Commissioning stroke services

Key recommendations

1. People seen by ambulance staff outside hospital should be screened using a validated tool, to diagnose stroke or TIA, and transferred to a specialist acute stroke unit within 1 hour.
2. Patients with acute stroke who meet any of the indications for urgent brain imaging should receive this within 1 hour.
3. Patients with suspected stroke should be admitted directly to a specialist stroke unit and receive thrombolysis if clinically indicated.
4. Patients with acute stroke should have their swallowing screened within 4 hours of admission by a specially trained professional before being given oral food, fluid or medication, and have a plan for the provision of adequate nutrition.
5. Patients with acute 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, and by all relevant members of the team within 72 hours. Documented multidisciplinary goals should be agreed within 5 days.
6. Patients who need ongoing inpatient rehabilitation should be treated in a specialist stroke rehabilitation unit.
7. Patients should be offered a minimum of 45 minutes of each active therapy that is required, for a minimum of 5 days a week.
8. Patients who have continued loss of bladder control after 2 weeks should be reassessed to identify the cause and have a treatment plan involving both patient and carers.
9. All patients should be screened within 6 weeks, using a validated tool, to identify mood disturbance and cognitive impairment.
10. Patients discharged from hospital with residual stroke-related problems should be followed up within 72 hours by specialist stroke rehabilitation services.
11. Carers should be provided with a named point of contact for stroke information, written information about the patient’s diagnosis and management plan, and practical training to enable them to provide care.