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

symptoms who screen positive using a validated tool, in whom hypoglycaemia has
been excluded, and who have a possible diagnosis of stroke, should be transferred to a
specialist acute stroke unit as soon as possible and always within 1 hour.
B Patients with suspected stroke should be admitted directly to a specialist acute stroke
unit and assessed for thrombolysis, receiving it if clinically indicated.
C Patients with stroke should be assessed and managed by stroke nursing staff and at
least one member of the specialist rehabilitation team within 24 hours of admission
to hospital, and by all relevant members of the specialist rehabilitation team within 72
hours, with documented multidisciplinary goals agreed within 5 days.
D Patients with acute stroke should receive brain imaging within 1 hour of arrival at the
hospital if they meet any of the indications for immediate imaging.
E Patients with acute stroke should have their swallowing screened, using a validated
screening tool, by a specially trained healthcare professional within 4 hours of
admission to hospital, before being given any oral food, fluid or medication, and they
should have an ongoing management plan for the provision of adequate nutrition.
F Patients who need ongoing inpatient rehabilitation after completion of their acute
diagnosis and treatment should be treated in a specialist stroke rehabilitation unit,
which should fulfil the following criteria:
● it should be a geographically identified unit
● it should have a coordinated multidisciplinary team that meets at least once a week
for the interchange of information about individual patients
● the staff should have specialist expertise in stroke and rehabilitation
● educational programmes and information are provided for staff, patients and
carers
● it has agreed management protocols for common problems, based on available
evidence.
G Patients with stroke who have continued loss of bladder control 2 weeks after
diagnosis should be reassessed to identify the cause of incontinence, and have an
ongoing treatment plan involving both patients and carers.
H All patients after stroke should be screened within 6 weeks of diagnosis, using a
validated tool, to identify mood disturbance and cognitive impairment.
I All patients whose acute symptoms remit within 24 hours (ie TIA) should be seen by
a specialist physician (eg in a specialist neurovascular clinic or an acute stroke unit)
within the time determined by their clinical features (see section 4.2).
3.2.2 Sources
3 Organisation of stroke services
A–E Consensus; National Institute for Health and Clinical Excellence 2010d
F Consensus; National Institute for Health and Clinical Excellence 2010d; Stroke
Unit Trialists’ Collaboration 2007; Quality markers nine and ten of the National
Stroke Strategy (Department of Health 2007)
G–H Consensus; National Institute for Health and Clinical Excellence 2010d
I Follows on from evidence concerning management of transient ischaemic attacks
(4.2.1 C, D, E)
© Royal College of Physicians 2012 21