ABSTRACT NUMBER: ESOC2026A994 REDUCING OUT-OF-HOURS VARIATION IN ACUTE STROKE IMAGING FOLLOWING EMERGENCY DEPARTMENT CT RELOCATION

Abstract Background and aims Timely acute stroke care is essential. UK national guidelines recommend brain imaging and administration of thrombolysis within one hour of presentation, and admission to a stroke unit within four hours. An audit at University Hospitals Dorset identified reduced compliance with these standards, particularly for out-of-hours presentations. In response, a service redesign was implemented, relocating the CT scanner within the Emergency Department to improve access to urgent brain imaging. Methods A retrospective audit of acute stroke care against national time-based standards was undertaken, followed by a re-audit after CT scanner relocation. Data were obtained from the Sentinel Stroke National Audit Programme and local electronic health records. Key outcomes included time to brain imaging, thrombolysis in eligible patients, and stroke unit admission. Performance was analysed by time of presentation to compare in-hours and out-of-hours care. Results Cycle 1 demonstrated reduced compliance with national standards, with longer times to brain imaging and greater variation for out-of-hours presentations. Following CT scanner relocation, Cycle 2 showed improved imaging timeliness, with the proportion of patients receiving brain imaging within one hour increasing (54.7% to 62%). Average time to imaging improved across all shifts. The difference between in-hours and overnight presentations reduced from 66 to 25 minutes. Time to thrombolysis improved, whilst stroke unit admission showed limited improvement. Conclusions Baseline compliance with national stroke standards was suboptimal, particularly out of hours. CT scanner relocation was associated with improved access to timely brain imaging and reduced variation, supporting structural service redesign as an effective quality improvement strategy in acute stroke care. Conflict of interest Pia Zaldua: Nothing to Disclose