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Transient Ischaemic Attack (TIA) and Stroke (age over 16)

  

NICE advise assessment by specialist within 24 hours


IMPORTANT UPDATE JUNE 2022 Centralisation of stroke services across Coventry and Warwickshire.

13th June 2022, UHCW will hold TIA (Transient Ischaemic Attack) clinics for all Coventry, Rugby and South Warwickshire patients that have been referred with suspected TIAs.

South Warwickshire Foundation Trust will no longer see any TIA patients who have been referred to a TIA clinic.

This is the first step in phase two of the centralisation of stroke services across Coventry and Warwickshire.

1st August 2022,  all patients from North Warwickshire with suspected TIAs will be seen in a TIA clinic at UHCW.

This means that from this date, all patients from Coventry and Warwickshire who are referred to a TIA clinic will now be seen at UHCW.

1st September 2022, any patient with stroke symptoms picked up by the ambulance service will be taken to UHCW.

If the symptoms then resolve, for example in the emergency department, the patient will be sent home and referred to the TIA clinic at UHCW.

If the symptoms have resolved by the time the ambulance service sees them, then they will not be taken to hospital unless clinically indicated.

There will of course be patients who self-present at their local Emergency Department after having a TIA whose symptoms have resolved, these patients will have their TIA referral made by the local hospital.

New referral forms will be published shortly

NICE Guidance 2019

1.1 Rapid recognition of symptoms and diagnosis

Prompt recognition of symptoms of stroke and transient ischaemic attack

1.1.1 Use a validated tool, such as FAST (Face Arm Speech Test), outside hospital to screen people with sudden onset of neurological symptoms for a diagnosis of stroke or transient ischaemic attack (TIA).

1.1.2 Exclude hypoglycaemia in people with sudden onset of neurological symptoms as the cause of these symptoms.

1.1.3 For people who are admitted to the emergency department with a suspected stroke or TIA, establish the diagnosis rapidly using a validated tool, such as ROSIER (Recognition of Stroke in the Emergency Room).

Initial management of suspected and confirmed TIA

1.1.4 Offer aspirin (300 mg daily), unless contraindicated, to people who have had a suspected TIA, to be started immediately.

1.1.5 Refer immediately people who have had a suspected TIA for specialist assessment and investigation, to be seen within 24 hours of onset of symptoms.

1.1.6 Do not use scoring systems, such as ABCD2, to assess risk of subsequent stroke or to inform urgency of referral for people who have had a suspected or confirmed TIA.

1.1. Offer secondary prevention, in addition to aspirin, as soon as possible after the diagnosis of TIA is confirmed.

Referrals

Referrals should be made using the following form ( EMIS versions awaited- see right – updated versions awaited)

 

 

Referrals for TIA should be made by email (in and out of hours) – appointments are available within 24 hours

Coventry & Warwickshire and North Warwickshire (all areas) GP:

email uhcw.tia@nhs.net

IF THE PATIENT HAS HAD MORE THAN ONE TIA EPISODE IN THE LAST WEEK – REFER TO ED OR DISCUSS WITH THE STROKE / MEDICAL TEAM URGENTLY

Assessment of Stroke

Stroke

If suspected arrange 999 hospital admission.

The para-medics will alert the Emergency Department at UHCW, then the stroke team will be available to treat the patient on arrival.

F is for Facial weakness (can the person smile? has their mouth or eye drooped?)

A is for Arm weakness (can the person raise both arms?)

S is for Speech problems (can the person speak clearly and understand what you say?)

T is for Time to call 999 (stroke is a medical emergency)

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