The annual results of the Stroke Improvement National Audit Programme (SINAP), commissioned by the Healthcare Quality Improvement Partnership (HQIP) and run by the Royal College of Physicians’ Stroke Programme were recently published. The audit collects data on the care of stroke patients in the three days following a stroke. This article summarises the key recommendations and how Cellma can assist in meeting these.

Some of the key findings included;

• Stroke care for patients is improving overall
• 53% of patients are admitted to a stroke unit within four hours of their arrival at hospital
• Over a third of patients are still being admitted to non-specialist units when they should be admitted to stroke units
• All incontinent patients should have a clear continence management plan within 72 hours of admission; this is only happening in 57 per cent of cases

Stroke is still the most common cause of severe, acquired disability in adult life (The Stroke Association 2011) and costs the economy an estimated £8 billion per year in England alone - and it is likely that it costs proportionate amounts in Scotland, Wales and Northern Ireland (National Audit Office, 2010). Cellma can significantly improve the safety, quality and efficiency of care delivered in stroke services. This would not only improve the outcomes for patients, but also relieve the significant financial burden placed upon the economy. It has been suggested that in the UK 40% of strokes could be prevented by controlling high blood pressure alone (Van Gijin, 2002), such financial savings could be redistributed, including provisions of public awareness campaigns.

Cellma further reduces the risk of stroke by ensuring patients are monitored appropriately and receive follow ups. Tasks and alerts can be set which then generate automated patient reminders via text message or email to prompt action. If patients do not have reviews carried out in the appropriate time frame this is flagged to the clinical team to follow up.

The annual stroke review (The Stroke Association, 2011) highlighted community care integration as an important element of best practice stroke care. Cellma facilitates and promotes integrated and community care through information sharing and on referrals. Cellma uses unique patient identifiers to ensure only one centrally held record is created per patient. All patient data is then accessible via any Trust connected terminal at any given time to the entire MDT across as many sites as required.

The top ten areas with recommendations for change in the SINAP report are discussed below, along with how Cellma can assist in meeting and measuring these goals.

Recommendations for using audit results

• Every member of the multi-disciplinary team and managers should have shared responsibility for discussing and acting on these audit results.

Cellma can assist in meeting this recommendation in a number of ways, including sharing of information, both on a patient and service level, across all members of the MDT and management. Cellma also allows users to set tasks for themselves or colleagues, an alerts system ensures these are carried out.

• It is important that commissioners read this report and use the findings to implement change. They should be concerned about those units who do not collect data in this way or make results available in the public domain.

Cellma’s comprehensive reporting module reports on all data collected, meeting all national, local and statutory guidelines. Three levels of reporting are available in Cellma;

• Dashboards (administrative and clinical): Provide a dynamic snapshot of user defined variables that are delivered as standard or easily customised by the user to fulfil their specific reporting requirements.
• Advanced patient search: Represents Cellma’s ad-hoc reporting ability and allows users to generate specialised reports in real time. Users can define the parameters on which the report is based to generate tabular or graphic reports on any aspect of their clinical service.
• Pre-defined Reports: These pre-defined reports set by the user in advance are often used to meet statutory or research requirements. Clients can write these reports in-house or RioMed can set Cellma to deliver them to the user at regular intervals.

Only 99 hospitals from 88 Trusts (representing 58% of all eligible trusts) achieved the target quota of submitting a minimum of 20 stroke records for SINAP. Cellma’s predefined reports can be used to generate the information required for SINAP, streamlining the process and encouraging more hospitals to meet the data quota. As this data would be captured at the point of contact and the reports generated automatically this would significantly reduce the reporting burden.

Patients and patient groups should use this report to lobby for improved access to all aspects of high quality services consistently and to encourage non-participating hospitals to submit data to national level stroke audits.

Dr Pippa Tyrrell, clinical lead for SINAP, said "While care is improving in hospitals that participate in the audit, we would encourage all hospitals who care for stroke patients to submit all of their data for scrutiny because this is a very important driver to improve care for everyone with acute stroke."If you are aware that your hospital is not submitting data to SINAP why not suggest Cellma as a means of collecting the required data?

Clinical recommendations

• All patients should be directly admitted to a stroke unit equipped to manage acute stroke patients.

Cellma can help by monitoring the number of suspected stroke patients admitted into hospital and directly into specialist acute stroke units. Cellma also monitors the proportion of patients with suspected stroke assessed for thrombolysis who receive it in accordance with NICE technology appraisal guidance 122 (2007) and NICE clinical guideline CG68 (2008).

• Patients should receive the same standards of care whether they arrive at hospital in hours or out of hours.  Differences in the availability of specialist staff and interventions such as imaging out of hours need to be urgently addressed.

Cellma’s evidence based best practice assessments promote standardised care across teams, ensuring all healthcare professionals are delivering care in the same way and to the same high standard.Cellma can also manage all investigation requests, including imaging, electronically via HL7, JDBC or XML messaging. This would facilitate the rapid request and reporting of imaging investigations at any given time.

• Co-ordination of care must be improved to reduce the delays within hospital control.On arrival in hospital, patients should be triaged rapidly to a specialist stroke team, undergo brain scanning, be thrombolysed where appropriate and be admitted to a stroke bed in a designated stroke unit.

Cellma facilitates patient triage in line with stroke care pathways, including referral to a specialist stroke team; undergo brain scanning, be thrombolysed where appropriate and admittance to a stroke bed in a designated unit.All members of the MDT have access to one centrally accessible real time patient record, ensuring information sharing and informed decision making.

• Care for patients who suffer a stroke while already in hospital needs to be improved. Improving education across the Trust about stroke symptoms and how to contact the stroke team will reduce the current delays. 

The latest version of Cellma is both touch screen and mobile compliant, facilitating bedside assessments across the hospital. Furthermore on referrals can be made to the stroke team by other specialities using Cellma. Cellma will report on the number of patients suffering a stroke whilst in hospital and measure the response time from onset of symptoms to referral to the specialist stroke team.

• All stroke patients should have access to a stroke service that can deliver thrombolysis safely and effectively, and patients who are eligible for thrombolysis should receive it.

Cellma will automatically identify patients suitable for thrombolysis and prompt users to take action. The number of eligible patients referred for thrombolysis will be measured against those delivered in order to meet SINAP reporting requirements.

• All incontinent patients should have a clear plan for continence management within 72 hours of admission.

Cellma will allow users to enter incontinent patients on to the correct care pathway, which will then prompt appropriate actions, such as generation of a continence management plan within 72 hours. Cellma will report on the percentage of incontinent patients who receive a continence management plan within the recommended time frame.

• Public awareness campaigns should be regularly maintained to drive home the message that stroke needs to be treated as a medical emergency. By improving awareness, patients will recognise stroke symptoms and present more quickly at hospital.

Cellma facilitates an educational element to the stroke service, encouraging patients via text, email and letter to attend follow ups and regular checks.

For more information about how your Stroke service can benefit from using Cellma, or for a demonstration, please do not hesitate to contact us on 02380 277044 or This e-mail address is being protected from spam bots, you need JavaScript enabled to view it