TOS Tendon Hammer Ophthalmoscope Stethoscope Methods Prospective data

TOS • 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

Results- Phase 1 (March-May 2011) • Trust A • Trust B – 30 patients included – 26 patients included Tendon hammer Ophthalmoscope Stethoscope (S) (T) (O) UHB City Yes 15 50% 6 20% 29 96. 7% No 15 50% 24 80% 1 3. 3% Yes 22 84. 6% 19 73. 1% 25 96. 2% No 4 15. 4% 7 26. 9% 1 3. 9%

Diagnoses at Trust A Migraine Seizure MS Encephalopathy Weakness SAH Other

Diagnoses at Trust B Stroke TIA Migraine Seizure Functional Bell's palsy Other

Source of Referrals at Trust A 10% 23% 7% A&E 37% CDU Medical wards Surgical wards ITU 23%

Ward (Trust A) Tendon Hammer Ophthalmoscope Stethoscope Yes (%) No (%) A&E 1 (50) 0 (0) 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) 7 (100) 0 (0) ITU 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 • City – 15 patients included – 22 patients included Tendon hammer Ophthalmoscope Stethoscope (S) (T) (O) UHB City Yes 8 53. 3% 6 40% 14 93. 3% No 7 46. 7% 9 60% 1 6. 7% Yes 17 77. 2% 22 100% No 5 22. 7% 0 0%

Phase 2 - Diagnoses at Trust A Migraine PD Weakness Functional MS Meningitis MSA Other

Phase 2 - Diagnoses at Trust B Stroke Seizure Functional MS Visual loss Papilloedema Encephalopathy Cerebral tumour Other

Marc h– May 2011 UHB City UHB June – July 2011 City Tendon hammer (T) Ophthalmoscope (O) Stethoscope (S) Yes 15 50% 6 20% 29 96. 7% No 15 50% 24 80% 1 3. 3% Yes 22 84. 6% 19 73. 1% 25 96. 1% No 4 15. 4% 7 26. 9% 1 3. 9% Yes 8 53. 3% 6 40% 14 93. 3% No 7 46. 7% 9 60% 1 6. 7% Yes 17 77. 2% 22 100% No 5 22. 7% 0 0%