నైరూప్య

An audit project to improve the service management of patients presenting with acute stroke compared to the standard guidelines.

Hussein Taqi, Mohanad Aldiwani , Ahmed Zwain

Stroke is a preventable and treatable disease. Over the past two decades, a growing body of evidence has overturned the traditional perception that stroke is simply a consequence of aging that inevitably results in death or severe disability. Evidence is accumulating for more effective primary and secondary prevention strategies, better recognition of people at highest risk and interventions that are effective soon after the onset of symptoms. Understanding of the care processes that contribute to a better outcome has improved, and there is now a good evidence to support interventions and care processes in stroke rehabilitation.

A retrospective study was conducted in Nevill Hall hospital over nearly 20 months. 31 patients were included in the comparative study with majority of them octogenarians and females were predominant. Nearly two thirds of the patients were complaining from hypertension and half of them were smokers. more than two thirds of patients were on anticoagulants either on warfarin or NOACs which required reversal of the agent in the first group.

While the adherence to the guidelines in the neurological observation and blood pressure measurements were achieved, there was significant lag in the arrangement of the CT scans whether for those who were admitted in the frontline (30% only) or those who showed acute deterioration in their GCS which required immediate repeat of the scan. Also, there was a noticeable delay in neurosurgical referral which could be acknowledged that most of the cases deemed to be out of the scope of intervention, but possible a clearer documentation needs to be seen to accomplish a safe and quality effect pathways for stroke team in future.

After analyzing the data available, a necessity for a clear set of guidelines has been created to guide the treating physicians who are dealing with stroke patients in the acute admission units. This could be done by guiding posters or flyers to encourage them for rapid CT scan requests either on presentation on times of acute deterioration in those groups of patients who can also require a rapid and cost effective referral to the neurosurgical teams in the tertiary centres.