22. European Stroke Conference 592 Acute stroke: emergency management, stroke units and complications Identifying Barriers to Delivering Prompt Acute Stroke Care in a British Emergency Depart-ment 658 © 2013 S. Karger AG, Basel Scientific Programme (ED). J. Preston1, N. Gainsborough2, I. Kane35 Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brigh-ton, UNITED KINGDOM1, Royal Sussex County Hospital, Brighton and Sussex University Hos-pitals NHS Trust, Brighton, UNITED KINGDOM2, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UNITED KINGDOM3 Background UK acute stroke care is heavily dependent on ED recognition + activation of stroke pathways to deliver prompt stroke care including thrombolysis, usually without a dedicated stroke team out of hours (OOH). Within these constraints the NHS aims to deliver equitable care 24 hours a day. UK data show median time from admission to stroke team arrival increases from 87 to 188 minutes in + OOH respectively. Median door to needle (DTN) time nationally + locally was 69 + 65 minutes re-spectively, exceeding a target of 60 minutes. The sources of delay in our department were unclear. Methods Participant observation method of qualitative assessment was used to assess 8 in-hours acute stroke calls. Field notes consisted of basic observations: delay between admission + call, clinical parame-ters + a summary. Particular attention was paid to team members present, their actions, interactions, attitudes + their impact on the sequence + success of the call. Visual depictions of the scenes were made to illustrate team working. Results ED team members were frequently absent on arrival of the stroke team leading to insufficient man-power to deliver prompt treatment. Handover from ED doctors was infrequent, but when present was from a senior clinician. Attitudes + actions of ED nurses imply ownership for this emergency lies solely with the stroke team, responsibility is discharged to them rapidly + informally. Full ob-servations were complete in 62%. The area of ED used was influential. Pictorial examples of good + bad practice are shown. Conclusions Inter-departmental working may be inadvertently acting to reinforce barriers. Stroke team involve-ment was introduced to support + facilitate management within the ED, but dependence has evolved + appears to have disengaged ED staff almost entirely, which further compounds performance OOH. Future work must concentrate on improving interdepartmental working including consolidation of role expectations + education for all team members.
Karger_ESC London_2013
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