Stroke is the third most common cause of death and a leading cause of severe disability, but there is strong clinical evidence to suggest that the delivery and organisation of specialised stroke care following a stroke can reduce the chances of morbidity and mortality in the future for a patient.

Barnsley Hospital’s Stroke Services have been developed in order to provide the best possible evidence-based care around the needs of the Stroke / TIA (Transient Ischemic Attack – Mini Stroke) patient, their carers and family and there is a strong team commitment and enthusiasm in driving the service forward even more in the future.

Acute Stroke Unit (ASU) – Our ASU provides specialist services for people who have had a new suspected stroke or high risk TIA.

The ASU has a range of specialist medical, nursing and therapy staff. The facilities and equipment are used by all members of the multi-disciplinary stroke team.

Patients receive  an initial emergency department review, and if suitable they are then referred to the Stroke Response Nurse who will assess the patient, complete relevant screening and arrange appropriate investigations ie CT head scan, before they are transferred to the ASU. The acute stroke team aim to stabilise the patient to prevent further strokes and maximise recovery potential.

Activities of the acute stroke unit

 Early assessment and CT head scanning to detect or exclude haemorrhage and any other pathology.

• Direct admission from ED for all potential stroke/TIA patients. Some of these patients may eventually be identified as a stroke mimic and removed from the stroke pathway.
• Assessment for Thrombolysis treatment (clot busting) –.
• Monitoring clinical observations which include : – Blood pressure, pulse, temperature and respirations, neurological observations and oxygen levels as required
• Initiation of treatment and investigation according to type of stroke
• Referral to appropriate members of the Therapy team, physiotherapy, occupational therapy, speech and language therapy, dietetics and any other members that may need to intervene with the patient.
• Safe management of nutrition and hydration (with options for nasogastric or PEG feeding where needed)
• Investigations ( both inpatient and outpatient) to find
• Secondary prevention and health education including reducing lifestyle risks

Outpatient stroke services

Barnsley Hospital offers an outpatient clinic appointment for patients discharged from the acute stroke unit or who are referred by GP’s. These clinics are either led by the  stroke consultant or stroke specialist nurse.

High Risk TIA clinic – The TIA clinics are led by the Stroke Specialist Nurse or one of the Stroke Response Nurses with support from the stroke consultant.

The low risk TIA clinic is run by South West Yorkshire Partnership Foundation Trust (SWYFT) and is led by the stroke consultant or Stroke Nurse Consultant.

Referral into the TIA clinics is either by the emergency department or by a GP practice. High Risk TIA referrals are faxed to the Barnsley Hospital appointment centre and an appointment will be made for the same or next day. Low Risk TIA referrals are faxed to SWYFT’s community clinic.

TIA is a medical emergency – anyone suffering a suspected TIA should see a doctor immediately

As part of your consultation a concise history will be taken, which will include date and time of onset of symptoms, what symptoms you have experienced and for how long these symptoms lasted.

Following your consultation if a diagnosis of TIA is suspected, you may require several investigations, which usually include:

• Blood pressure testing
• Blood tests
• ECG test
• Carotid Doppler studies
• You may need a CT scan or MRI scan
• You may need an echocardiogram and/or 7 day cardiac monitoring

The majority of these investigations will be carried out on the same day of your clinic appointment, so please be prepared for a lengthy day.

Once your tests have been carried out, you may be started on medication and the recommendations for on-going management will be forwarded to your GP via letter. Usual treatment is medication to control your blood pressure and cholesterol and medication to prevent blood clots forming.

You will also receive education and advice re lifestyle factors and reducing risks

A follow up appointment will be made to attend 3-4 weeks later for the results of investigations and on-going management.

Rehabilitation and Discharge – Some patients may require on-going rehabilitation once deemed medically stable. These patients will be transferred to the Stroke Rehabilitation Unit based at Kendray Hospital, however if inpatient rehabilitation is not required, they may receive on-going rehabilitation by the hospital at home team which offers patients early, supported discharge from the hospital by providing active nursing and therapy rehabilitation and support in their own home.

All stroke patients will receive a Specialist Nurse 6 week home visit following discharge, this will include, evaluation of treatment and review of lifestyle management and changes.

Mandy’s Story