Stroke Referrals - Weekday Professional Line

 Stroke pathway- BNSSG Wide 

Please note: for stroke admissions distinction is made around the severity of the patient’s presenting symptoms and their baseline function/mobility before onset of symptoms

All acute strokes are now directed to NBT, rather than their respective local hospital ( change commencing on 17/5/23).

See below a visual summary of this, with further detail.

* please advise clinicians to use the dedicated stroke line 0117 414 5619 if contacting the stroke consultant, rather than asking for the stroke consultant via switch ( the latter can mean the clinician is put through to the front- door thrombolysis consultant instead, who may not have time to take their call).

Patients with disabling deficits (can’t walk unaided or significant communication or visual deficit)

• Call 999 for  NBT ED admission – if onset <6 hours (this includes patients with mild and severe symptoms)
• Call 999 for  NBT ED admission – patient presenting as stroke (with disabling deficits) and onset 6-24h/or onset unknown (if unable to mobilise pre-stroke discuss with stroke team first)
• Discuss with stroke team – those with disabling deficits and >24h since onset (and those with onset 6-24h and unable to mobilise pre-stroke)
• Please note: if patient self-conveying to NBT ED it is imperative to advise the Stroke ANP on 0117 4149092

Patients with ongoing mild deficits (purely sensory symptoms, facial weakness, mild communication deficits, mild motor deficit or ataxia – still independently ambulant)

• If onset <1 week – send to NBT Stroke SDEC (check SDEC criteria below), if outside SDEC hours discuss with stroke team
• If onset >1 week ago (or uncertain about best pathway) – call stroke consultant 08:00-16:00 0117 414 5619, or stroke SpR at other times (bleep 1490)
• Please see the above file with NBT stroke admission pathways

Stroke SDEC eligible patients

Patients eligible for the stroke SDEC pathway will be reviewed by the Stroke Team at Gate 36 ( SDEC).

Stroke SDEC patients must arrive before 6pm - if this is not possible, please discuss with the stroke team on alternative arrangements.

Please indicate such patients in your 2 line clinical summary by writing FOR NBT STROKE SDEC at the start of your 2 line summary.

NBT Stroke Team contact details

TIAs

Further information on TIA clinic referrals and process can be found here:

If symptoms or signs persist at time of presentation then treat as suspected stroke (see Stroke Remedy page)

If wished, TIA cases can be discussed with the Stroke Consultant of the day on 0117 414 5619.

Posterior circulation stroke ‘Is it Vertigo or CVA?’

Both acute medics and stroke consultant agree very difficult to distinguish in the community. Is it true acute onset vestibular syndrome: look at risk factors; ear symptoms pointing to peripheral cause; any neuro findings on examination. NB/ HINTS isn’t very reliable and hasn’t been validated when delivered by ‘non-experts’.

If just Vertigo with no neuro signs then TIA referral should be fine, if GP really feels it is a stroke not BPPV then ED (NB/ they may be discharged home and seen in TIA clinic if appropriate). If additional neurology then definitely for ED.

Beware the patient with vertigo and new onset neck pain (dissection that could progress), Stroke team advise to discuss with them. To note, if query vertebral  dissection but stable and outside  thrombosis time then can be managed in TIA clinic. (although if significantly raised BP maybe worth discussing with stroke team in the first instance.)

Mechanical thrombectomy, can be done up to 24hrs from onset of symptoms, Dr Grimshaw advises anyone FAST +ve <24hrs of suspected stroke symptoms to be referred to ED.
**July 2021** There may be changes happening in July re Thrombectomy and BNSSG STP in stroke. Service would be in hours 08:00-18:00 only.