Stroke quality standard

9. All patients after stroke are screened within 6 weeks of diagnosis, using a validated tool, to identify mood disturbance and cognitive impairment.
10. All patients discharged from hospital who have residual stroke-related problems are followed up within 72 hours by specialist stroke rehabilitation services for assessment and ongoing management.
11. Carers of patients with stroke are provided with a named point of contact for stroke information, written information about the patient´s diagnosis and management plan, and sufficient practical training to enable them to provide care.

This NICE quality standard defines a high standard of care within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide patients and the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

Stroke is a preventable and treatable disease. It can present with the sudden onset of any neurological disturbance, including limb weakness or numbness, speech disturbance, visual loss or disturbance of balance. Over the last 20 years, a growing body of evidence has overturned the traditional perception that stroke is simply a consequence of ageing that inevitably results in death or severe disability. Evidence is accumulating for more effective primary and secondary prevention strategies, better recognition of people at highest risk who are most in need of active intervention, interventions that are effective soon after the onset of symptoms, and an understanding of the processes of care that contribute to a better outcome. There is also now good evidence to support interventions and care processes in stroke rehabilitation. In the UK, the National Sentinel Stroke Audits have documented changes in secondary care provision over the last 10 years, with increasing numbers of patients being treated in stroke units, more evidence-based practice, and reduced mortality and length of hospital stay. This quality standard provides clinicians, managers and service users with a description of what a high-quality stroke service should look like.

This quality standard covers care provided to adult stroke patients by healthcare staff during diagnosis and initial management, acute-phase care, rehabilitation and long-term management.

The stroke quality standard is based on the understanding that stroke services are commissioned from and coordinated across all relevant agencies to encompass the whole stroke care pathway. An integrated approach to providing services is fundamental to the delivery of high-quality care to patients with stroke.

• Stroke areas of care map: see the quality statements mapped against the areas of stroke care

• 'National stroke strategy' (Department of Health 2007)
• 'Department of Health: progress in improving stroke care' (National Audit Office 2010)
• 'Department of Health: reducing brain damage: faster access to better stroke care' (National Audit Office 2005)

'Stroke: national clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic attack | (TIA)' (Royal College of Physicians 2008, NHS Evidence accredited), which incorporates 'Stroke: diagnosis and initial management of acute stroke | and transient ischaemic attack (TIA)' (NICE clinical guideline 68). NHS Evidence accredited

Director

Val Moore

Consultation and field testing of the stroke quality standard took place from 27 November 2009 to 15 January 2010. In total, 644 stakeholders were contacted during consultation and the NICE field team visited ten provider organisations to discuss the draft standard in detail. All eligible comments were reviewed by the Topic Expert Group and Quality Standards Programme Board and the standard was updated accordingly.

• Stroke field testing and consultation report

• Patient information
• Cost impact and commissioning assessment
• CG68 Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA): slide set
• CG68 Service for the diagnosis and initial management of acute stroke: commissioning guide
• CG68 Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA): audit support

Many organisations share NICE's commitment to improve quality by making it clear what quality care is for patients and the public, health and social care professionals, commissioners and service providers.

So that these standards reach the widest possible audience, some of the organisations who have been involved in the development process, and who endorse the stroke quality standard, have become partners in its publication.

Royal College of Physicians