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Following your assessment and initial treatment in the hospital emergency department, it may be necessary for you to be admitted directly to the hospital stroke unit.

Nearly all patients who are suspected of having a stroke or are diagnosed as having a stroke should be admitted directly to the specialist stroke unit.

 

What you can expect

These are the standards that you should expect:

 

National Institute for Health and Clinical Excellence (NICE) Quality Standard for Stroke

 

Patients with acute stroke receive brain imaging within 1 hour on arrival at the hospital if they meet any of the indications for immediate imaging.

What this means for you:

  • A brain scan (CT scan) is essential to help the stroke specialists diagnose a stroke so patients with a suspected stroke that meet the guidelines for immediate imaging should be scanned within 1 hour of arrival at the hospital.
  • The National Institute for Health and Clinical Excellence (NICE) estimate that about 50% of all stroke patients are likely to meet these criteria for immediate imaging.
  • Thus the national Accelerating Stroke Improvement programme has an aspiration that across the NHS, 50% of patients are scanned within 1 hour and 100% are scanned within 24 hours.

 

Patients with suspected stroke are admitted directly to a specialist acute stroke unit and assessed for thrombolysis, receiving it if clinically indicated.

What this means for you:

  • All hospitals that care for people who have had a suspected stroke, must have a specialist stroke unit or ward where the medical, nursing and therapy staff are specially trained in working with people who have had strokes.
  • The expectation should be that all patients with a suspected or diagnosed stroke are admitted to the specialist stroke unit, though the national Accelerating Stroke Improvement programme have an aspiration that at least 90% of patients are directly admitted to a stroke unit.
  • The specialist stroke team must assess all patients to see if they would benefit from thrombolysis (the "clot busting" drug if the cause of your stroke is a blood clot) and be able to administer the medicine at any time of day or night. Only a small proportion of patients will be clinically indicated to receive thrombolysis and these should be set out in locally agreed clinical guidelines.

There is comparative data on the hospital's performance on the local proportion of patients who are directly admitted to a stroke unit.

 

Patients with acute stroke have their swallowing screened by a specially trained healthcare professional within 4 hours of admission to hospital, before being given oral food, fluid or medication, and they have an ongoing management plan for the provision of adequate nutrition.

What this means for you:

  • At all times of day and night, there needs to be a specially trained member of staff on duty who can assess whether you can swallow properly.
  • If you have a problem with swallowing then the team will help you immediately and you will have intensive support from a professional specially training in dysphagia (swallowing difficulties) within 24 hours.

There is currently no data on whether hospitals providing swallowing screening within 4 hours of admission but the annual Sentinel Audit collects comparative data on the percentage of patients who are screened for swallowing problems within 24 hours of admission.