Practice Quality Improvement Report

A telephone hotline for transient ischaemic attack and stroke: prospective audit of a model to improve rapid access to specialist stroke care

BMJ 2010; 341 doi: (Published 03 July 2010) Cite this as: BMJ 2010;341:c3265
  1. Enda Kerr, stroke medicine trainee,
  2. Nolan Arulraj, stroke medicine trainee,
  3. Maggie Scott, secretary to the transient ischaemic attack clinic,
  4. Mike McDowall, data manager,
  5. Margrethe van Dijke, audit coordinator,
  6. Sarah Keir, stroke physician,
  7. Peter Sandercock, neurologist,
  8. Martin Dennis, stroke physician
  1. 1Department of Clinical Neurosciences, Western General Hospital, Edinburgh
  1. Correspondence to: M Dennis martin.dennis{at}
  • Accepted 15 May 2010


  • Problem 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.

  • Design 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).

  • Setting Stroke and transient ischaemic attack services in Lothian, a region of Scotland with a population of 810 000.

  • Key measures for improvement Delays to assessment at a rapid access transient ischaemic attack and stroke clinic; delays to appropriate treatment.

  • Strategy for change 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.

  • Effects of change 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, …

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