341 Auditing the timing of CT-Brain and Angiograms in suspected acute stroke

Abstract

Abstract Background Timing of neuroimaging play a key role in the management and ultimate outcomes of patients presenting to hospital with a suspected acute stroke. The NICE Guidelines on the initial management of suspected acute stroke and the NHS National Stroke Service Model set a target of less than 20 minutes between arrival to hospital and having a CT-Brain and CT-Angiogram performed, analysed, and reported. A clinical audit was performed looking at the timing of all CT-Brain studies performed in 2022 at a level three hospital in Ireland where acute stroke was the suspected presentation. Methods A total of 206 CT-Brain and CT-Angiogram studies were included in the audit. The time of the patients’ registration in the emergency department was compared to the timestamp on NIMIS of the completion of each CT study and of the time of publication of the radiologist’s report. For patients already admitted on a hospital ward, the time that the CT study was requested was used in lieu of arrival time. Results The average time between arrival in the emergency department and the completion of CT-Brain was 82 minutes. The average time between the completion of the CT and the publication of the radiologist’s report was 26 minutes, however many studies had verbal reports delivered to the requesting physician prior to publication of the report. Altogether, the average time for the performance and reporting of a CT-Brain and Angiogram in patients with suspected acute stroke was 108 minutes. Conclusion The average of 108 minutes from door to scanner to reported CT-Brain and Angiogram is significantly longer than the 20 minutes recommended by the NICE Guidelines. This hospital serves a large, rural catchment which makes late presentations common, adding to the urgency of neuroimaging for these patients. In future, key areas of in-hospital delay in CT performance and reporting should be identified and given close attention.