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%