UK Stroke Forum Supplement - February 2024 - 21

Abstracts
21
*
*
Standardise Our Approach
Identify And Mitigate Key Delays
Method:
* Retrospective Audit Of All Patients Referred To Sheffield For Mt
Between January 2022 And December 2022, Identified From
Ssnap Data. We Analysed Paper And Electronic Case Notes,
Imaging Results, And Thrombolysis Debrief Audit Notes
Process Mapping Of Patient Journey From Symptom To Transfer
*
Results:
* We Sent 19 Patients For Mt, Thrombolysing 8 Of Them, 2 Of
Those 8 Outside The Ct Scanner (Bolus Only)
* The Mean Dido Time (Available For 18/19 Patients) Was 80
Minutes, Median 49 Minutes, Range 27-198 Minutes
* The Two Quickest Dido Times (27 And 31 Minutes) Had
Thrombolysis Outside The Ct Scanner, And Were Transferred By
The Same Paramedic Crew That Brought Them
* The Mean Wait For A Second Crew Was 48 Minutes, Median 25
Minutes
*
Patients Presenting To Bassetlaw Hospital, A Non-Stroke Centre
Within The Trust, Also Experienced Significant Delays
Conclusion: Key Improvements Suggested By This Evaluation Include:
* A Robust Approach To Bassetlaw Self-Presenters
* Negotiation With Ambulance Trusts To Keep The Same Crew
* A Formalised Approach To Deliver The Thrombolytic Bolus
Near To Ct Rather Than Transferring To The Doncaster Stroke
Unit
Acute Care (Service Development)
A Neuro Physiotherapy Led Clinic To Support The
Management Of Functional Neurological Disorder In
The Hyper-Acute Setting
D. Shivji, P. Petrochilos, W. Bierrum, C. Nicholson,
A. Alim-Marvasti, C. Lane, A. Chandratheva, R. Simister,
S. Haider, M. Balaratnam
Department Of Therapies And Rehabilitation, National Hospital For
Neurology And Neurosurgery, Uclh, London, Uk, Department Of
Neuropsychiatry, National Hospital For Neurology And Neurosurgery, Uclh,
London, Uk, Department Of Stroke And Acute Neurology, National Hospital
For Neurology And Neurosurgery, Uclh, London, Uk, Department Of Therapies
And Rehabilitation, National Hospital For Neurology And Neurosurgery, Uclh,
London, Uk, Department Of Stroke And Acute Neurology, National Hospital
For Neurology And Neurosurgery, Uclh, London, Uk, Department Of Stroke
And Acute Neurology, National Hospital For Neurology And Neurosurgery,
Uclh, London, Uk, Department Of Stroke And Acute Neurology, National
Hospital For Neurology And Neurosurgery, Uclh, London, Uk, Department Of
Stroke And Acute Neurology, National Hospital For Neurology And
Neurosurgery, Uclh, London, Uk, Department Of Stroke And Acute Neurology,
National Hospital For Neurology And Neurosurgery, Uclh, London, Uk,
Department Of Stroke And Acute Neurology, National Hospital For Neurology
And Neurosurgery, Uclh, London, Uk
Introduction: Functional Neurological Disorder (Fnd) Is Sudden Onset
In Half Of Cases1 And One Of The Commonest Causes Of Stroke
Mimics, Comprising 8% Of All Stroke Admissions2. Timely Discussion
Regarding Fnd Can Be Difficult In A Hyperacute Setting With Lengthy
Waits For Community Therapy And/Or A General Neurology Clinic. We
Aimed To Determine The Feasibility And Effectiveness Of Novel
Hyperacute Fnd Mdt Clinic.
Method: A Model Was Created To Provide An Hyperacute Neuro
Physiotherapy Led Fnd Clinic With Neuropsychiatry And Neurology
Support. Records Were Reviewed For Patients Seen Over 13 Months At
Uclh And Acute Visits Recorded Forpre And Post Fnd Mdt Clinic Review.
Results: 17 Patients Were Seen Who Presented To Ed Via The Hasu
Pathway. Patients Were Seen Within 2 Months Of Acute Presentation
And Provided Individualised Information About Fnd, Pathway Navigation
And Self-Management Tools. 53% Required Neuropsychiatry Input And
12% Neurology Input.
Most Patients Were Seen Twice. 10 Patients Were Female, And The
Mean Age Was 38 Years. Most Common Symptoms Were Hemi Motor
And Sensory. 88% Had Other Psychiatric Comorbidities Such As Health
Anxiety, Depression, Complex Ptsd And Personality Disorder. Before Fnd
Clinic Review, The Average Number Of Attendances Was 3. 8 After
Review 88% Patients Did Not Re-Present To Acute Services.
Conclusion: An Acute Fnd Pathway Can Provide Timely Discussion,
Intervention And Reduce Pressure On Hasu Services. This Model Has
The Potential To Reduce Emergency Presentations And Hospital
Admissions And Is A Transferable Model Which Can Be Applied To
Other Hasu'S.
Acute Care (Service Development)
Evaluation Of The Implementation Of European
Stroke Guidelines For Thrombolysis In Wake-Up
Stroke Patients Or Those Presenting In An Extended
Time Window
V. Jones, G. Cumberbatch
St George'S University Hospitals NHS Foundation Trust, St George'S
University Hospitals NHS Foundation Trust
Introduction: Research Has Shown The Benefit Of Thrombolysing
Patients With Wake Up Stroke(Wus) Or Presenting With Stroke In An
Extended Time Window(Etw). New European Stroke Guidelines (2021)
Recommended Thrombolysis In These Scenarios To Patients Meeting
Specific Criteria With Advanced Imaging. Uk Ambulance Services
Changed Protocols In April 2022 To Blue Light All Fast Positive Patients
Presenting Within 10 Hours Of Onset Of Symptoms. A New Local
Pathway Was Implemented In October 2022 Following Staff Training To
Assess All Patients For Thrombolysis Presenting As Wus Or Within An
Etw Using Ct Perfusion.
Method: All Thrombolysis Cases From October 2022-March 2023 In A
Single Site Were Reviewed With Triangulation From Governance Reviews
And Ssnap Data. Wus And Etw Patients Were Identified As A Subset.
Data Reviewed Included Nihss Scores, Door To Needle Times (Dtn),
Thrombolysis Complications, Presence Of Large Vessel Occlusions And
Referrals For Thrombectomy.
Results: 52 Patients Were Thrombolysed In The 6 Months Following
Implementation Of The Pathway. 6 Of These Presented As Wus Or Etw
(11.5%) With A Median Nihss Of 8. All Of This Subset Had Large (N=2)
Or Medium Vessel Occlusion (N=4). Dtn Times Were Longer For The
Subset - Median 53 V 48 Minutes, Two Were Transferred For
Thrombectomy And None Had Complications Of Thrombolysis.
Conclusion: Implementation Of New Guidelines Appears Feasible And
Safe In Routine Practice, Extending The Potential For Treatment To A
Greater Number Of Patients, Including The Group With Large Or
Medium Vessel Occlusion.
Acute Care (Service Development)
A 5-Year Review On In-Hospital Stroke Support In
New Territories West Cluster Of Hospital Authority
Hong Kong
K. Chow
Hong Kong Hospital Authority
International Journal of Stroke, 19(1S)
UK Stroke Forum Supplement - February 2024

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