Stroke Care Audit Group
Since 1993 the Clinical Resource and Audit Group (CRAG, now part of NHS Quality Improvement Scotland – NHS QIS) have been publishing outcome indicators for stroke based on routinely collected hospital discharge data5. Their value as indicators of the quality of services is generally considered questionable because of concerns regarding the accuracy of diagnostic codes and insufficient data to take full account of casemix. Acknowledging these difficulties, the Scottish Executive and the CSO funded the Scottish Outcomes Study Group. This group has shown that it is feasible to measure the quality of hospital based stroke services by collecting data to allow more robust correction for variations in casemix and indicators of the process of care.
In 1998 the Scottish Stroke Collaboration was established under the auspices of the Royal Colleges of Physicians in Edinburgh, and the Physicians and Surgeons in Glasgow. This collaboration comprised all the physicians with responsibility for running hospital based stroke services in Scotland. Two of its principal aims were to set standards for stroke care and to develop a system by which these could be routinely monitored. This led to the development of the Intercollegiate Stroke Standards Group, which has already agreed upon some explicit standards for certain aspects of care. In addition, with funding from Chest Heart and Stroke Scotland (CHSS) and the Royal College of Physicians-Edinburgh (RCP(E)), the collaboration developed the Scottish Stroke Care Audit System (SSCAS), a computer program that was designed to facilitate stroke audit.
In 2002 the CRAG (now part of NHS QIS) agreed to fund SSCAS for three years to expand the audit to a minimum of ten Scottish hospitals. This funding began in November 2002.
The Scottish Stroke Care Audit aims to:
Routinely monitor the performance of Scottish Hospitals against nationally agreed standards for stroke care.
Monitor progress against goals set by the strategy developed by the CHD & Stroke Reference Group.
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.
Encourage different Health Boards to collect a common data set (with explicit definitions) to allow comparisons to be made between units and to facilitate benchmarking.
Provide data to allow better service planning.
Provide data for consultant appraisal to reflect an individual clinician’s performance.
Be flexible enough to meet the additional needs of individual users – e.g. it can be expanded to be used to provide information on particular weaknesses in local clinical care.
Bridge the gap between the routine data collection systems currently available (mainly through ISD’s Scottish Morbidity Record (SMR) Type 01) and expected future Clinical systems which will allow data for audit to be captured as part of routine care.
Drive improvements to the recording of patient care.
Drive improvements in the accuracy and clinical usefulness of routinely collected data.
Drive improvements in the organisation and delivery of stroke care and encourage sharing of good practice and adherence to best evidence.
All the Health Boards in Scotland are collecting data and participating in the Scottish Stroke Care Audit. All of the Health Boards have submitted data for the National Report
For further information on the Scottish Stroke Care Audit please refer to their website at www.strokeaudit.scot.nhs.uk.