Stroke/TIA services at Luton & Dunstable Hospital

Services

The Luton and Dunstable specialist stroke service commenced weekend TIA clinics from the 3rd September 2011 and was the first Trust in Beds and Herts to provide a 7-day TIA outpatient service.

Rapid Access clinics are provided on a Saturday and Sunday morning from 09:30 and are specifically aimed at high risk patients demonstrating symptoms with an ABCD score > 4.  The service provides individual consultation with a specialist stroke physician, diagnostics and treatment on a 'one-stop' basis.

The Luton and Dunstable Stroke Team provide specialist medical and rehabilitation services and is headed up by two specialist consultants.

Facilities

Providing services to patients across Luton, Bedfordshire and Hertfordshire, the Trust has a 28-bed unit with 8 hyperacute, monitored beds for hyperacute stroke patients.

The unit managed patients admitted in emergencies through the Emergency Department and accepts transfers from other hospitals.

Thrombolysis

This is a new specialist service, where a drug is used to dissolve blood clots in the brain, reducing the damage to the surrounding brain.  This is emergency treatment which has to be given within three hours of the stroke occurring and it may not be appropriate in every case.

Neurosurgery

There is close integration with the neurosurgical team at The Royal Free Hospital/ Queens Square for those patients who require neurosurgical intervention.

Vascular Surgery

The Trust works closely with the Bedfordshire Vascular Unit at Bedford Hospital and patients who are found to require surgery to their neck arteries are referred immediately to the vascular surgeons.

Clinics

The TIA (mini-stroke) clinic runs 7 days a week in the outpatient department at St Mary's Wing.  Urgent patients can be seen within 24 hours of referral and can have most of their investigations done on the same day.  This ensures the Trust offers patients a prompt diagnosis and treatment.

Follow up Stroke Clinic

All patients discharged from the stoke ward are offered a follow up appointment with the stroke medical team.

Who to Refer

Please ensure the patient has TIA/mini stroke with no/minimal impairment.

Rapid recognition of symptoms and diagnosis

  • In people with sudden onset of neurological symptoms a validated tool, such as FAST (Face Arm Speech Test) should be used outside hospital to screen for a diagnosis of stroke or TIA
  • People who have had a suspected TIA who are at high risk of stroke (that is, with and ABCD (prognostic score to identify people at high risk of stroke after a TIA) score of 4 or above) should have:
    • Aspirin (300 mg daily) started immediately
    • Specialist assessment and investigation within 24 hours of onset of symptoms
    • Measures for secondary prevention introduced as soon as the diagnosis is confirmed, including discussion of individual risk factors
  • People with crescendo TIA (two or more TIAs in a week) should be treated as being at high risk of stroke, even though they may have an ABCD score of 3 or below

Specialist care for people with acute stroke

  • All people with suspected stroke should be admitted directly to a specialist acute stroke unit following initial assessment, either from the community or from the A&E department

Who not to Refer

Patients with the following should not be referred:

  • Black outs
  • Collapse
  • Isolated vertigo
  • Memory impairment
  • Patients who cannot get to hospital

Resources

Map of Medicine Patient Pathway

Stroke TIA Map of Medicine Patient Pathway

NICE Guidelines

NICE Guidance - Treatment for TIA:
http://www.nice.org.uk/nicemedia/pdf/CG68PublicInfo.pdf

NICE Guidance - CG68 Stroke Quick Reference Guide:
http://guidance.nice.org.uk/CG68/QuickRefGuide/pdf/English

NICE Guidance - CG68 Stroke NICE guideline:
http://guidance.nice.org.uk/CG68/NICEGuidance/pdf/English

NICE Guidance - Full Guideline:
http://guidance.nice.org.uk/CG68/Guidance

NICE Guidance - CG68 Stroke: Understanding NICE Guidance Patient/Carer Version:
http://guidance.nice.org.uk/CG68/PublicInfo/pdf/English

Website Resources

NHS Choices - Stroke:
http://www.nhs.uk/conditions/Stroke/Pages/Introduction.aspx

Stroke - Act F.A.S.T:
http://www.nhs.uk/actfast/Pages/stroke.aspx

NHS Brain Stroke:
http://www.brainstroke.org.uk/

The Stroke Association:
http://www.stroke.org.uk/

The Brain and Spine Foundation - Stroke:
http://www.brainandspine.org.uk/information/publications/brain_and_spine_booklets/stroke/index.html

Brain Injury Rehabilitation Trust (BIRT):
http://www.thedtgroup.org/brain-injury/

Connect - The Communication Disability Network:
http://www.ukconnect.org/

NHS National Institute for Health Research - Stroke Research Network:
http://www.crncc.nihr.ac.uk/about_us/stroke_research_network/

Different Stokes - Support for Younger Stoke Survivors:
http://www.differentstrokes.co.uk/

Health Talk Online:
http://www.healthtalkonline.org/Nerves_and_brain/Stroke

NHS Choices - Transient Ischaemic Attack:
http://www.nhs.uk/conditions/Transient-ischaemic-attack/Pages/Introduction.aspx

Department of Health National Stroke Strategy:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyandguidance/dh_081062

The Brain and Spine Foundation - TIA:
http://www.brainandspine.org.uk/information/publications/brain_and_spine_booklets/tia_transient_ischaemic_attack/index.html

Patient Information Leaflets

Luton & Dunstable stroke patient info

Luton & Dunstable TIA patient info

Other Information

The clinic is situated in the Outpatient Department, ground floor, New St Mary's wing, Luton and Dunstable Hospital

Getting to the Luton and Dunstable Hospital



Last updated: 03/04/2013

Update due: 03/04/2014