Clinical Audit on Critical Time Standards for Hyperacute Stroke Management in Addenbrooke's Hospital, Cambridge, Uk: Measuring against National Targets

ABSTRACT

Background and Aims: The aim of this project was to compare the performance of Addenbrooke's acute stroke team from September 2018 - September 2021 to the UK National Stroke Service Model time-targets for hyperacute stroke management. This period was chosen to cover performance before and during COVID, because the pandemic instigated radical changes in hyperacute stroke management processes and team structure in Addenbrooke's Hospital. From this audit, we hoped to determine the effects of these changes - the strengths and weaknesses of different team and process permutations to advise the development of an ideal stroke service model. Method(s) Data on door-to-1st responder time, door-to-CT time, door-to-thrombolysis time, door-to-thrombectomy time and door-toconsultant time for patients presenting during working hours (Mon-Fri, 0900-1700) from September 2018 to September 2021 was extracted from Addenbrooke's Hospital SSNAP database. Statistical analysis revealed a non-parametric distribution, thus median time and IQR were calculated for comparison between different covering teams. Kruskal- Wallis analysis was used to compare data of different teams, and subsequently, if significance was identified, pairwise Mann-Whitney U tests were conducted to determine statistically different groups. Result(s) Door-to-1st responder, door-to-CT, door-to-thrombolysis, door-to-thrombectomy, and door-to-consultant time varied over the 3 years depending on cover. Group 4 was identified as having significantly lower door-to-1st responder and door-to-consultant times. Conclusion(s) Better staffing and top-down prioritisation for consultant review were identified as factors supporting quicker management. Reduction of door-to-CT time, simplification of CT algorithm for rapid thrombolysis and expansion of thrombectomy services were identified as changes which could potentially improve hyperacute stroke management in Addenbrooke's Hospital. (Figure Presented).