national-clinical-guidelines-for-stroke-fourth-edition

3 Organisation of stroke services
3.0 Introduction
This chapter considers stroke management from a population perspective, defining how
the whole stroke population should receive the highest quality stroke care possible. This
depends primarily upon the structures and processes that exist locally: how stroke
services are organised, what resources are available, and how the clinical teams undertake
their work.
If the organisation of stroke care is poor or if there are inadequate resources, then the
recommendations given in the other chapters of this guideline cannot be delivered.
Furthermore, if the clinical teams do not have sufficient knowledge and skills, and are not
consistent in their clinical practice, many patients will receive suboptimal care.
Thus, this chapter should be of great concern to all parties – patients and their families,
individual clinical staff, hospital and community managers, and service commissioners.
The recommendations made here are among the most important ones made in this
guideline and many of them have a strong evidence base to support them.
3.1 Overall organisation of acute services
Effective stroke care will only occur if the organisational structure allows and facilitates
the delivery of the best treatments at the optimal time. This section makes
recommendations that are primarily derived through logic and not directly from
evidence; for example, thrombolytic treatment (a recommended treatment) can only be
given within 3 hours if patients arrive in the appropriate setting within that time. These
recommendations apply to all stroke care.
3.1.1 Recommendations
A All community medical services and ambulance services (including call handlers)
should be trained to treat patients with symptoms suggestive of an acute stroke as an
emergency requiring urgent transfer to a centre with specialised hyperacute stroke
services.
B All patients seen with an acute neurological syndrome suspected to be a stroke should
be transferred directly to a specialised hyperacute stroke unit that will assess for
thrombolysis and other urgent interventions and deliver them if clinically indicated.
C All hospitals receiving acute medical admissions that include patients with potential
stroke should have arrangements to admit them directly to a specialist acute stroke
unit (onsite or at a neighbouring hospital) to monitor and regulate basic physiological
functions such as blood glucose, oxygenation, and blood pressure.
D All hospitals admitting stroke patients should have a specialist stroke rehabilitation
ward, or should have immediate access to one.
E All ‘health economies’ (geographic areas or populations covered by an integrated
group of health commissioners and providers) should have a specialist neurovascular
© Royal College of Physicians 2012 19