1. T O S Tendon Hammer Ophthalmoscope Stethoscope

2. 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

3. Results- Phase 1 (March-May 2011) Trust A – 30 patients included Trust B – 26 patients included Tendon hammer (T) Ophthalmoscope (O) Stethoscope (S) UHB Yes1550%620%2996.7% No1550%2480%13.3% City Yes2284.6%1973.1%2596.2% No415.4%726.9%13.9%

4. Diagnoses at Trust A

5. Diagnoses at Trust B

6. Source of Referrals at Trust A

7. Ward (Trust A) Tendon HammerOphthalmoscopeStethoscope Yes (%)No (%)Yes (%)No (%)Yes (%)No (%) A&E1 (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) Medical4 (57.1)3 (42.9)2 (28.6)5 (71.4)7 (100)0 (0) Surgical2 (28.6)5 (71.4)2 (28.6)5 (71.4)7 (100)0 (0) ITU0 (0)3 (100)0 (0)3 (100)2 (66.7)1 (33.3)

8. Ophthalmoscopes at Trust A 36 in total – 20 (55.6%) working – 15 (41.7%) not working – 1 (2.8%)missing

9. 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

10. Phase 2- Results UHB – 15 patients included City – 22 patients included Tendon hammer (T) Ophthalmoscope (O) Stethoscope (S) UHB Yes853.3%640%1493.3% No746.7%960%16.7% City Yes1777.2%1777.2%22100% No522.7%5 00%

11. Phase 2- Diagnoses at Trust A

12. Phase 2- Diagnoses at Trust B

13. Tendon hammer (T) Ophthalmoscope (O) Stethoscope (S) Marc h – May 2011 UHB Yes1550%620%2996.7% No1550%2480%13.3% City Yes2284.6%1973.1%2596.1% No415.4%726.9%13.9% June – July 2011 UHB Yes853.3%640%1493.3% No746.7%960%16.7% City Yes1777.2%1777.2%22100% No522.7%5 00%