The clock in acute stroke runs from when the patient was last seen normal, not from when the deficit was discovered. The two diverge most in exactly the patients where the decision is hardest: someone who wakes with a deficit, someone found on the floor, someone who lives alone and is brought in hours later by a relative who last spoke to them the previous evening.
Get the time from the person who last saw them, by phone if necessary, before anyone writes a time in the notes — once a number is recorded it propagates through every subsequent handover unchallenged. Ask what the patient was doing, not what time it was; people reconstruct times from events far more reliably than from clocks. And record who gave you the time and how, because the next clinician deciding on imaging-based selection needs to know whether the window is a fact or an estimate.
- Record last known well, and separately record when symptoms were discovered
- Ring the last person who saw the patient rather than accepting a second-hand time
- Anchor the time to an event — a television programme, a meal, a phone call
- Write down the source of the time in the notes, not just the time
- An unwitnessed onset is not the same as an unknown onset — imaging can still select
Why it matters
A single wrongly recorded onset time follows the patient through every handover and silently decides what they are offered.
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