From data to safer care: The role of stroke audit in improving quality of care

7 Sep 2026

Published in partnership with Patient Safety Learning.

Ensuring patients receive the right care at the right time is one of the most important patient safety challenges facing the NHS, not least in stroke care where every minute matters. Rapid recognition, assessment, timely access to reperfusion therapy and effective specialist rehabilitation can mean the difference between a good recovery and lifelong disability.

That challenge is becoming more significant. Stroke remains a leading cause of death and disability, with more than 92,000 people admitted to hospital with stroke across England, Wales and Northern Ireland during the period from April 2024 to March 2025. High-quality care for these patients requires coordination across the entire pathway, from prevention and emergency response through to specialist hospital care, rehabilitation and long-term support.

With this year’s World Patient Safety Day focusing on safe care for noncommunicable diseases, this article reflects on the critical role that national clinical audit plays in supporting safer care, with a focus on stroke. The Sentinel Stroke National Audit Programme (SSNAP), led by King’s College London and commissioned by the Healthcare Quality Improvement Partnership (HQIP), demonstrates how evidence-based standards developed from national guidelines can help drive quality improvement across a complex healthcare pathway.

Driving improvement through data and innovation

SSNAP measures the quality and organisation of stroke care across England, Wales and Northern Ireland. By collecting and analysing data across the patient journey, it gives a detailed understanding of where services are performing well and where care can be strengthened. This aligns closely with the ambitions of the NHS 10 Year Health Plan, which emphasises the importance of using data and innovation to improve outcomes, reduce inequalities and support continuous quality improvement.

While audit provides the evidence and insight to support improvement, progress in stroke care depends on the collective efforts of multidisciplinary stroke teams, patients and their representatives, commissioners, researchers, charities and many others working across the pathway. Clinical audit forms a vital part of that infrastructure, with routine, tangible, clinically meaningful data measured against evidence-based standards to support quality improvement and patient safety.

This role has become even more essential following publication of the new Cardiovascular Disease Modern Service Framework, which sets out a 10-year ambition to reduce premature deaths from heart disease and stroke through earlier prevention, access to organised stroke care and rehabilitation, supported by innovation and adoption of evidence-based interventions in order to reduce health inequalities. National clinical audit provides insight and stimulates enquiry to identify reasons for variation and priorities for quality improvement.

The impact of this approach can already be seen across stroke services. Many of the most encouraging developments reflect the same themes of data and digital transformation that underpin the NHS’s shift from analogue to digital healthcare. Advances in imaging, AI decision-support technologies and data-driven pathways are helping more patients access time-critical treatments and improving outcomes.

For example, SSNAP’s latest State of the Nation report, which covers April 2024 to March 2025 (2024/25), shows that access to brain imaging continues to improve. The proportion of patients receiving brain imaging within 20 minutes of hospital arrival increased from 26.5% April 2023 to March 2024 (2023/24) to 28.3% in 2024/25, and the proportion receiving imaging within one hour increased from 59.5% to 61.4%. These improvements matter because timely imaging is crucial to select patients for targeted effective hyper-acute treatments. Hospitals need to perform all the necessary imagery at the same time, as well as using artificial intelligence tools to support clinical decision-making, to improve the delivery of reperfusion therapy and provide patients the best opportunity to recover.

Encouragingly, access to hyper-acute treatments such as thrombolysis and thrombectomy has also improved. The proportion of patients receiving thrombolysis increased from 11.6% to 12.2%, while thrombectomy rates increased from 3.9% to 4.4% (2023/24 vs 2024/25). Both treatments can significantly reduce disability when provided promptly. Use of national audit data has stimulated quality improvement for thrombolysis rates in several stroke services and progress has been made for a number of time-metrics for thrombectomy, although growth of thrombectomy rates still requires further attention.

Further, there has been notable progress in the treatment of intracerebral haemorrhage, where the proportion of eligible patients receiving an appropriate hyper-acute intervention within one hour of hospital arrival increased from 24.9% to 32.0%, an important patient safety improvement for a group of patients who often experience poorer outcomes. These advances demonstrate how audit can support innovation by identifying where new approaches are succeeding and where further improvement is needed.

Progress is not universal

While there are many reasons for optimism, there are also areas where progress has been more difficult. Perhaps the most striking example is the growing delay between stroke onset and hospital arrival. In 2024/25, the median time from stroke onset to arrival at hospital increased to 4 hours and 11 minutes, compared with 2 hours and 25 minutes a decade earlier (2013/14). The reasons are complex and may include public awareness and recognition of symptoms, ambulance pressures and wider system factors. There is a continuing need for sustained public education to enhance awareness of stroke symptoms, faster ambulance recognition and triage through innovation such as pre-hospital video assessment.

Access to specialist stroke care, which is the most effective intervention to reduce disability and mortality from a population level, also remains challenging. Less than half of patients (46.5%) were directly admitted to a stroke unit within four hours of hospital arrival, while the proportion spending at least 90% of their hospital stay on a specialist stroke unit fell slightly to 74.0%.

Importantly, acknowledging these trends, through national clinical audit, is the first step in finding solutions in order to reverse them, and illustrates why continuous measurement and quality improvement is essential. National clinical audit helps identify where delays and barriers occur, enabling local systems to focus improvement efforts where they are likely to have the greatest impact on patient outcomes and safety.

Understanding variation: a nuanced picture

One of the most important messages from the recently published SSNAP Atlas of Variation Report is that variation is not necessarily unwarranted. Too often, variation is assumed to indicate poor performance. In reality, differences between areas may reflect population characteristics, levels of deprivation, geography, service configuration, patient preferences, access to specialist services or differences in local health needs.

For commissioners, this is an important distinction. The purpose of examining variation is not to assign blame. Rather, it is to understand why differences exist and to identify opportunities for learning and more equitable care. It is also important that organisations responsible for commissioning stroke care compare their performance with both peer organisations and the national average. These comparisons can highlight areas of good practice, encourage shared learning and support ongoing quality improvement across the stroke pathway.

This approach is echoed in the recently published Cardiovascular Disease Modern Service Framework, which argues that “success is judged on closing the gap, not just the average”. For commissioners, providers and clinical teams, this highlights the importance of looking beyond headline performance measures to understand where inequalities persist, where variation may reflect different population needs and where targeted efforts could have the greatest impact.

The Atlas provides numerous examples of variation. Nationally, 25.9% of patients with known atrial fibrillation were not receiving anticoagulation before their stroke, with a range regionally from 9.8% to 32.3% – a key opportunity for prevention. There is also substantial variation in thrombolysis rates and other aspects of care across different populations and regions.

The report also points to significant future challenges. Stroke admissions in England are projected to increase by 28.8% over the next decade, with considerable variation between areas (ranging between 7.1% in NHS Derby and Derbyshire to 61.5% in NHS North Central London). Understanding local patterns of demand and care delivery will become increasingly important for planning future services, and national clinical audit provides insight to support that planning.

Looking beyond hospital care

“One of our key goals is to make sure more patients can access the full specialist stroke pathway, as this leads to better recovery and outcomes.” SSNAP State of the Nation Report 2025

The NHS 10 Year Health Plan sets out a shift from hospital-based care towards more integrated community care, and stroke services are already moving in this direction. SSNAP reports continued growth in access to specialist community rehabilitation services following discharge from hospital. The proportion of patients discharged to a stroke/neurology-specific community rehabilitation service has increased to two-thirds of all discharges: 66.6% in 2024/25. Over a third (23.1%) of these patients were transferred to a combined stroke/neurology specific Early Supported Discharge and Community rehabilitation team. This reflects the ongoing commitment to implementation of the national service model for an integrated community stroke service across England.

However, the audit also highlights areas where further progress is needed once patients leave hospital. The proportion of patients receiving a 6-month review after stroke has continued to decline since 2019/20, falling to 35.1% in 2024/25 (38.8% in 2023/24). Long-term support after stroke is critical to patient outcomes and quality of life. As care increasingly shifts into community settings, robust data will remain help ensure services provide safe and equitable care.

Looking beyond recovery and rehabilitation, the NHS’s shift from sickness to prevention is equally relevant. Findings from the Atlas of Variation demonstrate opportunities to improve management of risk factors such as atrial fibrillation and hypertension before stroke occurs. Preventing strokes in the first place will be as important to improving population health as advances in acute treatment.

Evidence that leads to improvement

Overall, the story of stroke care is one of continued improvement, with SSNAP demonstrating how national clinical audit can support safer, higher-quality care for conditions such as stroke.  Importantly too, the programme has evolved over time and with the evidence. For example, in 2024 the audit initiated its most substantial reform to date, reflecting the 2023 National Clinical Guideline for Stroke and NICE stroke rehabilitation guidelines – setting a renewed benchmark for what best practice should look like. These standards provide confidence and reassurance to both clinicians and patients that the most effective stroke care is being delivered.

Over recent years, patients have benefited from advances in imaging, increasing access to specialist treatments and progress in aspects of hyper-acute care. Yet challenges remain, including delays before hospital arrival and the need to strengthen long-term community support.

Looking ahead, SSNAP’s comprehensive data collection and timely feedback aligns closely with NHS England’s recently published Quality Strategy, by enabling the use of meaningful data to identify unwarranted variation, monitor outcomes, support continuous improvement and drive more equitable care. Providing actionable intelligence across the stroke pathway, the audit helps create the conditions for safer, more effective and patient-centred services, while supporting the NHS ambition to use data and digital tools to improve quality at scale.

“National clinical audit helps make challenges visible. By providing robust evidence about what is working, where gaps remain and how services compare across populations, SSNAP enables clinicians, providers and commissioners to focus improvement efforts where they can make the greatest difference. With World Patient Safety Day shining a light on patient safety for noncommunicable diseases, the message from stroke audit is clear: better evidence leads to better decisions, and better decisions help deliver safer care for patients.” Chris Gush, HQIP CEO

Further resources from HQIP

• Discover more of our programmes, reports, and other resources and news related to neurology and stroke care.
• More articles on using healthcare data to improve and save lives
• How HQIP supports organisations to use clinical audit and healthcare data to drive improvement – from strategy development to implementation or training
• Reports and infographics
• Benchmarked results, searchable by project name, trust, hospital or unit