London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 753 771 Stroke prevention ‘Can you feel it?’ K. George1, E. Foster2, I. Natarajan3 Shropshire Community Trust, Telford, UNITED KINGDOM1, Shropshire and Staffordshire heart and Stroke Network, Telford, UNITED KINGDOM2, University Hospital North Staffordshire, Newcastle under Lyme, UNITED KINGDOM3 Background Care homes identified within Telford and Wrekin PCT with high ambulance and A&E attendances - a high number due to falls. Aim - to detect those with AF reducing the number of falls (a known cause). • Incentive introduced - highly qualified district nurse i.e. case manager visited both homes during week to monitor/observe residents, detect early signs/symptoms of illness commencing treat-ment if required or referring to GP • Training programme provided to care workers - aim to reduce ambulance call outs, reduce hospital admissions, empower care home staff, develop more proactive approach to management of illness. • Train the trainer package, e learning package developed Methodology A Cross-sectional study involving observation of 18 care home population at one specific point in time was conducted with the aim - to provide data on entire population under the study, also a descriptive study (neither longi-tudinal nor experimental) describing: the absolute risks/relative risks from prevalence of AF some feature of the population i.e. prevalence of AF to support inferences of cause and effect Result • Development of basic skills to detect irregular pulse across all levels of staff working within care home • Low cost training materials, e learning package being developed with BOOTS Chemis • Prevention of stroke from undetected A • Improved patient experien • Reduced hospital patient admission • Reduced calls to ambulance service • Empowered workforce able to take on proactive management of the prevention of diseas Number of irregular pulses detected along with those who went on to receive clinical / pharmaceuti-cal intervention Engagement of care home staff and managers has been sought to enable this project to take place. Engagement of GPs is continuing to ensure they understand the importance of follow-ing up the calls from care homes Conclusion Patient groups within care homes are the very elderly within our society, their needs are not always identified. This project puts them at the forefront of the campaign to ensure all those with AF are detected, managed appropriately and a STROKE prevent-ed. 772 Stroke prevention Carotid Endarterectomy Waiting Times after TIA significantly improve but still fall short: A 5-year Case Note Review. A.P. Stead1 St. George’s Hospital Medical School, London, UNITED KINGDOM1 Background: The 2008 NICE guidelines (CG68) state that Carotid Endartectomies (CEAs) should be performed within 14 days of Transient Ischaemic Attack onset to reduce the rate of future ischaemic stroke. Methods: A retrospective audit of the 234 patients who underwent CEA at WUTH between 2006 and 2010 was conducted to assess compliance with NICE guidelines (CG68). Time frames for each step of the care pathway were recorded, from symptom onset to surgical intervention, thus the origin of delays can be more clearly elucidated. Results: There was a significant improvement from 2006 to 2010 in the percentage of patients receiving in-tervention within 14 days (2006: 2.2% (1/45) vs 2010: 36% (18/50) P <0.001). There was some de-lay in referral times to vascular surgery from other services (median 11 days; range = 0:740), how-ever there was no significant difference between patients presenting to General Practitioners or via Accident and Emergency (median wait GP 8 days range = 0:179 vs A&E 5 days range = 1:386, P = >0.05). Over the 5 year period the median waiting time for intervention within the vascular team alone was 23.5 days (range 1:256). This improved significantly from 2006 to 2010 however, with the median waiting time in 2010 15 days (2:178). Conclusion: WUTH have made significant improvements from 2006-2010 in the proportion of CEAs performed that comply with NICE guidelines. However there is still considerable need for improvement. There were delays in all steps of the pathway, but the biggest delays occurred once the patient had already been referred to vascular surgery. A follow up of this audit will include a survey of relevant staff to reveal some useful information about what, specifically, enabled them to make these improvements and also assess what prevented them from performing 100% of CEAs as per NICE guidelines.
Karger_ESC London_2013
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