T O S
• Tendon Hammer
• Ophthalmoscope
• Stethoscope
Methods
• Prospective data collection March – May 2011• In-patients referred to neurology at University
Hospital Birmingham (UHB) (Trust A) and City Hospital (Trust B)– first contact with neurology– asked if they have been examined during this admission
with a tendon hammer, ophthalmoscope and stethoscope
• Additional data included: admission date, age, sex, ward, referral reason, documented neurology examination, diagnosis
Results- Phase 1 (March-May 2011)
• Trust A– 30 patients included
• Trust B– 26 patients included
Tendon hammer (T)
Ophthalmoscope (O)
Stethoscope (S)
UHBYes 15 50% 6 20% 29 96.7%
No 15 50% 24 80% 1 3.3%
CityYes 22 84.6% 19 73.1% 25 96.2%
No 4 15.4% 7 26.9% 1 3.9%
Diagnoses at Trust A
Diagnoses at Trust B
Source of Referrals at Trust A
Ward (Trust A)
Tendon Hammer Ophthalmoscope Stethoscope
Yes (%) No (%) Yes (%) No (%) Yes (%) No (%)
A&E 1 (50) 1 (50) 0 (0) 2 (100) 2 (100) 0 (0)
CDU (Clinical Decision Unit)
8 (72.7) 3 (27.3) 2 (18.2) 9 (81.8) 11 (100) 0 (0)
Medical 4 (57.1) 3 (42.9) 2 (28.6) 5 (71.4) 7 (100) 0 (0)
Surgical 2 (28.6) 5 (71.4) 2 (28.6) 5 (71.4) 7 (100) 0 (0)
ITU 0 (0) 3 (100) 0 (0) 3 (100) 2 (66.7) 1 (33.3)
Ophthalmoscopes at Trust A
• 36 in total
– 20 (55.6%) working
– 15 (41.7%) not working
– 1 (2.8%)missing
Trust A- Ophthalmoscopes & TOS
• A&E– 9 (100%) working ophthalmoscopes, but...– 2 (100%) patients don’t remember being
examined with an ophthalmoscope
• CDU– Total 4, 1 (25%) working– 9 (81.8%) patients don’t remember being
examined with an ophthalmoscope
Phase 2- Results
• UHB– 15 patients included
• City– 22 patients included
Tendon hammer (T)
Ophthalmoscope (O)
Stethoscope (S)
UHBYes 8 53.3% 6 40% 14 93.3%
No 7 46.7% 9 60% 1 6.7%
CityYes 17 77.2% 17 77.2% 22 100%
No 5 22.7% 5 22.7% 0 0%
Phase 2- Diagnoses at Trust A
Phase 2- Diagnoses at Trust B
Tendon hammer (T)
Ophthalmoscope (O)
Stethoscope (S)
March – M
ay 2011
UHBYes 15 50% 6 20% 29 96.7%
No 15 50% 24 80% 1 3.3%
CityYes 22 84.6% 19 73.1% 25 96.1%
No 4 15.4% 7 26.9% 1 3.9%
June – July 2011
UHB Yes 8 53.3% 6 40% 14 93.3%
No 7 46.7% 9 60% 1 6.7%
City Yes 17 77.2% 17 77.2% 22 100%
No 5 22.7% 5 22.7% 0 0%