Admission and discharge from the Stroke Unit (Guidelines)

• All patients with a new onset of Stroke/TIA should be notified to the Stroke Unit Team for review
• All patients presenting with clinically suspected new stroke within 4 and a half hours of onset should be considered for Thrombolysis (Refer to Thrombolysis Protocol)
• CT scanning to be performed on the day of admission/within 12 hrs
• Transfer to the Stroke Unit MUST occur within 24 hrs with the exceptions of those who have had thrombolysis who will remain in MHDU for the first 12 to 24 hrs.

• All patients who have a new clinical diagnosis of Stroke/TIA will be admitted to the Unit
• Discharge planning will commence on admission with Estimated Dates of Discharge being set as appropriate

All patients MUST be notified to the Stroke Unit Team

• Advice and support can be accessed via the Stroke Consultant, Dr Gethin Williams or via the Stroke Unit team on 01463 704451

• Referrals will be made to Hospital or Community based Services (including Social Services, Community Rehabilitation Team, Community Allied Health Professionals, CHSS Stroke Nurse, Day Hospital, Voluntary services) when appropriate and by mutual agreement
• Where the discharge from the hospital is complex an Individual Future Care Meeting will be called
• All transfers to Community Hospitals must be mutually agreed in advance with appropriate notes, discharge letter and medication accompanying the patient
• Advice support and information on the individual patient can be obtained from the Stroke Unit Team
• Shadowing opportunities and/or a practical management hand-over can be arranged by mutual agreement with the Stroke Unit if the patient has many complex needs
• Carers will be encouraged and supported to work with the stroke patient prior to discharge from the hospital

• Patients will be reviewed by the stroke service within 3 months of discharge
• Patients discharged to home will be followed up by the Stroke Coordinator
• Patients requiring ongoing support will be followed up by their relevant GP, Primary Care Team or Community Rehabilitation Team
• Patients discharged to Care Homes will have a 6 week review completed by a Social Worker. Further follow up will be provided by the Stroke Coordinator

The priorities for admission are:

• Diagnosis of Ischaemic or Haemorrhagic stroke
• Diagnosis of TIA

A Member of Stroke Unit Team will visit GA daily to assess and review patients for the Stroke Unit.

• Admission to the Unit must occur within 24 hours.
• In-patients who have a new onset of Stroke/ TIA should assessed by a member of the Stroke Team.

A clinical diagnosis of stroke must be made prior to referral for CT

• A CT scan MUST  be carried out on day of admission/ within 12 hours 
• Notify CT Scanning to arrange a scan on Ext: 4304
• CT slots are available every morning
• Stroke is a clinical diagnosis - Only 50-60% will have an appropriate lesion visible on CT

• Assessment and rehabilitation plans will be set with the patient and / or their family
• Dates of discharge will be discussed at the Multi-Disciplinary Team Meeting and will be when:
  • Agreed goals have been met
  • When active rehab ceases to be of benefit
  • When input is refused / lack of compliance

   And / or

1. Patient is transferred to Neurorehabilitation ward / Community Hospital  
2. Where needs are ongoing and transfer to a Care Home is required

Complex Discharges

• Individual Future Planning Meetings should be held if there are many needs and issues to be met

• Appointments can be made to discuss your family member's progress (with their permission) in the Stroke Unit. Please speak to the nursing staff to arrange. 
• Verbal & written information is available from the Stroke Coordinator or any member of the Stroke Team.
• A copy of the discharge letter will be given to all patients discharged from the Unit
• The Stroke Coordinator will advise and support patients and families after discharge from hospital
• The CHSS Advice Line operates Mon-Fri, 9.30-4.00, on 0808 8010899
• Patients and carers will be encouraged to take self manage their stroke condition with the support of the stroke team follow-up services

Further information can be found at:

• Stroke4Carers: verbal and written information and on-line tools
• Self Help 4 Stroke: Self management website for people who have had a stroke
• My Stroke Guide available from the Stroke association

Timely planning of discharge should be carried out in consultation with patients and carers. Appropriate information should be provided to patients and carers including relevant contact details, including information on the CHSS Stroke Nurse Service
Typically, discharge will be appropriate when:

• Patient is medically stable and has an appropriate place to be transferred to
• Allied Health Professionals have completed an assessment of function and activities
• Appropriate physical, psychological and social support is in place for the patient and their carers
• An agreed plan of transfer (including Equipment and Follow Up, Rehab / Support) is in place between the Hospital Team, and Patient and Carers, Primary Health Care Team, Social Services

• Information packs will be given to all patients discharged home from the Stroke Unit. The Stroke Nurse will be in touch by phone initially to arrange follow up 2-3 weeks post discharge home
• Information on statutory benefits should be given with referral to their local Citizens Advice Bureau, Welfare Rights Office or the Benefits Promotion Team
• Information and advice on returning to Driving will also be given where appropriate
• Information on local stroke clubs which offer social support, activities and companionship should be offered
• For patients transferred to Care Homes a review of care will be completed after 6 weeks by their social worker
• A stroke nurse follow up service will be available for all patients transferred to Care Homes