Amended October 2010. v2.3


Sussex Stroke Network Area Hospitals
Hospital location / Hospital / Hours / Time/age limits / Notes / Bypass
Brighton / Royal Sussex County Hospital / 24/7 service. / 3.5 hours
18-80 years / Will accept primary bypass patients from PRH (OOH) and NESH patients from South Crawley(OOH) to 3.5hrs from onset of symptoms. / N.B. Decision to thrombolyse >3hrs will be Consultant led, case-by-case decision.
Chichester / St Richards Hospital / Mon – Fri
09.00 – 17.00 / 3 hours
18-80 years / In operation / No
Eastbourne / Eastbourne DGH / 24/7 Service / 3 hours
18- 80 Yrs / In operation / No
Guildford / Royal Surrey County Hospital / 24/7 service / 3 hours
18-80 years / Will accept Surrey patients for primary bypass if geographically closer / Will accept patients from Surrey area if indicated using primary bypass checklist and geographically closer
Hastings / Conquest Hospital / 24/7 Service / 3 hours
18-80 years / In operation / No
Haywards Heath / Princess Royal Hospital / Mon – Fri
08.30 -16.30 / 3.5 hours
18-80 years -
IST3 trial, up to 6 hours & no upper age limitnot available OOH / OOHs bypass to RSCH (Brighton).
Decision to thrombolyse >3hrs will be Consultant led, case-by-case decision. / Yes, for OOHs and bank holidays only. Complete primary bypass checklist and, ifindicated bypass.
If not eligible for bypass admit to PRH.
Tunbridge Wells / Kent and Sussex Hospital / Mon-Fri
08.00-18.00
24/7 service on rota over four site’s, contact EDC, to identify which site is on call. / 3 hours
18-80 years / OOHs including bank holidays -call EDC to identify hospital on call for 24/7 thrombolysis. / Yes,(out of hours) complete primary bypass checklist and if indicated bypass to the relevant hospital on call that week. If not admit to K&S
Redhill / New East Surrey Hospital / Mon – Fri
08.00 – 20.00 / 3 hours
18-80 years / OOHs bypass to RSCH (Guildford) from North Crawley and Horsham area.
OOH’s Bypass to RSCH (Brighton) from South Crawley area. / Yes, for OOHs and Bank Holidays only; complete primary bypass checklist and if indicated, bypass.
If not eligible for bypass admit to NESH (Redhill).
Worthing / Worthing Hospital / Mon – Fri
09.00 – 17.00 / 3.5 hours
18-80 years / Hospital can facilitate 4.5hrs – decision on case basis by consultant / No
Surrey Stroke Network Hospitals
Hospital location / Hospital / Hours / Time/age limits / Notes / Bypass
Brighton / Royal Sussex County Hospital / 24/7 service. / 3.5 hours
18-80 years / Will accept primary bypass patients from PRH (OOH) and NESH patients from South Crawley (OOH) to 3.5hrs from onset of symptoms. / N.B. Decision to thrombolyse >3hrs will be Consultant led, case-by-case decision.
Carshalton / St Helier Hospital / No service / No service / Primary Bypass to nearest appropriate thrombolysis service - St George’s Hospital (Tooting) or RSCH (Guildford). / Yes. Complete primary bypass checklist and if indicated, bypass.
If not eligible for bypass admit to St Helier Hospital.
Chertsey / St Peters Hospital / 24/7 service / 3 hours
18-80 years / Will accept Surrey patients for primary bypass if geographically closer / Will accept patients from Surrey area if indicated using primary bypass checklist and geographically closer
Croydon / Mayday Hospital / No service / No service / Primary bypass to nearest appropriate thrombolysis service / Yes, Complete primary bypass checklist and if indicated bypass to nearest thrombolysis centre.
If not eligible for bypass admit to Mayday.
Epsom / Epsom General Hospital / No service / No service / Primary bypass to nearest appropriate thrombolysis service RSCH (Guildford) ASPH (Chertsey), for eligible patients. / Yes, Complete primary bypass checklist and if indicated, bypass.
If not eligible for bypass admit to EGH (Epsom).
Frimley / Frimley Park Hospital / 24/7 service / 3 hours
18-80 years / Will accept Surrey patients for primary bypass if geographically closer / Will accept patients from Surrey area if indicated using primary bypass checklist and geographically closer
Guildford / Royal Surrey County Hospital / 24/7 service / 3 hours
18-80 years / Will accept Surrey patients for Primary Bypass if geographically closer / Will accept patients from Surrey area if indicated using primary bypass checklist and geographically closer
Kingston-upon-Thames / Kingston Hospital / No service / No service / Primary bypass to nearest appropriate thrombolysis service.
St Georges (Tooting) / Yes. Complete primary bypass checklist and, if indicated, bypass to St Georges (Tooting). If not eligible for bypass admit to Kingston Hospital
Redhill / New East Surrey Hospital / Mon – Fri
08.00– 20.00 / 3 hours
18-80 years / OOHs bypass to RSCH (Guildford) from North Crawley and Horsham area.
OOHs bypass to RSCH (Brighton) from South Crawley area. / Yes, for OOHs and Bank Holidays only; complete primary bypass checklist and if indicated, bypass.
If not eligible for bypass admit to NESH (Redhill).
Tooting / St George’s Hospital / 24/7 service / 3 hours
18 to 80 yrs / Will accept patients from within the South West London area / Will accept patients from South West London area if indicated by using primary bypass checklist
Kent Stroke Network Area Hospitals
Hospital location / Hospital / Hours / Time/age limits / Notes / Bypass
Ashford / William Harvey / 24/7 service / 3 hours
18-80 years / IST3 trial, up to 6 hours & no upper age limit / Please note: IST3 trial not available out of hours and is not for bypass
Canterbury / Kent & Canterbury /
24/7 service / 3 hours
18-80 years / IST3 trial, up to 6 hours & no upper age limit / Please note: IST3 trial not available out of hours and is not for bypass
Dartford / Darrent Valley Hospital / Mon-Fri
08.00-18.00
24/7 service on rota over four sitescontact EDC, to identify which site is on call. / 3 hours OOH
6 hours (in hours)
18-80 years
(No upper age limit, in hours only) / OOHs including bank holidays call EDC to identify hospital on call for 24/7 thrombolysis.
IST3 trial, up to 6 hours & no upper age limit (Mon- Fri, 08.00-18.00)
Please note: IST3 trial not available for bypass or out of hours. / Yes, (out of hours), complete primary bypass checklist and if indicated bypass to the relevant hospital on call that week.
If not admit to DVH.
Please note: IST3 trial not available out of hours and is not for bypass
.
Farnborough
(Bromley) / Princess Royal University Hospital / No service / No service / Primary bypass to nearest appropriate thrombolysis service.
N.B. PRUH, Please consider King’s College Hospital London / Yes, for all stroke patients in the South East London catchment area 24/7 Complete primary bypass checklist and if indicated, bypass. If not admit to PRUH.
Gillingham
And
Medway Towns / Medway Maritime Hospital / Mon-Fri
08.00-18.00
24/7 service on rota over four site’s, contact EDC, to identify which site is on call. / 3 hours
18-80 years / OOHs including bank holidays call EDC to identify hospital on call for 24/7 thrombolysis. / Yes, (out of hours), complete primary bypass checklist and if indicated bypassto the relevant hospital on call that week.
If not admit to Medway Maritime.
London (Southwark) / King’s College Hospital / 24/7 Service / 3 hours
18- 80 years / Will accept North Kent patients for primary bypass if geographically closer. / Yes, complete primary bypass checklist and if indicated bypass to King’s College Hospital if geographically closer.
Maidstone / Maidstone Hospital / Mon-Fri
08.00-18.00
24/7 service on rota over four site’s, contact EDC, to identify which site is on call. / 3 hours
18-80 years / OOHs including Bank holiday’s call EDC to identify hospital on call for 24/7 thrombolysis. / Yes,(out of hours) complete primary bypass checklist and if indicated bypass to the relevant hospital on call that week. If not admit to Maidstone Hospital.
Margate / Queen Elizabeth the Queen Mother / 24/7 service / 3 hours
18-80 years / IST3 trial, up to 6 hours & no upper age limit / Please note: IST3 trial not available out of hours and is not for bypass
Sidcup / Queen Mary Hospital / No service / No service / Primary bypass to nearest appropriate thrombolysis service. Consider King’s College or nearest on-call West Kent thrombolysis centre.
N.B.: PRUH, Bromley & Queens, Romford planning for thrombolysis within 2010. / Yes, For all stroke patients in the South East London area 24/7. Complete primary bypass checklist and if indicated, bypass. If not admit to PRUH or Darrent Valley.
Tunbridge Wells / Kent and Sussex Hospital / Mon-Fri
08.00-18.00
24/7 service on rota over four site’s, contact EDC, to identify which site is on call. / 3 hours
18-80 years / OOHs including Bank holiday’s call EDC to identify hospital on call for 24/7 thrombolysis. / Yes, (out of hours) complete primary bypass checklist and if indicated, bypass to the relevant hospital on call that week.
If not admit to Kent & Sussex.

Guidance Notes

  • TIME IS BRAIN – 1.9 million brain cells die in each minute of the first 24hrs of acute stroke
  • Acute strokes, TIAs and resolved TIAs are to be treated as an EMERGENCY, all patients are taken to hospital.
  • SCOOP & GO – The earlier the thrombolysis the better – chances of recovery are twice as high at 90 mins than at 180 mins.
  • Please note the operational hours of Hospital Acute Stroke Services. Please refer to the Hospital Details Table in the Acute Stroke FASTrack Pathway document for information on individual hospitals – IF IN DOUBT ring EDC.
  • All patients who fulfil FAST track criteria should be conveyed using emergency procedure and a pre-hospital ASHICE
  • Do not build false expectations around thrombolysis for stroke patients, decision for thrombolysis is stroke consultant led.
  • Consider the use of one of the three Air Ambulance Services where appropriate.

Patient treatment/care/assessment

  • Refer to JRCALC September 2009 Stroke Clinical Practise Update & The National Pre-Hospital Group Stroke/TIA Guidelines -
  • Blood glucose - Check and Treat accordingly, hypoglycaemia of less than 4.0mmol/l should be treated in accordance with JRCALC guidelines – treating a hypoglycaemic episode is essential as it is one of the principle Stroke mimics.
  • Keep the patient cool – check the patient’s temperature and help to stop the patient over-heating. If necessary release clothes, unwrap from blankets and use the Air-conditioning. The aim is to keep the patient at a normal temperature rather than actively cool. This is because increases in body temperature, due to reduced self-regulation, are associated with poorer outcomes for Stroke Patients
  • Position - Transport in a semi recumbent position to maintain a patent airway and to prevent aspiration
  • Nil-by-mouth, including medications until a swallow assessment as been made, to prevent aspiration
  • Oxygen - Administer Oxygen only when necessary to maintain target Sp02 between 94%- 98% as per British Thoracic Society (2008) guidelines and JRCALC (April 2009) oxygen guidelines.
  • IV access/fluids – Intravenous access is not essential unless the patient requires specific interventions, such as for delivering IV glucose to correct hypoglycaemia. Do not delay transport to hospital as this can affect outcome

Patient history

  • Third party/relative history is often vital, please ask 3rd parties to attend hospital with patient, alternatively as an absolute minimum provide name and phone number of third party as this is vital for the stroke team.
  • Time of stroke to thrombolysis is 3 hours – please ensure that you record time of onset.
  • Please take relevant history from patient in the context of possiblethrombolysis.

The following list is an aide memoir and is not intended to be a screen for contra indications.However, this patient history will assist the stroke team to diagnose and treat the patient.

  • Did patient wake from sleeping?
  • Recent surgery/dental work?
  • Recent head or brain Injury?
  • Recent history of bleeding?
  • Clotting disorders?
  • Anti platelet therapies e.g. aspirin; clopidogrel etc.
/
  • Previous Stroke/SAH/MI or cardio vascular disease event?
  • FFamily history of cardio vascular disease/stroke/IHD?
  • DDiabetes?
  • PPregnant?
  • AAnti-coagulation therapies e.g. warfarin; heparins; tinzaparin, etc.