The impact of relocating CT scanning to the emergency department on hyperacute stroke admissions

Marigold, R, Weir, N., Crawford, P., Evans, S., Battersby Wood, E., Siddegowda, S., Lovett, J., Colchester, N, Morris, R. and Slaght, S (2018) The impact of relocating CT scanning to the emergency department on hyperacute stroke admissions. International Journal of Stroke, 14 (4S), 20. (doi:10.1177/1747493019882907).

Abstract

Introduction: Recent NICE guidelines highlight the need for urgent brain imaging in acute stroke, particularly in cases in which reperfusion therapies or blood pressure lowering might be indicated.

Additional guidance suggests the inclusion of CTA and perfusion scanning in helping decision making where mechanical thrombectomy might be indicated. A CT scan in the Emergency Department has been suggested as one of 12 measures used to reduce thrombolysis door to needle times.

Method: A new CT scanner came in to service in the Emergency Department in May 2018. Previously patients were transported down a long corridor and lift to the scanners in the neurosciences block.

We analysed data from 1707 patients before and after the new scanner came on line to see if there was any improvement in SSNAP performance.

Results: Time from clock start to CT scan improved by 8 minutes from 55 min to 47 min. Hyperacute stroke unit admissions within 4 hours rose from 69% to 72%, and the time between clock start and stroke unit arrival fell by 23 minutes from 2 hrs 36 min to 2 hrs 13 min.

Conclusion: An Emergency Department CT scanner can facilitate faster diagnosis and treatment of acute stroke and is part of a range of measures which can expedite thrombolysis, thrombectomy and acute blood pressure management. These data show that scanner relocation can produce demonstrable
improvements in SSNAP scanning and stroke unit admission performance, despite rising numbers of referrals and increasing pressure on urgent cross sectional imaging demand.

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