Background and Aims: SSNAP measures quality and organisation of stroke care in the UK. Domain 1.1 looks at the number of patients scanned within 1 hour of arrival at hospital. Local performance has improved significantly, in part related to innovative “direct to scan protocols” in extended working hours, although challenges include the reduced level of medical staffing and radiographer support at these times. Outside of normal working hours, stroke consultant support is via telemedicine. Methods: We set up a new process, in close collaboration with the regional ambulance service, which allows a single point of access referral and triggers cascaded urgent voice pager alert to the Hospital Out of Hours team (HOOH), portering staff radiographer and stroke nurse practitioner. We ran a direct to scan overnight pilot to assess safety and efficacy of this system and recorded all consecutive referrals. Results: In the first month there was a significant reduction in door to scan time from a mean of 47 minutes to 12 minutes. Conclusions: This accelerates urgent assessment of possible stroke to facilitate emergency treatment in the hyperacute stage. This significant reduction is an important step in improving 24/7 access to high quality hyperacute stroke care. Whilst our service does not currently offer 24/7 thrombectomy, this pilot protocol has now been implemented as a standard care process with maintained very rapid direct to scan times.
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