Appendix 2: Examples of organisational audit, case mix, and process audit questions (multidisciplinary involvement)

(A) ORGANISATIONAL AUDIT
Interdisciplinary services
1.5 Is there a consultant physician with specialist knowledge of Stroke who is formally recognised as having principal responsibility for stroke services?
		Yes [ ]	No [ ]
1.7 Is access to specialist nursing support routine for: (please mark all that apply)
	If applicable		Other wards
	Stroke unit	Rehab unit	All wards	Some	None
(a) Continence advice?	[ ]	[ ]	[ ]	[ ]	[ ]
(b) Pressure sore prevention?	[ ]	[ ]	[ ]	[ ]	[ ]
(c) Stroke care?	[ ]	[ ]	[ ]	[ ]	[ ]
Team working
Records
1.11a Do all professions contribute to a single set of patient notes for the management of stroke?
(please mark all that apply)	If applicable		Other wards
	Stroke unit	Rehab unit	All wards	Some	None
	[ ]	[ ]	[ ]	[ ]	[ ]
1.11b Are profession-specific notes normally accessible by all members of the multidisciplinary team responsible for the patient?
(please mark all that apply)	[ ]	[ ]	[ ]	[ ]	[ ]
Communication with patients and carers
1.19 Is there patient information literature displayed in unit/ward on the following?
(please mark all that apply)
(a) Condition specific literature on stroke	[ ]	[ ]	[ ]	[ ]	[ ]
(b) Patient versions of national or local guidelines/standards	[ ]	[ ]	[ ]	[ ]	[ ]
(c) Social services local community care arrangements	[ ]	[ ]	[ ]	[ ]	[ ]
(d) The Benefits Agency	[ ]	[ ]	[ ]	[ ]	[ ]
(e) Local voluntary agencies	[ ]	[ ]	[ ]	[ ]	[ ]
(f) How to feed back on services	[ ]	[ ]	[ ]	[ ]	[ ]

(B) EXAMPLES OF CASE MIX QUESTIONS
Demographic information (from PAS)
Patient audit number:		[ ]	Date of birth:	[	]
Sex:	Male	[ ]	Postcode for usual address:	[	]
	Female	[ ]
Stroke onset and hospital stay
1.	Date of stroke:	[	]
2.	Date of admission:	[	]
3.	Date of discharge:	[	]
4.	Date of death:	[	]
Functional status: pre-stroke and at discharge
5.	Living accommodation:		Pre-stroke	At discharge
	Independent housing		[ ]	[ ]
	Warden controlled		[ ]	[ ]
	Residential / nursing home		[ ]	[ ]
	Hospital		[ ]	[ ]
6.	If living at home:		Pre-stroke	At discharge
	Lives alone		[ ]	[ ]
	Lives with spouse/carer		[ ]	[ ]
7.	Dependency (using the Barthel ADL functional assessment scale) pre-stroke and at discharge (20 point version)
8.	Previous stroke: Yes [ ] No [ ]
Clinical status on admission
9.	Worst level of consciousness in 24 hours following stroke:
	Fully conscious			[ ]
	Drowsy (responds to speech)			[ ]
	Semi-conscious (not fully rousable)			[ ]
	Unconscious (responds to pain only/no response)			[ ]
	Dead			[ ]
10.	Side of body affected:
	No clear lateralising signs			[ ]
	Right side			[ ]
	Left side			[ ]
	Both			[ ]
At seven days
11.	Urinary continence at 1 week:
	0 = incontinent/catheterised			[ ]
	1 = occasional accident (max. once per 24 hours)			[ ]
	2 = continent (over previous 48 hours)			[ ]
	3 = patient died within 7 days			[ ]
12.	Clinical classification:
	Cerebral infarction			[ ]
	Intracerebral haemorrhage			[ ]
	Subarachnoid haemorrhage			[ ]
	Other			[ ]
	Don't know			[ ]

(C) EXAMPLES OF PROCESS AUDIT QUESTIONS
Physiotherapy assessment		Yes	No	No, but ...
2.2.1	Has the patient been assessed by a physiotherapist within 72 hours of admission?	[ ]	[ ]	[ ]
	Answer No, but... if patient died within 72 hours; patient is receiving palliative care.
Communication
2.3.1	Has there been an initial assessment of communication problems by the speech and language therapist within 7 days of stroke?	[ ]	[ ]	[ ]
	Answer No, but... if patient died within 7 days; the patient was still unconscious; it is documented that the patient had no communication problems; patient is receiving palliative care.
Ability to cope at home
2.3.2	Was the patient assessed by an occupational therapist within 7 days of admission?	[ ]	[ ]	[ ]
	Answer No, but... if patient died within 7 days; the patient was still unconscious; it is documented that the patient had no difficulties performing everyday activities; patient is receiving palliative care.