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Introduction: As one of the eight hyper-acute stroke units (HASUs) in London, we are constantly working hard to improve the quality of service we are providing in Northwick Park Hospital (NPH)1. For stroke patients we understand the sooner we bring them into HASU, the better their treatment outcome would be2. Therefore, it is crucial for us as stroke physicians or even as A&E doctors/nurses to quickly identify and made the diagnosis of stroke when patient first came to us, and then try to bring them up to the HAUS where they can receive the most appropriate treatment. However, in clinical practices, there are also cases where the first diagnosis of stroke were not able to be made in time and that we missed the stroke cases, the delays that had caused the patients have been one of the major obstacles when we try to improve the quality of care we provided. Therefore in this study, we would like to explore the possible reasons causing those miss strokes, so as to provide directions for improving our service in near further. Methodology: We compare the clinical record of all stroke patients being diagnosed and treated in NPH for the period of six months in 2014 and in 2018 respectively. All missed stroke cases were located and studied from both period. Baseline data was extracted, stroke subtype, presenting symptoms, pre-existing medical conditions before stroke and timing of first imagining. Time from arrival to be triaged, from arrival to be seen by A&E doctors, from arrival to be received by stroke team were also extracted from records. We compared horizontally between the different period of time to analysis the changed in the quality of care we delivered as well as the possible influence factors for the changes; and we compared the data vertically to analysis the possible influence factors that were significant to miss stroke diagnosis. Logistic regression was used to determine the risk ratio/odds ratio of the influence factors. Results: From this audit, we found that NPH stroke unit received 601 pt in the six months period in 2014, and 787 pt in the six months period in 2018, the managing capacity has increased by 30.95%. The miss stroke cases in 2014 accounting for 3.83% of total intake, while in 2018 is 4.07%, there is no significant difference between the two group of data (P>0.05). We also found that delayed referral for stroke cases was 1.50% in 2014 and 7.37% in 2018, the difference between the two group of data is significant (P<0.01) We are currently still collecting data from all 55 missed stroke cases, we expect to complete this and finish the report of our audit before the end of February 2019. Conclusion: Initial descriptive result from our audit suggested we, HASU of NPH, has been consistently providing care for stroke patient since the established of the unit in 2014. The quality of care we provided in the aspect of rapidly diagnosing stroke cases has remained the same despite the increased number of patients we received over the years. We also noticed there had been a significant delayed in referring possible stroke patient to stroke service in recent times comparing to before, we aim to address this point to our A&E colleagues once we located the influencing factors for the delays, so as to improve the service we provide as a whole in NPH. And finally, we aim to identify the most contributing factors that cause the miss stroke cases, and from that we can find ways to improve our service further. Future trend: This is just a small study to begin with, however, if we found enough proof of certain factor has major influence of affecting quick diagnosis of stroke, we can apply for a national study to confirm our finding and if positive, we can implement our current stroke path way in the hospital or even national institute of clinical excellence (NICE) guideline to improve stroke service being provided nationwide.


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© Copyright 2020 Morressier GmbH.
All rights reserved.