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■ PROFESSIONAL ISSUES Clinical Medicine 2009, Vol 9, No 3: 236–8 An urgent access neurovascular clinic: audit of timeliness Dennis Briley, Chris Durkin and Tom Meagher ABSTRACT – This study aimed to evaluate timeliness of an stroke or TIA and whether faster evaluations were provided for outpatient urgent access neurovascular clinic in a district high-risk patients. general hospital setting through an audit of delay from event to completion of evaluation following transient Methods ischaemic attack (TIA) or minor stroke. Participants included those referred for evaluation of suspected TIA or minor Data were prospectively collected from all attendees to the stroke. The median delay from event to completion was 16 urgent access neurovascular clinic between 2000 and 2006. The days, with 45% seen within two weeks of symptom onset, clinic was initially held on a fortnightly basis but it took place and 15% within one week of symptom onset. A weekly TIA weekly from 2004. In addition, in 2003 the referral proforma was clinic is not capable of achieving the National Clinical introduced to help assess the likelihood of a cerebrovascular Guidelines for Stroke recommendation for evaluation within diagnosis. one week of symptoms. This audit supports the National Data collection included the time of the most recent event Stroke Strategy recommendation for immediate evaluation (when known), the date of referral (information on the date of of patients presenting with a recent TIA or minor stroke. referral was not collected routinely until 2004), the date when seen in clinic, date of imaging (when performed) and the delay KEY WORDS: imaging, outpatient clinic, stroke, transient from the most recent event to completion of clinical opinion ischaemic attack and imaging. Basic demographics and vascular risk factors were recorded along with the final diagnosis and the results of inves- Introduction tigation. For this clinic, magnetic resonance imaging (MRI), including diffusion weighted imaging, was the primary brain Studies indicate that the highest risk of stroke after either a tran- imaging modality and carotid magnetic resonance angiogram sient ischaemic attack (TIA) or minor stroke is within the first (MRA) was the primary vascular imaging used, and they were two weeks.1 Interventions, such as carotid endarterectomy, have generally performed together.7,8 Stroke and TIA were diagnosed the greatest clinical benefit when performed quickly after the according to World Health Organization (WHO) criteria. index event.2 It is therefore recommended that patients receive Beginning in 2003, we requested general practitioner (GP) urgent outpatient evaluations following such events. The initial referrers to use a proforma to help assess patients. High-risk version of the National Clinical Guidelines for Stroke recom- symptoms were considered to be speech disturbance and motor mended evaluation within two weeks; the American Heart symptoms. Symptoms thought to indicate against a TIA include Association (AHA) guidelines recommend within one week, paraesthesias, amnesia and loss of consciousness. Based on the and in 2004 the Royal College of Physicians (RCP) updated the symptom
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