"About four hours ago" is the single most damaging phrase in a stroke handover. It was true when the ambulance crew said it, it is wrong by the time the scan is reported, and nobody can reconstruct which it was.
Write the clock time the patient was last seen normal, with the source — the patient, a witness, a phone record, a CCTV timestamp — and write it in the first note, before imaging. Everything downstream depends on it: eligibility for thrombolysis, whether imaging-based selection is needed, and whether a later reviewer can tell if the window was genuinely missed or merely recorded badly.
For a wake-up stroke, the last known well time is when the patient went to sleep, not when they woke. Say so explicitly in the note, because the two get conflated, and the conflation always runs in the direction of excluding a patient who was eligible.
- Write last known well as a clock time with its source, in the first note.
- For wake-up stroke, record the time of going to sleep and label it as such.
- Check for a corroborating timestamp — a last sent message, a phone call, a television programme.
- Re-record the time if a better witness arrives, with a note of what changed and why.
- Never convert to an interval in the handover; intervals age and clock times do not.
Why it matters
Thrombolysis eligibility turns on a number that is routinely recorded in a form that decays while the patient waits.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free