@article {Yape1, author = {C Yap and J Appleton and D Crossley and D J Nicholl}, title = {035 The TOS study: can we use our patients to help improve the quality of neurological referral?}, volume = {83}, number = {3}, pages = {e1--e1}, year = {2012}, doi = {10.1136/jnnp-2011-301993.77}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background We have previously shown that providing more ophthalmoscopes and training does not necessarily increase Foundation Years level of confidence at using an ophthalmoscope. Thus we developed a simple scoring system as an indirect measure of the quality of neurological examination skills- the TOS score, ie asking the patient if they could recollect being examined with a Tendon hammer (T), Ophthalmoscope (O) and Stethoscope (S)- the latter as a measure of recall.Methods We assessed TOS scores in 59 in-patients referred for a neurological opinion in two NHS Trusts.Results In Trust A (n=29){\textemdash}27\% of patients could not recall being examined with an ophthalmoscope, 11\% could not recall being examined with a tendon hammer. In Trust B (n=30){\textemdash}80\% of patients could not recall ophthalmoscopy, 50\% could not recall being examined with a tendon hammer. In both Trusts, only 3\% of patients could not recall being examined with a stethosope.Conclusions Measurement of TOS scores on patients referred to neurology is a simple method of measurement of quality of in-patient neurological assessment. The results can be feedback to the referring team- we have provided feedback on TOS scores to all medical staff as part of an ongoing survey. Of greater concern, the TOS scores can show how {\textquoteleft}Neurology NAD{\textquoteright} in the notes may actually mean {\textquoteleft}Neurology not actually done{\textquoteright} which has important implications.}, issn = {0022-3050}, URL = {https://jnnp.bmj.com/content/83/3/e1.199}, eprint = {https://jnnp.bmj.com/content/83/3/e1.199.full.pdf}, journal = {Journal of Neurology, Neurosurgery \& Psychiatry} }