Neurology and stroke services clinical quality indicators

Find out how we are doing in neurology and stroke medicine using the links below. More information on how we choose our indicators can be found by clicking on the link on the right hand side.

 

Community assessments in patients with neurological conditions

This clinical quality indicator measures the proportion of our patients with a long-term neurological condition who have been assessed by a multi-discplinary team within the last 12 months.

Rationale

The National Service Framework recommends that every person with a long-term neurological condition should receive an integrated multi-disciplinary assessment or review.

Our objectives

The National Service Framework targets were set to achieve a 10% year-on-year improvement, to reach 100% compliance by 2015.

We aim to meet this standard.

Comment on current performance

In 2012/13, 95% of patients on our register of patients with a long-term neurological condition received a multi-disciplinary review within the last 12 months.. We have therefore achieved our objective for this year.

 

Rehabilitation outcomes (NRC)

This clinical quality indicator measures the improvement in functional independence and assessment measures (FIM and FAM) for patients discharged from our neurological rehabilitation centre. Maximum score is 210. Higher is better. FIM scores are sub-divided into motor and cognitive scores.

Graph

Rationale

The functional independence measure (FIM) and functional assessment measure (FAM) are standardised outcome measures of rehabilitation, with established reliability and validity. Higher scores indicate higher levels of functional independence and ability after discharge.

Our objectives

We aim for all patients to achieve functional improvement demonstrated on FIM and FAM scores. Experience in stroke patients suggests that a change for FIM of:

  • 11-17 points on the motor scores or
  • 3 points on the cognitive scores or
  • 22 points in total

is clinically significant.

Comment on current performance

97% of our patients treated in our in-patient neuro-rehabilitation unit showed improvements in their FIM-FAM scores.

 

Rehabilitation outcomes (SAM)

This clinical quality indicator measures the improvement in functional independence and assessment measures (FIM and FAM) for patients with sub-acute neurological conditions, discharged from our rehabilitation service. Maximum score is 210. Higher is better. FIM scores are sub-divided into motor and cognitive scores.

Rationale

The functional independence measure (FIM) and functional assessment measure (FAM) are standardised measures of rehabilitation, with established reliability and validity. Higher scores indicate higher levels of functional independence and ability after discharge.

Our objectives

We aim for all patients to achieve functional improvement demonstrated on FIM and FAM scores. Experience in stroke patients suggest that a change in FIM of:

  • 11-17 points on the motor scores or
  • 3 points on the cognitive scores or
  • 22 points in total

is clinically significant. 

Comment on current performance

Expected in Summer 2014

 

Rehabilitation referrals

This clinical quality indicator measures the average waiting time, from referral to admission, for patients referred to our neurological rehabilitation centre (NRC).

Rationale

The National Service Framework recommends that people with a long-term neurological condition should have appropriate access to rehabilitation services, and be:

  • assessed within 5 working days of referral and
  • transferred to a rehabilitation unit within 2 weeks (if clinically appropriate).

Our objectives

The National Service Framework targets were set to achieve a 10% year-on-year improvement, to reach 100% compliance by 2015. We aim to meet this standard.

Comment on current performance

80% suitable patients referred to our in-patient neuro-rehabilitation unit were assessed within five working days in 2012/13.

97% suitable patients referred to our in-patient neuro-rehabilitation unit were admitted within two weeks in 2012/13.

 

Stroke

Organisational and clinical standards of stroke care assessed by the Sentinel Stroke National Audit Programme including the proportion of patients who:

  • were treated on a specialist stroke ward for at least 90% of acute hospital stay
  • were screened for swallowing disorder
  • had a brain scan within 24 hours of onset of symptoms
  • received aspirin witin 48 hours of onset of symptoms
  • were assessed by physiotherapist within 72 hours
  • were assessed by occupational therapist within four working days
  • were weighed during admission
  • were assessed for mood changes prior to discharge
  • were assessed for swallowing disorder by speech and language therapist
  • agreed rehabilitation goals with the multidisciplinary team
  • discussed their diagnosis with the team before discharge

Graph

Rationale

High standards of stroke care reduce mortality and improve functional outcome following stroke.

Standards of care are described in the:

  • National Clinical Guideline for Stroke (2012) published by the Intercollegiate Stroke Working Party
  • Clinical guideline: Stroke  (CG68; 2010) published by the National Institute for Health and Care Excellence
  • Quality standard: Stroke (QS2; 2010) published by the National Institute for Health and Care Excellence
  • National Stroke Strategy 2007 published by the Department of Health

Our objectives

We aim to deliver a standard of care that lies in the top 25% of trusts submitting data to the Sentinel Stroke National Audit Programme, despite the London-wide changes to the organisation and delivery of stroke care.

Comment on current performance

Our overall performance in the 2014 acute organisational audit lies in the upper quartile of trusts, as in 2012.