Stroke

Service Overview

Patients with a suspected acute stroke (symptoms not known to be >6hrs in duration) should be referred immediately via 999 SWASFT call.

Symptoms of Stroke - Know the FAST test (1,2)

Do not start anticoagulant or antiplatelet treatment until haemorrhagic stroke has been ruled out by brain imaging (4) .

All patients whose symptoms have NOT resolved, however mild, should be considered to be having Stroke rather than a TIA.

Patients with a suspected TIA where symptoms or signs have resolved - refer to the BNSSG TIA pathway

Acute Stroke Services at UHBW - closed

There is no Acute Stroke service on either UHBW site (UHB or Weston)

All patients with suspected acute stroke in BNSSG should now be referred to the NBT stroke service described below.

(NB. Patients outside of BNSSG where Weston was previously their nearest stroke service, should now be referred to Musgrove Park Hospital Taunton).

Acute Stroke Services at NBT

Acute Stroke -This service is for all patients in BNSSG.

Send patients with suspected Stroke of any severity with onset within the past 6 hours or unknown onset but potentially within last 6 hours to Southmead Hospital ED by calling 999*

Suspected Stroke with significant debilitating features (I.e. new loss of independent mobility, speech, or vision) with onset between 6 and 24 hours ago - call 999*

These Patients will be seen directly by the stroke team on arrival.

Do not start anticoagulant or antiplatelet treatment in the community at presentation as haemorrhagic stroke has to ruled out by brain imaging (4) .

Patients with more minor, acute onset neurological symptoms with onset between 6 and 24 hours ago - call the Weekday IUC Professional Line who will arrange assessment by the Acute stroke team in Southmead Hospital if appropriate.

If symptoms have been present for more than 24 hours - call the Weekday IUC Professional Line (WDPL)

The WDPL will advise where patient will be seen i.e. SMH Stroke SDEC /Direct Admission to Stroke Unit/local AMU/Other following discussion with the stroke team where required. 

*For information:

1. Thrombolysis for ischaemic stroke can be delivered up to 4.5 hours after onset
2. Acute blood pressure lowering (within 1 hour) is recommended in haemorrhagic stroke up to 6 hours from onset and may be considered beyond that
3. Thrombectomy can be considered for patients up to 24 hours from onset but only in patients with moderate to severe symptoms (NIHSS 6 or more)

Patients whose symptoms have resolved at time of assessment should be referred to TIA clinic at UHBW, which now covers the whole of BNSSG.

Non- acute Stroke Referrals

Patients whose symptoms occurred more than 1 week ago will not be seen via Stroke SDEC at NBT.

The options for these patients include:

1. Refer to TIA clinic
2. Refer to Neurovascular clinic via eRS
3. Advice and Guidance from stroke team
   1. Discuss with Stroke consultant on 0117 4145619 (0800-1600 Mon-Fri)
   2. eRS electronic A&G – response expected within 24hrs weekdays

Neurovascular Neurology / Stroke clinic at Southmead Hospital is accessible through e-Referral. The remit of this clinic covers stroke and other vascular brain disorders including long term complications, secondary prevention and investigation of aetiology.

Patients who have been seen and treated out of area and need local stroke follow up can also be seen in this clinic.

Community Stroke Services

Stroke Sub-Acute Rehabilitation Unit (SSARU) at South Bristol Community Hospital

The SSARU, run by Sirona care & health, provides rehabilitation assessment and focused therapy support for those that are fit for discharge but still have ongoing care needs. The service does not offer step up support, but forms part of the discharge pathway following an acute stay. Once individuals return home, their stroke care is handed over to the Integrated Community Stroke Service (ICSS) at Home team.

Integrated Community Stroke Service (ICSS) at Home

The Integrated Community Stroke Service (ICSS) at Home, run by Sirona care & health, aims to support people in the community across BNSSG after stroke and non-traumatic subarachnoid haemorrhage.  

ICSS at Home provides high quality home-based rehabilitation, helping individuals achieve their personal goals. Care is provided by a multi-disciplinary team of occupational therapists, physiotherapists, speech and language therapists, registered nurses, assistant practitioners, rehabilitation support workers and administrators. The team support people from the day they are discharged from hospital or a rehabilitation unit, for a time period agreed with individuals.  

Support includes personal care and meal preparation, working side by side with voluntary sector ‘life after stroke’ keyworkers to support service users in the best way possible. This includes partnership work with Bristol After Stroke in Bristol and South Gloucestershire and The Stroke Association in North Somerset.

ICSS at Home acceptance criteria  

• Over the age of 16 
• Registered with a GP in Bristol, South Gloucestershire or North Somerset 
• Confirmed diagnosis of stroke or non-traumatic subarachnoid haemorrhage 
• Identified stroke-related rehab goals or advice and support needs 

ICSS at home exclusion criteria  

• Functional neurological disorder and other traumatic or acquired brain injury including traumatic subarachnoid haemorrhage or subdural haemorrhage*. 

To refer someone in the community with stroke specific rehab needs please send the referral form to sirona.communitystrokeservice@nhs.net or to discuss a referral phone 0300 1255951. 

To refer from an acute or bedded rehab please send a TOCDOC to the Community Transfer of Care Hub (CTOCH).  

*Patients with traumatic brain injury please see the Head Injury Therapy Unit page.

Resources

(1) Symptoms of stroke | Know the FAST test | Stroke Association

(2) Stroke - NHS (www.nhs.uk)

(3) Stroke Association | Home

(4) Clinical Knowledge Summaries has useful advice on the principles of management of Stroke and TIA.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.