on an ECG at the time of assessment or during any hospital inpatient stay. Please also include AF proven on ECG at any time between the event for which they are being assessed and the current assessment. It should not include atrial flutter for which there is less robust evidence for the effectiveness of anticoagulation in stroke prevention.

Aspirin at onset Had the patient taken aspirin in the 24 hours prior to the onset of stroke symptoms?

On Warfarin at onset Whether the patient had been prescribed Warfarin prior to and at the time of first symptoms. This is a question related to patient management, please ignore complications relating to compliance.

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Field Name Definition Was the patient managed in an acute Stroke Unit

An acute stroke unit is defined as a specific ward or part of a ward where patients with acute stroke are admitted either directly from the community, from the accident & emergency department or after a brief (usually <24 hours) stay in a medical assessment area.

Entry to acute SU Date of entry to acute Stroke Unit, from any source - e.g. acute receiving unit or from another ward or hospital.

Exit from acute SU Date when patient moves out of acute stroke unit whether it is to home or another ward or hospital.

Unit Identity of hospital or other provider unit containing the acute Stroke Unit.

Consultant This should be the consultant under whose care the patient was while in this unit.

Was the patient managed in a rehab Stroke Unit

A stroke rehabilitation unit is a ward or part of a ward which is designated specifically for the rehabilitation of patients with stroke and in which the majority of patients will have had a stroke. Multidisciplinary team meetings should take place at least weekly and the staff will have received specific training in stroke.

Entry to rehab SU Date of entry to rehab unit, from any source - e.g. stroke unit or from another ward or hospital.

Exit from rehab SU Date when patient moves out of stroke rehabilitation unit whether it is to home or another ward or hospital.

Unit Identity of hospital or other provider unit containing the Rehabilitation Stroke Unit.

Consultant This should be the consultant under whose care the patient was while in this unit.

Was the patient managed in a rehab unit

A normal rehabilitation unit is a ward or part of a ward which is designated specifically for the rehabilitation of patients with no particular emphasis on any disease or condition.

Entry date Date of entry to rehab unit, from any source - e.g. stroke unit or from another ward or hospital.

Exit date Date when patient moves out of rehabilitation unit whether it is to home or another ward or hospital.

Unit Identity of hospital or other provider unit containing Rehabilitation Unit. Consultant This should be the consultant under whose care the patient was while

in this unit. Whether Aspirin given in hospital

This should be completed by reference to the drug chart.

A patient may have been using aspirin but this is stopped on / immediately after admission for any reason, e.g. pending results of CT or other tests.

In these circumstances, ignore this use of aspirin when considering how to answer this question. If aspirin is restarted, answer Yes, and enter the date restarted as date started. If not restarted, enter No.

If a patient has been using aspirin and this is continued without break, enter Yes, with the date of admission as the date started.

If a patient is never given aspirin answer No. If newly prescribed aspirin, enter Yes with the date started.

If the patient is being audited for a stroke that occurred when they were already in hospital, only that period after their stroke should be considered. In other words, the time of stroke should be treated as the time of admission to hospital when considering how to answer this question.

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Field Name Definition Date Aspirin started Date aspirin first given after hospital admission or after the stroke onset

if stroke occurred in hospital. This should be completed by reference to the drug chart.

A patient may have been using aspirin but this is stopped on / immediately after admission for any reason, e.g. pending results of CT or other tests.

In these circumstances, ignore this use of aspirin when considering how to answer this question. If aspirin is restarted, enter the date restarted as date started.

If a patient has been using aspirin and this is continued without break, enter the date of admission (or onset if stroke occurred in hospital) as the date started.

If newly prescribed aspirin, enter the date started Final Discharge from hospital on Aspirin

Did aspirin appear on the discharge prescription or list of drugs which the patient should have been taking after discharge.

Final Discharge on Clopidogrel (Plavix)

Did Clopidogrel (Plavix) appear on the discharge prescription or list of drugs which the patient should have been taking after discharge.

Final Discharge on Dipyridamole (Persantin)

Did Dipyridamole (Persantin/Asasantin) appear on the discharge prescription or list of drugs which the patient should have been taking after discharge.

Final Discharge on Warfarin

Did Warfarin appear on the discharge prescription or list of drugs which the patient should have been taking after discharge.

Final Discharge on an ACE inhibitor

Did an ACE Inhibitor appear on the discharge prescription or list of drugs which the patient should have been taking after discharge.

Final Discharge on a Diuretic

Did a Diuretic appear on the discharge prescription or list of drugs which the patient should have been taking after discharge. Diuretic is defined as a drug given with the defined intention of increasing urine flow from the kidneys.

Final Discharge on another anti-hypertensive

Did another anti-hypertensive appear on the discharge prescription or list of drugs which the patient should have been taking after discharge.

Final Discharge on a Statin

Did a Statin appear on the discharge prescription or list of drugs which the patient should have been taking after discharge.

CT Computerised tomography of the brain. CT Date Date of first CT after stroke onset. MRI Magnetic Resonance Imaging scan of the brain. MRI Date Date of first MRI after stroke onset. Evidence of new haemorrhage on scan

Based on either review of actual scan or the radiologists report. Please include haemorrhage which is thought to be secondary to cerebral infarction i.e. haemorrhagic transformation of infarction. If there are only vague signs of possible petechial haemorrhage into an infarction it would be reasonable to code haemorrhage as being absent. In this field we are trying to establish whether there was a definite contra-indication to antithrombotic medication given and acknowledge the difficulties of distinguishing primary haemorrhage from that into an area of infarction.

Classification of Stroke Syndrome

This refers to the clinical syndrome at the time of maximal deficit. Coding should take account of the results of imaging where available.

ICD 10 final diagnosis

Pick the most appropriate and specific ICD 10 code from the list provided.

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Field Name Definition Swallow screen recorded

A two stage assessment aimed to establish first whether it is safe to proceed with a formal assessment of swallowing safety and second to determine, using a simple water swallow test, whether the patient can safely be given free oral fluids and food. Failure on either part should lead to the patient being put 'nil by mouth' and given at least hydration and sometimes nutrition via an alternative route until a formal assessment by a speech and language therapist.

The fact that a screening test for swallowing problems has been carried out and its results, should be documented in the medical notes.

Swallow screen Date Date first Swallowing assessment performed.

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Appendix B Comments on presented data from Health Boards

Health Board Comments

Ayrshire & Arran As a result of the QIS visit and the national audit figures, Ayrshire

& Arran MCN have instigated a recurring commitment for speech

and language therapy to train nursing staff in swallow screening.

This will ensure that all new and existing staff will have ongoing

training where appropriate.

Argyll & Clyde No comments

Borders % given aspirin within 2 days following Definite Ischaemic

Event.

In process of developing a patient group directive for the

administration of aspirin following scan. We hope this will address

this area.

% Discharged on Antihypertensive following definite Ischaemic

Event.

NHS Borders local policy does not advise reducing Blood Pressure

during acute ischaemic event. Follow up to take place in General

practice after 2 months.

Dumfries &

Galloway No comments

Fife Data submission

The data submitted from NHS Fife on stroke patients is collated

from the SSCAS database, the General Registrar’s Office (GRO),

and from SMR01 forms.

We strive to ensure that the quality of the data submitted is verified

by a process which involves cross-matching all of the data received

thereby reducing any anomalies:

• In 2004 we observed that a small number of deceased

patients captured by GRO were absent from SMR01 data,

and similarly that some data held in SSCAS was missing

from SMR01 and vice-versa.

• The terminology in discharge letters is sometimes vague

and can create disparities in final diagnoses.

We have worked closely with our coding department, and been

successful in reducing irregularities thereby improving the quality

of our data, and we aim to continue with this process in the coming

year.

Survival Analysis

It was noted that the proportion of patients included in these

analyses varied between hospitals and Health Boards (i.e.38% to

72%). We felt that this variance made it difficult to make

comparisons in an equitable manner.

In the case of NHS Fife, 55.9% of data was included in the Survival

Analysis table. We conclude that one of the reasons for this low

return may be due to the absence of some mandatory case-mix

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adjustors; this was recently highlighted to us during a telephone

conversation, and we now realise that this was an error on our part

by representing unassessable information by entering symbols in

place of a negative reply. It is therefore regrettable that we were

unable to depict a more accurate outcome of our mortality rate in

the report.

Inpatient Tables

In NHS Fife, data is submitted for both “TIA” and “Stroke” in-

patient care. There appears to be some disparity in the data

collection methods used, which makes it difficult to derive a direct

comparison of results defined as ischaemic events. In addition, the

results do not appear to reflect the “NHSQIS” standard relating to

aspirin.

Outpatient Tables

The data collection method used in recording “Out-patient” activity

does not capture those patients attending the clinic, who had

previously been admitted as “in-patients”. In Fife, our figures

suggest that up to 25% may have been omitted from the actual

clinic numbers.

Forth Valley All Forth Valley acute hospital services underwent reorganisation

in October 2005. A new Acute Stroke Unit opened at Stirling.

There is no longer acute receiving at Falkirk. All acute Stroke

Services are now located in Stirling Royal Infirmary and rehab

Stroke Services in Falkirk & District Royal Infirmary. As of

October 2005 data should no longer be presented seperately for

both sites.

We had a significant amount of missing data at the time our report

data were submitted. This has been addressed. However there are

significant differences between the figures in the draft report and

what we now have since we rectified the problem.

Highland Inpatient Data

The Stroke Unit opened fully in June 2005. It is early days to

reflect on the impact that the Unit has had but the data supports that

that secondary prevention is more consistently managed due the

appointment of the Stroke Physician, and the development and

implementation of the secondary prevention protocol across

Highland.

There remain challenges in meeting the criteria for CT scanning,

but the development of a new referral system which is currently

being piloted in Raigmore Hospital, and improved CT scanning

provision in Raigmore (and in the next 12 months at Caithness)

should see this improve. Running parallel to this is the prescribing

of antiplatelet therapy which should also show significant

improvement when this happens.

Swallow screening training has been rolled out Highland wide but

appears to have made no impact on practice and this is a further

challenge that requires to be addressed. The majority of screening is

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taking place after the patients come to the Stroke Unit at Raigmore

which is not reflected in these figures. Recruitment and retention

has some impact on these figures, and it also reflects the need for

outreach cover where the therapist works single-handed.

Outpatient Data

The outpatient data reflects the impact that the NVC has made on

Stroke Services in Highland. We have seen a notable reduction in

the number of TIAs and non-disabling strokes admitted as

inpatients. Protected slots for all investigations have now been

secured and the impact of this will be reflected in future figures.

Pathways have been developed and these will go some way to

reduce the waiting time for all patients. At present we are seeing

86% of patients within the 14 days of referral, and would hope to

improve this further, with the development of NVCs in all of the

District General Hospitals

Lanarkshire The report indicates a high level of case ascertainment for stroke in

Lanarkshire, good progress in earlier access to stroke units and

encouraging results for case-mix adjusted case fatality. The

ongoing challenge in early CT access is being addressed by the

local Diagnostics Collaborative - initial plans include roll out of

extended hours imaging, while a longer term goal will be to

increase capacity through an additional CT scanner for Lanarkshire.

Access to imaging impacts directly on time to aspirin

implementation. Training of staff to undertake swallow screen

remains a priority and is being taken forward in partnership with

leads for Unscheduled Care. Redesign of the stroke pathway with

shorter lengths of stay is increasingly shifting the implementation

of antihypertensive and warfarin therapy to the post discharge

period. This is achieved through systematic community based

rehabilitation and follow up by a specialist team according to

agreed stroke secondary prevention protocols.

Greater Glasgow • Due to staffing issues the numbers of patients included in

the audit particularly in North Glasgow are not complete.

We now have a full-time audit nurse doing SSCAS for

North Glasgow and she has already made significant

inroads into the backlog so by next year our case inclusion

will be much more accurate. At present the numbers for all

3 North Glasgow stroke services are incorrect.

• Stobhill is still showing a poor percentage of patients

scanned within 48 hours but a local audit earlier this year

suggested that figures were much better than that

• The Western Infirmary note that they have a significant

number of patients on trial drugs or on clopidogrel but this

cannot be recorded and thus appears as ‘not on aspirin’

• Some concern was expressed about the reliability of the

casemix adjusters especially for the increasingly large

cohort of patients who present within 3 hours. There does

not seem to be uniformity about when the information is

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obtained about function post stroke and thus eg where a

patient has thrombolysis the function later in the day of

admission or when they reach the inpatient as opposed to

the emergency treatment area may already be better. This

will influence the casemix the hospital appears to be dealing

with.

Grampian INPATIENTS:

% admitted to SU within 1 day & Stroke Unit Management Patients whose notes remain unaudited are not included in this

figure so it probably lower than 69%. Is there any way of adding

these patients into future analysis even though there may be no

other data available to reflect a more accurate picture of all patients

identified as a potential stroke?

Patients with Days from Admission to Scan <= 2 days

Improvement since last period audited. Discussions are ongoing re

easier access to weekend CT scanning.

Swallow Screening

Swallow screening shows improvement from period 03/04. We

assume this is due to wider use of the Swallowing Assessment

protocol in our Acute Assessment Unit.

OUTPATIENTS:

Diagnosis- only 54% of patients seen at clinic are diagnosed with

Stroke/TIA. 32% are diagnosed as non cerebrovascular. An on-line

referral system for GPs will commence on 1st August with

improved referral guidelines and we shall be looking to see a

reduction in the number of inappropriate referrals to the clinic.

Lothian No comments

Tayside Data extracted from SSCAS in Ninewells Hospital does not reflect

an accurate picture of admissions etc as a large amount of data has

not been entered onto the SSCAS database. Admission figures

produced by local audit show 605 definite strokes admitted through

Ninewells Hospital in 2005-06. This figure is comparable with the

number identified by ISD over a 19 month period (757).

Orkney Stroke Unit Admissions

Data on Stroke Unit was not collected for 2004. However, 85% of

stroke patients are admitted to an ASU at some point during their

stay in hospital, since that is the percentage who are transferred for

scanning in Ward 11 Aberdeen Royal Infirmary. Some of these

admissions were very brief, being just day trips, but others were

more protracted.

Clearly most of these admissions were not within one day, but since

40% were scanned within 48hrs, it is conceivable that a proportion

of these were within 24hrs.

Shetland No comments

Western Isles No comments

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Appendix C Steering Committee Membership

Sheena Borthwick, Lothian Health Board

Linda Campbell, Highlands Health Board

Beatrice Cant, NHS Quality Improvement Scotland

Mairi Cauldwell, Scottish Executive Health Department

Campbell Chalmers, Chest, Heart and Stroke Scotland

Martin Dennis, Chair of National Advisory Committee for Stroke

Robin Flaig, Scottish Stroke Care Audit

Gordon Lowe, SIGN

Mike McDowall, Scottish Stroke Care Audit

Keith Muir, SIGN

David Stott, RCPE Scottish Stroke Collaboration

Documents

National Report on Stroke Services in Scottish Hospitals ... · • Support management decision making by: • providing data to allow better service planning; • providing data