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

● nursing staff specifically trained and competent in the management of acute stroke,
covering neurological, general medical and rehabilitation aspects
● imaging and laboratory services
● rehabilitation specialist staff.
B Each stroke rehabilitation unit and service should be organised as a single team of
staff with specialist knowledge and experience of stroke and neurological
rehabilitation including:
● consultant physician(s)
● nurses
● physiotherapists
● occupational therapists
● speech and language therapists
● dietitians
● psychologists
● social workers
● easy access to services providing: pharmacy; orthotics; orthoptists; specialist
seating; patient information, advice and support; and assistive devices.
C Each specialist stroke rehabilitation service should in addition:
3.3.2 Sources
● have an education programme for all staff providing the stroke service
● offer training for junior professionals in the specialty of stroke.
A Follows on from evidence and recommendations concerning acute stroke care (4.5
and 4.6)
B Follows on from evidence concerning stroke rehabilitation units (3.2.1 F) and
Langhorne et al 1998
C Follows on from stroke rehabilitation unit evidence and many recommendations
made in chapter 6
3.3.3 Implications
The recommendations will require a considerable increase in the provision of some
specialties in stroke services, especially clinical psychology and social workers. Patterns of
work also need to be reviewed to deliver sufficient direct therapy, perhaps removing some
administrative duties and ensuring that time is not spent by qualified therapists on tasks
that could be done by less qualified staff. Social work provision will require collaborative
funding with social services.
3.4 Telemedicine
3 Organisation of stroke services
Direct delivery of acute stroke care by specialists cannot always be achieved in every hospital
because of geographical issues or staffing shortages. Telemedicine, allowing a stroke
physician to talk to the patient and/or carer, watch a clinical examination and view the
imaging can be used safely for evaluation of the appropriateness of thrombolysis and other
acute treatments, as an alternative to face to face in a specialist stroke centre. Various forms
of telemedicine (using telephone consultation, video camera linkage with or without remote
access to radiology) have therefore been tested in a number of settings over recent years.
© Royal College of Physicians 2012 23