ABSTRACT NUMBER: ESOC2026A2300 IMPROVING ECG DOCUMENTATION FOR ATRIAL FIBRILLATION DETECTION IN ACUTE STROKE ADMISSIONS: A RE-AUDIT

Abstract Background and aims Atrial fibrillation (AF) is a major modifiable risk factor for ischaemic stroke yet remains under-detected in acute stroke admissions. National guidelines recommend routine ECG monitoring to facilitate early AF detection and timely initiation of secondary prevention. A 2024 audit at Fairfield General Hospital identified suboptimal ECG documentation. This re-audit evaluated whether compliance improved following audit feedback alone. Methods A prospective re-audit included 32 adult patients admitted with stroke or TIA to Ward 5 between 2–10 April 2025. Patients transferred from other hospitals were excluded to reflect local admission pathways. Outcomes were compared with the 2024 audit cohort (n=40). Measures included ECG availability during initial clerking, availability by post-take ward round (PTWR), completion rates of requested ECGs, and the proportion of patients with no ECG performed at any stage. Results ECG availability during initial clerking increased from 45.0% to 56.3% (+11.3 percentage points). Availability by PTWR improved from 52.5% to 65.6% (+13.1 percentage points). Compliance with subsequent ECG requests rose from 45.5% to 71.4% (+25.9 percentage points). Completion of requested ECGs by PTWR showed the greatest improvement, increasing from 30.0% to 90.0% (+60.0 percentage points). The proportion of patients with no ECG at any stage decreased from 22.5% to 12.5%. Conclusions ECG documentation compliance improved substantially despite no formal implementation of previously recommended interventions, suggesting audit feedback and clinician awareness can independently drive practice change. However, ongoing documentation gaps highlight the need for system-level interventions and repeated audit cycles to achieve optimal AF detection in acute stroke care. Conflict of interest Muhtasim Fuad: Nothing to disclose, Haris Mohammad: Nothing to disclose, Sadaf Alvi: Nothing to disclose, Narayanamoorthi Saravannan: Nothing to disclose, Amrita Badanahatti: Nothing to disclose, Shrina Patel: Nothing to disclose, Saad Abbas: Nothing to disclose