SWL TIA Clinic Details as at April 2011
Hospital / Weekdays / Weeknights/Weekends
Bank Holidays / Service details
Croydon
Fax TIA Referral to:
0208 401 3741
(ward fax)
Name and Number of key contacts:
TIA administrator
Denise Fido
020 8401 3351 (3701) / High Risk:
Tell patient to attend Open Access clinic within next 24 hours (or A&E) / High Risk:
Admit to Hospital via A and E. / Open Acess clinic 9.00 – 3.30pm Monday to Friday (excl BankHolidays)
Heathfield 1 Ward
Ground Floor London Wing
CroydonUniversityHospital
London Road Croydon.
020 8401 3351 (3701)
Report to Reception Desk
Low Risk:
Tell patient to attend Open Access clinic same or next day / Low Risk:
Send to next open access TIA clinic
Kingston
TIA Fax Referral to:
020 8934 3884
Name and
Number of key contacts:
MGPU
020 8934 3883
(Catie Patterson) / High Risk:
Telephone MGPU and Fax referral Mark as urgent. Let patient know they will be seen within 24 hours / High Risk:
Refer to medical SpR on call for admission to MAC for investigations / Monday to Friday (excl Bank Holidays) daily clinics held at 2pm on the MGPU.
The stroke/TIA clinic can also be accessed via Drs McNabb / Choy secretary (ext 2276), fax 020 8934 3287
MARK THE REFERRAL AS URGENT
Low Risk:
Fax referral Mark as urgent / Low Risk:
Fax referral Mark as urgent
St George’s
For any patient with a TIA in the last 7 days:
Call 07826 934 376
Mon-Fri 9am-6pm
If afterhours bleep Stroke Registrar via 0208 672 1255
NB: High Risk patients can also be referred to the ED / High Risk or TIA in last 7 days:
Between9am-6pm Mon-Fri
Call the Stroke Consultant on
0782 693 4376 / High Risk or TIA in last 7 days:
Onweekday evenings and at weekends: bleep Stroke Registrar via St George’s switchboard - 0208 672 1255 / High Risk patients or TIA in last 7 days seen on Hyperacute Stroke Unit HASU or Neurosciences day unit within 24 hoursnds)
Late presenting patients with TIA seen on Neurosciences Day Unit Mon-Fri.
If last TIA >7 days ago:
fax referral form to
020 8725 4591 / If last TIA >7 days ago:
fax referral form to
020 8725 4591
St Helier
TIA Fax Referral to:
020 8296 2421
Name and Number of key contacts:
See individual pathways for High risk and Low risk for further details / High Risk:
Mon-Thur 8.00-16.00
Fri 8.00-12.00.
Phone 07791 123499 and fax referral to 0208 2962421 / High Risk:
Sun –Thurs 16.00-08.00
Ask patient to phone stroke secretary on 020 8296 2404at 9am to arrange assessment. Fax referral to 0208 2962421 / See St Helier pathway for further details.(next page)
Pathway and referral form also available on intranet and trust website
Fri 12.00 – Sun 16.00 and Bank Holidays
Arrange admission via Medical registrar
Low Risk:
Fax referral to TIA clinic on 020 8296 2421.
Ask patient to phone stroke secretary on 020 8296 2404 next working day for low risk appointment

KingstonTIA CLINC REFERRAL FORM

KingstonHospital NHS Trust
TIA CLINIC
REFERRAL FORM
**FAX NUMBER: 02089343884
(Please fax referral urgently)
Stroke team bleep 463 (Stroke registrar) / Source of referral (please ring):
GP / A&E / MAU / Paramedic / Other

Date and time of First Contact with 1st HCP

Date__ /__ /__: time __ : __ (24h clock)
Name of referrer and contact phone number:
Date and time of referral:
Date__ /__ /__: time __ : __ (24h clock)
CLINIC DATE: Date__ /__ /__: time __ : __ (24h clock)
GP STAMP( name and address)
Patient details
Name :
Sex :
D.O.B. :
Address:
Tel. No.:
Carer’s name
Tel / Date and time of onset of symptom(s)
Date__ /__ /__: time __ : __ (24h clock)
Brief history
Previous TIA’s or Stroke? Yes / No
If yes, when and how many
Handed Left / Right
Preferred language
Interpreter needed Yes / No / Driver Yes / No
Is Hospital transport required? Yes / No
Type required Car Ambulance
ABCD2 SCORE
if presenting within 7 days / POTENTIAL
POINTS / POINTS / Past Medical History:
Age >/=60 / 1
< 60 / 0
BP Systolic >140 or Diastolic ≥ 90 / 1
Systolic <140 & Diastolic < 90 / 0
Clinical features
Unilateral weakness / 2
Speech disturbance / 1
Sensory Loss/ other symptoms / 0
Duration >/= 60 minutes / 2 / Family History:
10 – 59 minutes / 1
< 10 minutes / 0
Diabetes Present / 1 / Social History:
Absent / 0
TOTAL SCORE
If score 4 or above, or more than 1 TIA in a week, or on anticoagulant follow high risk pathway
Current Drug Therapy:
Please start aspirin 300mg of immediately. If aspirin intolerant consider alternative anti-platelet
Please specify: -
  • If on Aspirin at time of event and/or other anti-platelet drug(s)
If on Warfarin and why? Most recent INR with date (if known):
Please circle any known additional risk factors:
Previous TIA / CVA, IHD Known carotid disease Atrial Fibrillation
Hypertension, Diabetes, Impaired LV function Acohol
Hyper-lipidaemia, Smoking Current /Ex Peripheral vascular disease Obesity
if current number/day