Impact of a Stroke Same Day Emergency Care Service on MRI Wait Times and Patient Flow in Mild Stroke Presentations

Background With an aging and increasingly comorbid population, stroke services in the United Kingdom face substantial pressure. A significant proportion of admissions under the stroke team involve patients presenting with mild symptoms. Current guidelines recommend urgent MRI for cases with mild symptoms and/or diagnostic uncertainty. A stroke Same Day Emergency Care (SDEC) service is designed to provide rapid investigations, treatment, and discharge for patients presenting with mild stroke symptoms and a low probability of stroke. This study aims to investigate whether a stroke SDEC pathway reduces MRI wait times and hospital admissions among patients presenting with mild stroke symptoms. Methods A retrospective study was conducted in the stroke department at a single tertiary center. Mild stroke symptoms were defined as a National Institutes of Health Stroke Scale (NIHSS) score ≤ 4. Patients with NIHSS ≤ 4 were identified from the stroke department referral database over two six-week periods: pre-SDEC (September 23 to November 3, 2024) and during the stroke SDEC trial period (November 4 to December 16, 2024). MRI wait times, diagnoses, and admission rates were analyzed. Results During the pre-SDEC period, 73 patients had NIHSS ≤ 4, with a mean MRI wait time of 16 hours and 33 minutes; 86% of these patients were admitted to the stroke unit. During the stroke SDEC trial period, 104 patients had NIHSS ≤ 4, with a mean MRI wait time of 11 hours and 34 minutes; 66% were admitted. Among these, 40 patients with NIHSS ≤ 4 were seen in the stroke SDEC, with a mean MRI wait time of three hours and 50 minutes and an admission rate of 20%. Average MRI wait times across the stroke department for patients with NIHSS ≤ 4 decreased significantly between the pre-SDEC and stroke SDEC trial periods (p = 0.016), alongside a reduction in admission rates (p = 0.00269). Conclusions During the stroke SDEC trial period, mean MRI wait times and stroke unit admission rates among patients with mild stroke symptoms were significantly reduced. This approach facilitates rapid diagnosis and treatment while increasing inpatient capacity for stroke patients with more severe deficits and/or those requiring thrombolysis or mechanical thrombectomy.