Department of Clinical Neurosciences, Western General Hospital, Edinburgh.
BMJ. 2010 Jul 2;341:c3265. doi: 10.1136/bmj.c3265.
Patients with transient ischaemic attack or stroke benefit from early diagnosis, specialist assessment, and treatment with thrombolysis, and from stroke unit care and secondary prevention. The challenge with such patients is to minimise delays and ensure that treatment is appropriate, and to provide this care with the available resources.
An ongoing prospective audit of a transient ischaemic attack and stroke clinic (1 January 2005 to 30 September 2009), as part of the Scottish Stroke Care Audit, and a three month targeted audit of immediate telephone access to a specialist stroke consultant (1 February 2009 to 30 April 2009).
Stroke and transient ischaemic attack services in Lothian, a region of Scotland with a population of 810,000.
Delays to assessment at a rapid access transient ischaemic attack and stroke clinic; delays to appropriate treatment.
In February 2007 we introduced a 24 hours a day, seven days a week hotline to a consultant, who provided immediate advice on diagnosis, investigation, and emergency treatment for patients with transient ischaemic attack or stroke, and suggested the most appropriate care pathway, which might include an early appointment in a transient ischaemic attack and stroke clinic.
The introduction of the hotline was associated with an immediate and sustained reduction in delays to assessment (from 13 to three days) and treatment. The proportion of participants taking statins at the time of visiting the clinic increased from 40% before the introduction of the hotline to 60% after the hotline was in place. Also, the hotline contributed to a reduction in the delay from last event to carotid surgery, from 58 days to 21.5 days. A total of 376 calls were received during the three month audit. Of the 273 (88%) referrers who responded to our questionnaire, 257 (94%) were very satisfied with the advice given over the hotline.
Although associated with some disruption to the activities of the consultants, a 24 hours a day, seven days a week telephone hotline to a consultant is a feasible and effective means of reducing delays to specialist assessment and treatment of patients with transient ischaemic attack or stroke.
患有短暂性脑缺血发作或中风的患者受益于早期诊断、专家评估以及溶栓治疗，受益于卒中单元护理和二级预防。此类患者面临的挑战是尽量减少延迟，并确保治疗恰当，并利用现有资源提供此类护理。
苏格兰卒中护理审核的一部分，对 2005 年 1 月 1 日至 2009 年 9 月 30 日期间的短暂性脑缺血发作和卒中门诊（一个）进行的持续前瞻性审核，以及对 2009 年 2 月 1 日至 2009 年 4 月 30 日期间即时电话访问专家卒中顾问的三个月针对性审核。
洛锡安区的卒中与短暂性脑缺血发作服务，洛锡安区是苏格兰的一个地区，拥有 810,000 人口。
快速就诊的短暂性脑缺血发作和卒中诊所评估延迟；适当治疗延迟。
2007 年 2 月，我们引入了一个 24 小时/7 天的热线，为患者提供有关诊断、检查和紧急治疗的即时建议，为短暂性脑缺血发作或中风患者建议最合适的护理路径，包括在短暂性脑缺血发作和卒中诊所的早期预约。
热线的引入立即且持续减少了评估（从 13 天减少至 3 天）和治疗延迟。在引入热线之前，在就诊时服用他汀类药物的参与者比例为 40%，而在引入热线之后则增加至 60%。此外，热线还将从最后一次发病到颈动脉手术的延迟时间从 58 天缩短至 21.5 天。在三个月的审核期间共收到了 376 个电话。在对我们的问卷调查做出回应的 273 名（88%）转介者中，257 名（94%）对热线提供的建议非常满意。
尽管给顾问的活动带来了一些干扰，但每天 24 小时、每周 7 天的电话热线为顾问提供了一种可行且有效的方法，可减少短暂性脑缺血发作或中风患者的专科评估和治疗延迟。
