Ischemic Stroke

- Implementation considerations

In this section key recommendations are provided to guide the funding, planning and delivery of services along the entire pathway of stroke care. These recommendations will not provide the anticipated benefits for people with stroke unless organisations that plan and deliver health and social care fully support their implementation.

Recommendations:

1. Comprehensive stroke services should include the whole stroke pathway from prevention (including neurovascular services) through pre-hospital and acute care, early rehabilitation, secondary prevention, early supported discharge, community rehabilitation, systematic follow-up, palliative care and long-term support.

2. A public education and professional training strategy should be developed and implemented to ensure that the public and emergency personnel (e.g. staff in emergency call centres) can recognise when a person has a suspected stroke or TIA and respond appropriately. This should be implemented in such a way that it can be formally evaluated.

3. Along the pathway of stroke care, there should be protocols between healthcare providers and social services that enable seamless and safe transfers of care without delay.

4. The provision of comprehensive acute stroke services may require the development of hub-and-spoke models of care (where a few hospitals in a region are designated to provide the hyperacute care for all patients), or telemedicine networks and other forms of cross-site working.

5.The optimal disposition of acute stroke services will depend on the geography of the area served, with the objective of delivering the maximum number of time-critical treatments to the greatest number of people with stroke.

6. A public education and professional training strategy should be developed and implemented to ensure that the public and emergency personnel (e.g. staff in emergency call centres) can recognise when a person has a suspected stroke or TIA and respond appropriately. This should be implemented in such a way that it can be formally evaluated.

7.  Healthcare providers should enact all the secondary stroke prevention measures recommended in this guideline. Effective secondary prevention should be assured through a process of regular audit and monitoring.

8. Healthcare authorities should play an active role in promoting secondary vascular prevention, which is a public health issue as well as being relevant to the individual person with stroke.

9. Stroke rehabilitation services should be provided to reduce limitation in activities, increase participation and improve the quality of life of people with stroke using therapeutic and adaptive strategies.