UK Stroke Forum 2025 | A survey on neurological monitoring practices and clinician perspectives on acute stroke care

So my paper was my first publication from my PhD which was funded by an NIHR doctoral research fellowship and it was the results from a UK-wide survey looking at practice of neurological assessment and monitoring after stroke across the whole of the UK. So there was a 70% response rate despite COVID, which shows the engagement that we got from clinicians about how important a topic is. Some of the key findings were things that we expected to find. So we know that for the ongoing monitoring at the bedside after stroke, the most used tools are the NEWS and the Glasgow Coma Scale, neither of which are stroke-specific, and maybe pick up on deterioration in patients a little bit too late and we should be doing something sooner, which was the whole premise of my PhD. We also know that actually there’s massive variation in what people are doing when and for which patients, dependent on the stroke type, the severity, which hospital they’re in, the time of day even can have an impact on that, but we found even for thrombolysed patients within the first 0 to 8 hours there are actually 21 different schedules being used across the UK. And that’s causing untold variation which could be having an impact on patient outcomes but is also having an impact on workforce efficiency and we need to do more. So my next steps are to do some more to find out what are the items that we should be doing and how we should be doing them and at what frequency so that we’re more standardized in terms of that monitoring after stroke, linking alongside other big trials like Optimus Main that’s looked at thrombolysis, but my follow-on work could be more across the whole stroke population because everyone’s at risk of deterioration and we just need some more guidance on, as I said before, what we should be doing, when, and for which patients, hopefully to then be able to act when we notice deterioration, that’s the crucial part, so that we can improve those outcomes, but equally, as I said, it’s about staffing levels as well, so some places may be doing it more often than we need to, some places not enough, which could impact on the outcome but also has a massive impact on that workload for those at the bedside that are doing it, which for the ongoing monitoring is predominantly nursing staff, but again I’m aware it’s a multidisciplinary approach and I’ve had brilliant support from everyone to get the paper and hopefully we’ll get some follow-on from that.

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