37IMPROVING SPEED OF ACCESS TO CAROTID ULTRASOUND FOR PATIENTS WITH ACUTE STROKE AND TRANSIENT ISCHAEMIC ATTACK: A PLAN-DO-STUDY-ACT (PDSA) CYCLE AUDIT

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Abstract

Evidence-base: Significant carotid stenosis increases stroke risk. Early carotid imaging in the high-risk period following Transient Ischaemic Attack (TIA) or stroke is fundamental to optimising benefit from carotid endarterectomy. NICE 2008 and Intercollegiate Stroke Working Party 2012 recommend that all patients suitable for endarterectomy have carotid imaging within one week of non-disabling (anterior circulation) stroke or TIA.

Change Strategies: This retrospective audit analysed time from request to carotid ultrasound (CUSS) during September 2012 in Tauranga Hospital; 8 patients were post-stroke, 10 had a TIA. Mean wait for inpatients was 6.2 days (range 1-19 days) and outpatients 13.4 days (8-21 days). Strategies to reduce delays were multi-faceted: an online TIA pathway was introduced for GPs and hospital doctors, with guidance on timely CUSS requesting. An acute Stroke unit was opened in January 2013 with a team dedicated to managing inpatient stroke and TIA. The radiology department helped develop a new CUSS request form to improve scheduling prioritisation. Educational meetings on management of cerebrovascular disease were held with Radiologists, GPs and Hospital Doctors. These changes were made without any additional funding.

Change effects: The second audit cycle was completed for all CUSS patients in March 2013; 8 post-stroke, 20 with TIA. Inpatient waiting time fell to 1.2 days (range 0-4), low risk outpatient TIA referrals waited 7.1 days (1-12) from the time of the request being made.

Conclusion: This audit demonstrated a significant reduction in waiting times for CUSS in acute stroke/TIA patients after implementing a number of changes in a District General Hospital. Demand for CUSS has increased, with greater numbers of requests for TIA patients, perhaps reflecting increased clinical vigilance in aggressively addressing risk factors following TIA. Timely referral from the acute event to the TIA clinic needs to be addressed to further reduce waiting times.

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