Ambulance screening and transfer to an acute stroke unit

Quality statement

People seen by ambulance staff outside hospital, who have sudden onset of neurological symptoms, are screened using a validated tool to diagnose stroke or transient ischaemic attack (TIA). Those people with persisting neurological symptoms who screen positive using a validated tool, in whom hypoglycaemia has been excluded, and who have a possible diagnosis of stroke, are transferred to a specialist acute stroke unit within 1 hour.

Quality measure

Structure

(a) Evidence of local arrangements to ensure that a validated tool is used by ambulance staff to screen for stroke or TIA in people with sudden onset of neurological symptoms.

(b) Evidence of local arrangements to ensure those people with persistent neurological symptoms who screen positive using a validated tool, in whom hypoglycaemia has been excluded, who have a possible diagnosis of stroke, are transferred to a specialist acute stroke unit within 1 hour.

Process

(a) Proportion of people with sudden onset of neurological symptoms who are screened for stroke or TIA outside hospital by ambulance staff using a validated tool.

Numerator: the number of people screened for stroke or TIA using a validated tool.

Denominator: the number of people with sudden onset of neurological symptoms seen outside hospital by ambulance staff.

(b) Proportion of people with persisting neurological symptoms who screen positive using a validated tool, in whom hypoglycaemia has been excluded, who have a possible diagnosis of stroke, who are transferred to a specialist acute stroke unit within 1 hour.

Numerator: the number of people who are transferred to a specialist acute stroke unit within 1 hour.

Denominator: the number of people with persisting neurological symptoms who screen positive using a validated tool, in whom hypoglycaemia has been excluded, who have a possible diagnosis of stroke.

Description of what the quality statement means for each audience

Service providers ensure that there are agreed local policies and protocols for ambulance staff to use validated tools to screen for stroke or TIA in people with sudden onset of neurological symptoms outside hospital, and that there is immediate access (1 hour) to a specialist acute stroke unit for those with persisting neurological symptoms.

Ambulance personnel ensure that they use a validated tool to screen for stroke or TIA in people with sudden onset of neurological symptoms outside hospital. They ensure that people with persisting neurological symptoms who screen positive using a validated tool, in whom hypoglycaemia has been excluded, and who have a possible diagnosis of stroke, are transferred to a specialist acute stroke unit within 1 hour.

Commissioners ensure that services are in place for ambulance staff to assess people who have sudden onset of neurological symptoms outside hospital using a validated tool. They ensure that services are in place for people with persisting neurological symptoms who screen positive using a validated tool, in whom hypoglycaemia has been excluded, and who have a possible diagnosis of stroke, to be transferred to a specialist acute stroke unit within 1 hour.

People with sudden onset of neurological symptoms can expect to be assessed by ambulance staff using a validated tool to diagnose stroke or TIA. People with persisting neurological symptoms who screen positive using a validated tool, in whom hypoglycaemia has been excluded, and who have a possible diagnosis of stroke, can expect to be transferred to a specialist acute stroke unit within 1 hour.

Definitions

The goal of 1 hour set by this statement has been selected to take into account the differences between urban, rural and remote locations. However, trusts can set appropriate targets for their local service configurations.

Examples of validated tools are Face-Arm-Speech-Test (FAST) or the Recognition of Stroke in the Emergency Room (ROSIER) Scale.

Symptoms are assumed to be persistent if they are still present when ambulance staff arrive at the patient's location.

Data source

Structure

Local data collection.

Process

Trusts can collect data via the Sentinel Stroke Audit and through local data collection.