Improving Stroke Induction Information for Resident Doctors in a District General Hospital: A Quality Improvement Project

Background

General Medical Council (GMC) recommends effective departmental inductions to support doctors to transition and work in complex, unfamiliar situations with sick patients. Acute stroke care is time critical, multidisciplinary, multi-specialty clinical work and requires doctors to fully comprehend and be able to perform assessments and interventions correctly and timely. This requires effective and tailored clinical induction.

Introduction

In our hospital, stroke medicine induction is delivered in large group teaching as part of geriatric medicine and general medicine induction sessions. While resources are available on trust intranet, it lacks rapidly accessible guidance for resident doctors to reference during acute stroke calls or managing unwell stroke patients.

Feedback from resident doctors revealed that existing stroke induction requires optimising to tailor information essential for resident doctors (such as stepwise guide to stroke call) and to improve accessibility.

We aimed to create a concise, practical, and accessible induction package tailored to stroke emergencies.

Methods

As initial data, we obtained feedback from resident doctors regarding quality of traditional stroke induction.

Based on the feedback, we designed a two-part resource:

• Poster: Colour-printed to draw attention in emergency areas, with key stroke call actions highlighted for quick reference. It included a QR code, enabling residents to instantly access and download the full induction booklet on their phones.
• Booklet: A concise, trust-based PDF covering team structure, HASU timetable, pathway, stroke bleep responsibilities, imaging, thrombolysis criteria, and red flags.

We repeated survey questionnaires in the second cohort of resident doctors who underwent departmental induction with stroke induction poster and resident doctors’ handbook information to assess change.

Results

Initial survey (n=15) revealed limited preparation: 4% structured induction, 4% NIHSS training. Confidence to perform urgent tasks such as stroke thrombolysis preparation, imaging transfer, and pathway navigation was low among resident doctors.

After introducing the booklet and poster with QR access, 100% of residents found the resources useful. Reported improvements included confidence with the bleep, clarity of stroke pathways, and smoother thrombolysis preparation. Feedback particularly valued the easy visibility of the poster, rapid access to the booklet via QR code, and the concise format. Suggestions included adding simulation training and refining the stroke pathway flowchart.

Conclusions

Stroke induction colour poster and concise booklet as part of stroke induction package significantly improve resident doctors’ preparedness for acute stroke care. This intervention is low-cost, sustainable, and scalable across other emergency specialties. We aim to further evaluate and incorporate clinical skills sessions such as simulation training in upcoming circuits.