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The National Clinical guideline for stroke, recommends that services for people with stroke should provide screening for mood and cognition within six weeks of stroke using validated tools. In HASU assessing mood and cognition in a timely fashion has been challenging. In 2013 a previous audit showed cognitive screening at 48% and mood screening at only 7%. We instituted a number of measures to improve compliance including education events for MDT staff, a bespoke stroke clerking proforma, to include data collection boxes. We also introduced the briefer ‘YALE questionnaire’ for mood, and the Montreal Cognitive Assessment Tool (MOCA). We also piloted occupational therapy staff using a ‘screening sticker’ in patient notes. A daily MDT was also introduced, primarily to improve patient flow, but also to prompt action planning. Mood screening improved to 92% and cognition screening to 95% on detailed notes audit. These high compliance figures were however not fully reflected on SSNAPP although compliance has improved. SSNAP data input is completed by a single coder, non clinical staff member. We plan to employ a second data clerk and further revise the stroke proforma.

SSNAP measures quality and organisation of stroke care. Domain 1.1 looks at the number of patients scanned within 1 hour of arrival at hospital; local trust performance is 57.4% (national average 51.3%), with the specialist stroke unit at 79.2%. This is in part related to ‘direct to scan protocols’ in extended working hours, but we currently lack equivalent medical staffing and radiographer support during this time. We aimed to explore which factors impacted on scanning time out of hours. An initial consecutive 14 day sample identified delays in approval of scan request by the duty radiologist. A new Standard Operating Procedure allowed specialist stroke nurse practitioners (SNPs) to request CT head scans directly with the duty radiographer, eliminating need for liaison with the radiologist. A repeat 14 day analysis identified additional factors resulting in delays, including delays in scan request and in-hospital competing emergency clinical scanning requirements, meaning no significant improvement in percentage of patients scanned within 1 hour was observed. The mean time from arrival to scan performance was 52 min, but 21.8% of patients did not undergo a CT head within 1 hour of arrival. Further strategies are required to maximise patients meeting this target.