Abstract Number: Esoc2026a505 Impact of Medical Shift Patterns and Registrar Job Rotations on Acute Stroke Management Within a Uk General Hospital

Abstract Background and aims UK national stroke guidelines recommend brain imaging and administration of thrombolysis within one hour of suspected stroke, as delays to these time-critical interventions are associated with worse outcomes. This study examined whether medical shift patterns and rotating registrar staffing influenced the timeliness of CT imaging and thrombolysis. Methods A retrospective review was conducted at Royal Bournemouth Hospital including patients diagnosed with stroke between 1 October 2024 and 30 September 2025. Data were obtained from the Sentinel Stroke National Audit Programme. Outcomes included time to brain imaging (20 minutes, 1 hour) and the rate and timing of thrombolysis. Performance was compared by medical shift pattern and by dates of registrar job rotations (beginning versus end of job rotations). Results Compliance with imaging standards was consistently worse out of hours; a higher proportion of patients presenting in-hours received brain imaging within 20 minutes (27.6%) and within one hour (54.5%) compared with overnight presentations (12.5% and 47.5%, respectively). In-hours imaging performance improved from the beginning of register job rotations to the end (39% within 20 minutes; 61% within one hour), while no improvement was observed overnight. Rates of thrombolysis were similar across shift patterns and rotation stages; however, time to thrombolysis was on average 19 minutes shorter by the end of rotations (p = 0.009). Conclusions Adherence to national imaging targets was worse out of hours; this disparity was seen regardless of registrar job rotations, suggesting system-level factors drive overnight delays. However, registrar experience was associated with improved in-hours imaging performance and faster administration of thrombolysis. Conflict of interest All authors - nothing to disclose