Audit Program Research Articles

Strengthening crisis resilience in German primary care by using quality indicators: findings of a process evaluation in the RESILARE project

BackgroundIn recent years, health systems worldwide have been confronted with several crises such as natural disasters or the COVID-19 pandemic, that affected lives and health of many people. In light of waves of infections and heat, climate change is considered to be the biggest health threat of the 21st century. Strengthening individual and organizational crisis resilience in healthcare settings thus becomes a crucial factor in maintaining care quality and protecting vulnerable patients during such crises. The RESILARE project therefore aimed to develop and evaluate quality indicators that support primary care practices in preparing for and adapting to crisis-related challenges.MethodsIn a three-phased process, indicator development was based on systematic literature research and qualitative data, a two-stage expert panel process, and pilot testing in a maximum of n = 35 ambulatory practices during an outreach visit. Practice-individual indicator-related status and benchmarking information were provided via feedback reports to complete the audit and feedback program. A mixed-methods process evaluation used semistructured interviews with participating General practitioners and nonphysician health professionals to explore support and challenges for the implementation of the derived set of quality indicators. Two online surveys were conducted to evaluate all indicators and the two-part feedback report. Qualitative data were analyzed inductively using a thematic analysis approach. Survey data were analyzed descriptively.ResultsA total of n = 32 indicators covered four domains: (1) individual resilience, (2) crisis prevention, (3) organizational resilience, and (4) climate resilience. N = 34 practices participated in the piloting and the process evaluation. Participants generally attributed a high relevance to the domains, and considered the indicator set suitable for implementation into existing quality management systems. Planning and implementation of measures that strengthen crisis resilience in practices were triggered or intensified by piloting the indicators and by the two-part feedback report. The identified challenges involved the volume of indicators and practice-individual implementation of renewable energy sources on rented premises. Participants expressed their desire for peer exchange regarding proven concepts for crisis resilience.

Assessing Adherence to Acute Stroke Therapy Guidelines: An Audit Study

Abstract Background The 2023 National Clinical Guidelines for stroke for the UK and Ireland recommended that people with motor recovery goals post stroke should receive at least 3 hours (180 minutes) of rehabilitation per day on at least 5 out of 7 days a week. This is a significant change to previous guidelines that recommended that patients receive at least 45 minutes of each therapy for a minimum of 5 days (NICE 2013). In 2022, the UK Sentinel Stroke National Audit Programme found that only 11.9% received more than 45 minutes of physiotherapy. This highlights that many services were not achieving previous recommendations. Methods In an Irish hospital, two new stroke assistant posts were funded with the aim to maximise therapy time. An audit was performed on compliance with the 2023 national guidelines on an acute stroke unit in august 2023 for patients that were identified as having motor goals post stroke. Data was collected in the form of minutes of direct patient contact time by each therapy –physiotherapy, occupational therapy, speech and language therapy and therapy assistants. This data was compared against recommended therapy time and presented as a percentage of this. Results 9 acute stroke patients who were identified as having motor goals were randomly selected. It was found that none of these patients were meeting current therapy guidelines. When compared to the recommendations, the average amount of therapy that patients received per day ranged from 44 minutes – 132 minutes. On average, patients received 49.1% of recommended therapy. It was also found that therapy assistants were providing, on average, 59.3% of the actual therapy received. Conclusion Stroke patients are not receiving the recommended amount of therapy as per the most recent guidelines. Although the addition of stroke assistants significantly increased therapy time, guidelines were still not achieved.

Adiposity and mortality among intensive care patients with COVID-19 and non-COVID-19 respiratory conditions: a cross-context comparison study in the UK

BackgroundAdiposity shows opposing associations with mortality within COVID-19 versus non-COVID-19 respiratory conditions. We assessed the likely causality of adiposity for mortality among intensive care patients with COVID-19 versus non-COVID-19 by examining the consistency of associations across temporal and geographical contexts where biases vary.MethodsWe used data from 297 intensive care units (ICUs) in England, Wales, and Northern Ireland (Intensive Care National Audit and Research Centre Case Mix Programme). We examined associations of body mass index (BMI) with 30-day mortality, overall and by date and region of ICU admission, among patients admitted with COVID-19 (N = 34,701; February 2020–August 2021) and non-COVID-19 respiratory conditions (N = 25,205; February 2018–August 2019).ResultsCompared with non-COVID-19 patients, COVID-19 patients were younger, less often of a white ethnic group, and more often with extreme obesity. COVID-19 patients had fewer comorbidities but higher mortality. Socio-demographic and comorbidity factors and their associations with BMI and mortality varied more by date than region of ICU admission. Among COVID-19 patients, higher BMI was associated with excess mortality (hazard ratio (HR) per standard deviation (SD) = 1.05; 95% CI = 1.03–1.07). This was evident only for extreme obesity and only during February–April 2020 (HR = 1.52, 95% CI = 1.30–1.77 vs. recommended weight); this weakened thereafter. Among non-COVID-19 patients, higher BMI was associated with lower mortality (HR per SD = 0.83; 95% CI = 0.81–0.86), seen across all overweight/obesity groups and across dates and regions, albeit with a magnitude that varied over time.ConclusionsObesity is associated with higher mortality among COVID-19 patients, but lower mortality among non-COVID-19 respiratory patients. These associations appear vulnerable to confounding/selection bias in both patient groups, questioning the existence or stability of causal effects.

The Role of Activating Joint Audit Programs in Reducing The Exchange Rate Volatility Risks "A Field study"

The Role of Activating Joint Audit Programs in Reducing The Exchange Rate Volatility Risks "A Field study"

Current Application of the Medical Device Single Audit Program (MDSAP) as a Global Regulatory Reliance Framework for the Inspection of Medical Devices.

The globalization and rapid advancements in medical technologies necessitate the harmonization of international regulatory frameworks to ensure the efficient and timely clinical application of medical products, including pharmaceuticals and medical devices. Regulatory reliance, a critical component of this harmonization process, is a powerful tool that provides efficient access for economic entities and regulatory authorities, promoting predictable decision-making and accelerating approvals. The Medical Device Single Audit Program (MDSAP) serves as a regulatory reliance framework for medical device inspections. Implemented by countries including Japan, the United States, Canada, Australia, and Brazil, MDSAP allows third-party certification bodies, recognized by these regulatory authorities, to conduct audits on medical device manufacturers. The outcomes of these audits are shared with the regulatory authorities, who use them for regulatory assessments and decision-making. Since transitioning to its implementation phase in 2017, MDSAP has been widely utilized in various countries. This review provides an overview of the adoption and utilization of MDSAP in major countries, exploring the program's impact on regulatory processes and its potential as a method of regulatory reliance to facilitate timely access to effective and safe medical devices.

The Impact of Account-Level Inspection Risk on Audit Program Planning Decisions

SYNOPSIS Prior research suggests oversight inspections lead to unintended consequences by motivating auditors to manage inspection risk. The current study provides evidence of the impact of a misalignment between inspection and mis-statement risks at the account level, where planning decisions are made. We predict auditors feel pressures to address more immediate inspection risks at the expense of adequately responding to mis-statement risks as prescribed by auditing standards. Employing an experiment with 182 experienced auditors, we manipulate account-level inspection risk (low or high). As hypothesized, auditors plan more hours for an account with higher inspection risk and correspondingly assign fewer audit hours to other accounts with lower inspection risk, even if mis-statement risk is high for those accounts, suggesting an unwarranted shift in audit efforts. Our findings suggest inspection risks impair auditors’ effort allocation decisions and thus may undermine the audit risk model as the normative benchmark for program planning. Data Availability: Contact the second author. JEL Classifications: M42; M48.

National Surgical Quality Improvement Program audit of contemporary perioperative care for radical cystectomy.

To examine the impact of increased compliance to contemporary perioperative care measures, as outlined by enhanced recover after surgery (ERAS) guidelines, among patients undergoing radical cystectomy (RC). From the National Surgical Quality Improvement Program database we captured patients undergoing RC between 2019 and 2021. We identified five perioperative care measures: regional anaesthesia block, thromboembolism prophylaxis, ≤24 h perioperative antibiotic administration, absence of bowel preparation, and early oral diet. We stratified patients by the number of measures utilised (one to five). Statistical endpoints included 30-day complications, hospital length of stay (LOS), readmissions, and optimal RC outcome. Optimal RC outcome was defined as absence of any postoperative complication, re-operation, prolonged LOS (75th percentile, 8 days) with no readmission. Multivariable regressions with Bonferroni correction were performed to assess the association between use of contemporary perioperative care measures and outcomes. Of the 3702 patients who underwent RC, 73 (2%), 417 (11%), 1010 (27%), 1454 (39%), and 748 (20%) received one, two, three, four, and five interventions, respectively. On multivariable analysis, increased perioperative care measures were associated with lower odds of any complication (odds ratio [OR] 0.66, 99% confidence interval [CI] 0.6-0.73), and shorter LOS (β -0.82, 99% CI -0.99 to -0.65). Furthermore, patients with increased compliance to contemporary care measures had increased odds of an optimal outcome (OR 1.38, 99% CI 1.26-1.51). Among the measures we assessed, greater adherence yielded improved postoperative outcomes among patients undergoing RC. Our work supports the efficacy of ERAS protocols in reducing the morbidity associated with RC.

Six-month post-stroke review provision across southwest England: a service evaluation

Background/Aims Six-month post-stroke reviews are advocated for all stroke survivors. There is no recommended service model, with many variations in practice. The aim of this service evaluation was to describe and evaluate the 6-month post-stroke review service provision across the South West England Integrated Stroke Delivery Networks. Methods A mixed-methods service evaluation for 10 services was undertaken, consisting of: a stakeholder meeting to define the scope and review criteria; a mapping exercise to define core service features and activity data; a 12-month retrospective Sentinel Stroke National Audit Programme clinical data audit plus a 1-month prospective audit detailing identified unmet needs, actions to address needs and patient satisfaction; service provider and user guided discussions; and options appraisal synthesising data from all sources to inform service development. Results Considerable variations in service configuration, processes and outcomes existed across services. Guided discussions with 40 service users and 20 service providers revealed predominantly positive experiences. There was perceived value in the review, a key ingredient being its person-centred nature. However, some felt that the review was generic and more of a tick-box exercise. Many staff appeared unaware of differing 6-month post-stroke review models across the region and rarely used Sentinel Stroke National Audit Programme data to reflect on service outcomes or inform service development. Sharing of good practice across services appeared limited. Conclusions Data did not support a specific preferred service model. Findings suggested 6-month post-stroke reviews should not be a ‘one size fits all’ model, with flexibility in format and timing to optimise value. A knowledge sharing and evidence-based culture should be encouraged to nurture service development.

Post-discharge surgical site infection surveillance using patient smartphones: a single-centre experience in cardiac surgery

Background/Aims Surgical site infections following cardiac surgery pose significant risks and financial burdens to both patients and healthcare systems. This study aimed to explore the implementation and outcomes of a novel surgical wound monitoring system using patient smartphones for post-discharge surveillance. Methods The study was conducted at a London-based cardiothoracic tertiary referral centre, where 1358 patients undergoing cardiac surgery between January 2021 and March 2023 were enrolled onto the surgical wound monitoring system. Data were collected from the National Cardiac Audit Programme dataset, the monitoring syste and Hospital Episode Statistics data. Comparisons between patients who did or did not respond to surveillance requests were performed. A nested confirmatory analysis assessed antibiotics reported by patients through the digital route compared with antibiotics given by GPs or in outpatients. Results The overall response rate for surgical wound monitoring using patient smartphones was 86.6%. Patients who were female, from areas of higher deprivation and lived closer to the hospital were less likely to engage with surgical wound monitoring. Although not statistically significant, the current study suggests that patients with surgical site infections who used smartphones for surgical wound monitoring were less likely to be re-admitted or have further surgery and had shorter readmission stays. The accuracy of antibiotic use for surgical site infections using the surgical wound monitoring system was 96.5%. Conclusions This study underscores the potential of digital technologies, particularly smartphones, in efficient and accurate post-surgical monitoring. The findings suggest that the use of digital monitoring systems may improve patient outcomes, with potential for wider system-level benefits.

Prospective Audit and Feedback for Antimicrobial Treatment of Patients Receiving Renal Replacement Therapy in Community-Based University Hospitals: A before-and-after Study.

In South Korea, because of manpower and budgetary limitations, antimicrobial stewardship programs have relied on preauthorization. This study analyzed the impact of a prospective audit and feedback (PAF) program targeting inpatients undergoing intermittent hemodialysis or continuous renal replacement therapy, which was implemented at two community-based university hospitals. During three years of PAF, 27,906 antimicrobial prescriptions were reviewed, with 622 (2.2%) interventions. The mean incidence density per 1000 patient days of multidrug-resistant organisms, except for carbapenem-resistant Acinetobacter baumannii, decreased in the study population, whereas it increased among inpatients. Multivariable Poisson regression analysis revealed that after PAF, the incidences of vancomycin-resistant Enterococcus and mortality decreased (incidence risk ratio, 95% confidence interval: 0.53, 0.31-0.93 and 0.70, 0.55-0.90, respectively). Notably, after PAF, incorrect antimicrobial dosing rates significantly decreased (tau -0.244; p = 0.02). However, the incidences of other multidrug-resistant organisms, Clostridioides difficile, length of stay, and readmission did not significantly change. This study shows that in patients undergoing intermittent hemodialysis or continuous renal replacement, targeted PAF can significantly reduce multidrug-resistant organism rates and all-cause hospital mortality, despite limited resources. Furthermore, it can improve antimicrobial dosage accuracy.

Efektivitas Tata Kelola Penanganan Anak Stunting oleh Dokter dan Tenaga Kesehatan di Kota Yogyakarta

The governance management of stunting children in Yogyakarta is carried out through the Stunting Case Audit (AKS) program. This program was implemented as an effort to meet the zero stunting target of Yogyakarta City through early intervention to reduce and prevent the appearance of similar cases from the audited areas. To find out that the AKS program has succeeded in achieving its goals, it is necessary to conduct a study to examine the effectiveness of the AKS program. This research is using a qualitative approach by comparing the suitability of program implementation with indicators of effectiveness. The results of this research explain that from the four effectiveness indicators used, only one indicator met the implementation of AKS. Indicators of timeliness have been met, while indicators of target accuracy, goal attainment and the emergence of expected results have not been met the expectation.

791-P: The Impact of Age on Response to Injectable Semaglutide—Insights from the Association of British Clinical Diabetologists’ Audit Programme

791-P: The Impact of Age on Response to Injectable Semaglutide—Insights from the Association of British Clinical Diabetologists’ Audit Programme

The effect of audit training in universities on the audit expectation gap

The audit expectation gap (AEG) is a phenomenon where there is a difference between what people expect of auditors and what they can do. This research was conducted in 2023 with 336 university students in Vietnam to assess the effect of university training on the AEG related to auditors' responsibilities. The reliability of the scale and the average difference between student groups were tested using SPSS 29 software. The results showed that AEG exists among accounting students who have studied auditing subjects. Most of these students have higher expectations than other students. This study also revealed that the university's auditing program and auditing courses effectively narrowed the AEG to two in nine auditor's responsibilities and one in nine auditor's responsibilities, respectively. However, it is important to note that these changes were only cognitive. Students still expect auditors to fulfill crucial responsibilities such as detecting fraud, predicting bankruptcy, evaluating ongoing operations and serving as the "family doctor" of the enterprise. Therefore, training for students can help narrow the AEG about certain audit responsibilities. A better approach is to strengthen the responsibility and authority of auditors. The future of the audit profession depends on the demands of stakeholders and the capabilities of the profession. The auditing profession must accept new demands for auditor responsibilities in the new context. This also has implications for audit bodies in narrowing the audit expectation gap in Vietnam.

Trust in cervical screening and attributions of blame for interval cancers following a national controversy.

This study investigated levels of trust and attributions of blame in connection with a cervical screening programme following a controversy related to the programme's audit, incorporating an experimental test of the effectiveness of new information materials. We compared responses in Ireland (N = 872) to equivalent responses in Scotland (N = 400). Participants in Ireland were randomly assigned to either a treatment group that received the information materials or a control group that did not. Participants then responded to questions about their trust in cervical screening and to whom they would attribute blame in a range of scenarios describing women diagnosed with cervical cancer between screening rounds. Results showed that the control group in Ireland had lower trust and attributed higher blame towards screening services than participants in Scotland. However, exposure to information materials in the treatment group improved trust and reduced blame. The findings suggest that public controversies influence perceptions of screening programmes and underscore the importance of transparent, choice-based communication in mitigating these effects. The findings have valuable implications for screening services worldwide as all screening programmes will have associated false negative and false positive results.

OSLD nanoDot characterization for carbon radiotherapy dosimetry

Objective. This study characterized optically-stimulated luminescent dosimeter (OSLD) nanoDots for use in a therapeutic carbon beam using the Imaging and Radiation Oncology Core (IROC) framework for remote output verification. Approach. The absorbed dose correction factors for OSLD (fading, linearity, beam quality, angularity, and depletion), as defined by AAPM TG 191, were characterized for carbon beams. For the various correction factors, the effect of linear energy transfer (LET) was examined by characterizing in both a low and high LET setting. Main results. Fading was not statistically different between reference photons and carbon, nor between low and high LET beams; thus, the standard IROC-defined exponential function could be used to characterize fading. Dose linearity was characterized with a linear fit; while low and high LET carbon linearity was different, these differences were small and could be rolled into the uncertainty budget if using a single linearity correction. A linear fit between beam quality and dose-averaged LET was determined. The OSLD response at various angles of incidence was not statistically different, thus a correction factor need not be applied. There was a difference in depletion between low and high LET irradiations in a primary carbon beam, but this difference was small over the standard five readings. The largest uncertainty associated with the use of OSLDs in carbon was because of the k Q correction factor, with an uncertainty of 6.0%. The overall uncertainty budget was 6.3% for standard irradiation conditions. Significance. OSLD nanoDot response was characterized in a therapeutic carbon beam. The uncertainty was larger than for traditional photon applications. These findings enable the use of OSLDs for carbon absorbed dose measurements, but with less accuracy than conventional OSLD audit programs.

The Burden of Stroke Mimics Among Hyperacute Stroke Unit Attendees with Special Emphasis on Migraine: A 10-Year Evaluation.

Stroke and migraine are common neurological illnesses that cause tremendous suffering for patients. Certain diseases can mimic the clinical manifestations of an actual stroke. Migraine is one of the most commonly reported stroke mimics. The main goals of this study are to look at the prevalence of stroke mimics on the stroke pathway of Sheffield Teaching Hospitals and how many of them are migraines. A retrospective service evaluation was conducted at the hyperacute stroke unit (HASU) of the Royal Hallamshire Hospital (RHH) in the United Kingdom. The total admissions from 2013 to 2022 were collected from the Sentinel Stroke National Audit Programme database, and the number of stroke mimics was evaluated each year. The burden of migraine stroke mimics was also evaluated. Then, a one-year sample of stroke mimics was extracted to look for the types of each mimic. From 2013 to 2022, 45.75% (n = 12156) of the stroke pathway patients (n = 26573) were stroke mimics, with an increment of up to 55% in the years 2021and 2022. During these10 years, migraine stroke mimics accounted for 10.21% of admissions (n = 1240). The three most common mimics in a one-year sample of stroke pathway patients were migraine (14.70%) (n = 373), functional neurological disorders (FNDs) (7.17%) (n = 182), and Guillain-Barré syndrome (6.66%) (n = 169). Seizures, syncope, and metabolic derangements were reported as mimics in 4.17% (n = 106), 3.14% (n = 80), and 1.77% (n = 45), respectively. About half of the HASU attendees were stroke mimics rather than actual strokes, and the most common mimics were migraines.

Post-discharge surgical site infection surveillance using patient smartphones: a single-centre experience in cardiac surgery

Background/Aims Surgical site infections following cardiac surgery pose significant risks and financial burdens to both patients and healthcare systems. This study aimed to explore the implementation and outcomes of a novel surgical wound monitoring system using patient smartphones for post-discharge surveillance. Methods The study was conducted at a London-based cardiothoracic tertiary referral centre, where 1358 patients undergoing cardiac surgery between January 2021 and March 2023 were enrolled onto the surgical wound monitoring system. Data were collected from the National Cardiac Audit Programme dataset, the monitoring system and Hospital Episode Statistics data. Comparisons between patients who did or did not respond to surveillance requests were performed. A nested confirmatory analysis assessed antibiotics reported by patients through the digital route compared with antibiotics given by GPs or in outpatients. Results The overall response rate for surgical wound monitoring using patient smartphones was 86.6%. Patients who were female, from areas of higher deprivation and lived closer to the hospital were less likely to engage with surgical wound monitoring. Although not statistically significant, the current study suggests that patients with surgical site infections who used smartphones for surgical wound monitoring were less likely to be re-admitted or have further surgery and had shorter readmission stays. The accuracy of antibiotic use for surgical site infections using the surgical wound monitoring system was 96.5%. Conclusions This study underscores the potential of digital technologies, particularly smartphones, in efficient and accurate post-surgical monitoring. The findings suggest that the use of digital monitoring systems may improve patient outcomes, with potential for wider system-level benefits.

Surgical recovery from the COVID-19 pandemic in English adult neurosurgical centres

Objectives The COVID-19 pandemic required a change in resource priority from Neurosurgical care in order to treat medically unwell patients suffering from the complications of COVID-19 infections. We demonstrate the impact of COVID-19 on total bed days in 24 Neurosurgical centres in England offering adult Neurosurgery as well as the total spells (single inpatient episodes) for operative Neurosurgical patients between 2020 and 2022 when compared with 2019. Methods We used Capse Healthcare Knowledge System software iCompare in order to show the change in total spells for patients undergoing a primary or secondary Neurosurgical procedure as defined using the National Neurosurgical Audit Programme (NNAP) OPCS-4 coding framework between 2019 and 2022. Results The overall mortality rate of COVID-19 patients was 12.3% and the percentage of total bed days taken up by COVID-19 patients in hospitals at large was on average 7.7%. The total number of spells for all procedures over the 24 centres in 2022 was 39,019 compared with 45,742 in 2019. There was a cumulative deficit of 24,904 spells. The loss of spells was not equally distributed across regions and hospital Trusts. The average number of referral to treatment pathways completed within 18 weeks has declined from 76% to 57% over the study period and the referral to treatment clearance time has risen from 17 to 24 weeks. Conclusions The mean elective cranial output in 2022 compared with 2019 is at 88% with spinal output lagging at 69%. If the rate of change year on year were to remain at current levels then we would reach pre-pandemic levels of output by 2026.

Model of Quality Assurance and Audit Quality Based on International Standards for Internal Auditing

Purpose — This study aimed to address the concept of internal audit quality and how to enhance and improve the quality of internal audit units in hospitals by identifying and designing a proposed new model based on the International Auditing Standard 1300 to ensure quality assurance and improve transparency and accountability. Design/methodology/approach — This study aims to achieve these objectives. Qualitative methods and semi-structured interviews using an inductive approach were adopted to cover the theoretical aspect of research and the deductive approach to develop a new model for a quality assurance and transparency program in hospitals in Iraq Mosul City. Findings —The findings of this internal audit division do not cover all hospital activities. In addition, it is not possible to apply standardized audit programs to the various units. Rather, the type of activities carried out by these units should be considered, whether service, economic, commercial, or agricultural. Thus, many factors improve the quality of internal auditing related to work procedures in the unit. Among the most important recommendations is implementing a quality assurance and transparency program in these hospitals to raise the quality of internal auditing and carry out its activities efficiently and effectively. Practical implications —This proposal can serve as a guide for later use by those authorities as they evaluate and determine the strength of the internal audit of any establishment, company, or governmental institution. Therefore, hospitals must apply the paragraphs that are not included in the program, and there should be greater interest in the paragraphs that are applied in a weak way to reach real integration of the quality assurance and improvement program, which enhances the quality of internal auditing on all hospital activities. Originality/value —This paper describes a quality assurance and transparency program in these hospitals to improve internal audits and efficiency.

A service evaluation of a new regional integrated stroke service in the NHS

Background: Stroke is the UK's leading cause of disability and contributes to numerous deaths. In response, centralised stroke care is on the rise, both globally and in the UK. A local trust has formed a regional stroke centre to provide efficient and timely emergency treatment. Aims: This article evaluates hyperacute performance in a new service, identifying areas for improvement and monitoring standards. It also aims to address and minimise shortfalls in preparation for the upcoming opening of a designated stroke hub, which will admit patients directly to the stroke team, bypassing the emergency department. Methods: Data were extracted from the Sentential Stroke National Audit Programme (SSNAP) database from 26 September 2022 to 26 January 2023. Comparison was made to national quarterly SSNAP data from October 2022 to December 2022, due to the corresponding publication dates. Literature was sourced from the Cumulative Index to Nursing & Allied Health database. The main targets within SSNAP based on the first 4 hours of patient care were identified and analysed. Findings: From admission, 64% of patients underwent computer tomography scanning under 1 hour from admission, compared to a national average of 56.6%; 76% of patients underwent a swallow screening under 4 hours from admission, compared to a national average of 71.5%; and 37% of patients achieved admission to the hyperacute stroke unit under 4 hours from admission, compared to a national average of 39.5%. National average data were taken directly from SSNAP national averages from the report spanning October 2022 to December 2022. Conclusion: In comparison to national averages in many areas, the current service is performing well; however, there are many areas for improvement to address. Although the outlook for stroke care looks more promising as newer technologies emerge, stroke prevalence is increasing simultaneously. Stroke continues to cost the UK upwards of 26 billion pounds per year and causes significant detriment to survivors. Therefore, healthcare has a duty of care to continue to improve standards and innovate to improve outcomes.