Abstract

SSNAP measures quality and organisation of stroke care. Domain 1.1 looks at the number of patients scanned within 1 hour of arrival at hospital; local trust performance is 57.4% (national average 51.3%), with the specialist stroke unit at 79.2%. This is in part related to ‘direct to scan protocols’ in extended working hours, but we currently lack equivalent medical staffing and radiographer support during this time. We aimed to explore which factors impacted on scanning time out of hours. An initial consecutive 14 day sample identified delays in approval of scan request by the duty radiologist. A new Standard Operating Procedure allowed specialist stroke nurse practitioners (SNPs) to request CT head scans directly with the duty radiographer, eliminating need for liaison with the radiologist. A repeat 14 day analysis identified additional factors resulting in delays, including delays in scan request and in-hospital competing emergency clinical scanning requirements, meaning no significant improvement in percentage of patients scanned within 1 hour was observed. The mean time from arrival to scan performance was 52 min, but 21.8% of patients did not undergo a CT head within 1 hour of arrival. Further strategies are required to maximise patients meeting this target.