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

National clinical guideline for stroke
(TIA) service able to assess and initiate management of patients within 24 hours of
transient cerebrovascular symptoms.
F There should be public and professional education programmes to increase awareness
of stroke and the need for urgent diagnosis and treatment (see section 3.17).
3.1.2 Sources
A–B Follows on from evidence concerning thrombolysis (4.6.1 A–D)
C Follows on from evidence and recommendations concerning physiological
management (4.12.1 A, B)
D Follows on from evidence concerning stroke units (3.2.1 B)
E Follows on from evidence concerning transient ischaemic attacks (4.2.1 C)
F Follows on from evidence concerning immediate treatments (eg 4.6.1 A–D) and
quality marker one of the English Stroke Strategy (Department of Health 2007)
3.1.3 Implications
These recommendations have major implications for the organisation of acute medical
services within any ‘health economy’ (locality). In principle, the cost consequences should
be positive because more effective stroke care will reduce long-term rehabilitation and
care costs. However, it will be important to maintain the effectiveness of other acute
services when improving stroke services.
3.2 Specialist stroke services
There is strong evidence in favour of specialised stroke unit care to deliver effective acute
treatments that reduce long-term brain damage and disability if given within a few hours.
In this context:
> a specialist is defined as a healthcare professional with the necessary knowledge and
skills in managing people with the problem concerned, usually by having a relevant
further qualification and keeping up to date through continuing professional
development. It will usually also require a good knowledge of stroke, especially in
acute care settings. It does not require the person exclusively to see people with stroke,
but does require them to have specific knowledge and experience of stroke.
> A specialist team or service is defined as a group of specialists who work together
regularly managing people with a particular group of problems (for this guideline,
stroke) and who between them have the knowledge and skills to assess and resolve the
majority of problems. At a minimum, any specialist unit (team, service) must be able
to fulfil all the relevant recommendations made in this guideline. As above, the team
does not have to manage stroke exclusively, but the team should have specific
experience of and knowledge about people with stroke.
3.2.1 Recommendations
A People seen by ambulance staff outside hospital, who have sudden onset of
neurological symptoms, should be screened using a validated tool to diagnose stroke
or transient ischaemic attack (TIA). Those people with persisting neurological
20 © Royal College of Physicians 2012