A quality improvement programme with a specialist nurse in a neurovascular clinic

To measure the impact of a quality improvement programme with a stroke specialist nurse and increased capacity at neurovascular clinics.

Transient ischaemic attack and minor stroke are medical emergencies prompting urgent assessment and treatment. Delays in specialist assessment and management are frequent and may increase stroke risk.

Pre- and post evaluation of intervention.

All patients referred to a neurovascular clinic were recorded during two phases: 2006-2008 and 2010-2012. For the 2010-2012 period, a stroke specialist nurse contacted all patients with appointment details, provided driving advice and asked for an eyewitness to attend the clinic. Diagnosis, delay in specialist assessment, prevalence of transient ischaemic attack/minor stroke as confirmed at the clinic and compliance with UK driving regulations were measured and compared before and after this intervention.

A total of 1327 patients were assessed in the two study phases. Referrals to the neurovascular service increased without a decrease in the prevalence of transient ischaemic attack/minor stroke. Delays from clinical event to assessment were decreased for referrals from 36·5-13 days, and adherence to the UK driving restrictions improved for confirmed transient ischaemic attack/minor stroke patients from 61-94%. Fewer patients failed to attend a neurovascular appointment arranged by the stroke specialist nurse than those who failed a general neurology appointment arranged by partial booking.

This quality improvement programme reduced delays for all referred patients, improved compliance with driving regulations and demonstrated efficient use of neurovascular clinic spaces. Increasing local capacity may unmask more transient ischaemic attack/minor stroke patients.

A stroke nurse can help improve the efficiency of a neurovascular clinic and improve patient safety with driving advice.