title: A telephone hotline for transient ischaemic attack and stroke: prospective audit of a model to improve rapid access to specialist stroke care.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  Stroke and transient ischaemic attack services in Lothian, a region of Scotland with a population of 810,000.
  
  
  METHODS
  Delays to assessment at a rapid access transient ischaemic attack and stroke clinic; delays to appropriate treatment.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical Neurosciences, Western General Hospital, Edinburgh.
authors.forename: Enda
authors.initials: E
authors.lastname: Kerr
authors.forename: Nolan
authors.initials: N
authors.lastname: Arulraj
authors.forename: Maggie
authors.initials: M
authors.lastname: Scott
authors.forename: Mike
authors.initials: M
authors.lastname: McDowall
authors.forename: Margrethe
authors.initials: M
authors.lastname: van Dijke
authors.forename: Sarah
authors.initials: S
authors.lastname: Keir
authors.forename: Peter
authors.initials: P
authors.lastname: Sandercock
authors.forename: Martin
authors.initials: M
authors.lastname: Dennis
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D015277:Hotlines; D006801:Humans; D002546:Ischemic Attack, Transient / Q000628:therapy*; D008297:Male; D008485:Medical Audit; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation; D012307:Risk Factors; D012606:Scotland; D020521:Stroke / Q000628:therapy*