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THE EFFECT OF HOW STAFF ARE DEPLOYED OVERNIGHT ON PERFORMANCE IN THROMBOLYSIS

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ESOC-2019

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Abstract

Background and Aims: Previous audit data of thrombolysis identified slower door to needle times at night of 2 hours; over twice as slow as the day. A delay of 2.5-3 hours means the number of good outcomes is halved Our objectives were: •To determine whether staffing specialties and numbers had an effect on overnight performance of the unit •To provide evidence and justification for a more standardised overnight team set-up for stroke units.Methods: •Identified the ‘A’ and ‘D/E’ graded stroke units for thrombolysis performance using the Sentinel Stroke National Audit Programme data DEC-MAR 2018. •Contacted each stroke unit through telephone or e-mail. •Asked the following questions: Which member of the team was responsible for assessing potential stroke patients for overnight admissions? Was stroke nurse cover available overnight? Who decides whether a patient should undergo thrombolysis? Results: •The majority of higher performing units utilize either a specialist stroke, medical or emergency department registrar as the first medical assessor. •All ‘A’ grade units have a stroke specialist nurse on rota overnight. •Grade ‘A’ units tend to have an on call consultant as the thrombolysis decision maker. •Grade D/E units tend to utilise Telemedicine as a thrombolysis decision making tool. Conclusions: •This evidence supports that Stroke specialists delivering the service at the door is associated with better performing units. •There is a national lack of standardisation of how overnight stroke teams are set up. •Stroke units should assess whether they need to alter their overnight team set up to improve thrombolysis performance.

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© Copyright 2020 Morressier GmbH.
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