Session 4 – Stroke Care in Hospital
LOCAL STROKE UNITS
The region is served by 8 stroke units that provide different types of care. Ambulances will always take a suspected stroke patient to the nearest Hyper Acute Stroke Unit (HASU) that is open.
Salford Royal Hospital is the largest HASU in the country and treats stroke patients 24/7 from a catchment area of Bolton, Central Manchester, Salford, Trafford and Wigan. It also treats patients from all of Greater Manchester and Eastern Cheshire overnight when the other two HASUs are closed.
Fairfield General HASU treats patients 6.45am-10.45pm from Bury, North Manchester, Oldham and Rochdale. Overnight, patients from these areas go to Salford Royal HASU. Stepping Hill HASU also treats patients between 6.45am-10.45pm from Eastern Cheshire, South Manchester, Stockport and Tameside. Again, out of hours patients in these areas go to Salford Royal HASU. The three HASUs also act as District Stroke Centres (DSC) providing inpatient rehabilitation for their own residents.
There are five stand alone DSCs located at Manchester Royal Infirmary, Royal Albert Edward Infirmary, Royal Bolton Hospital, Tameside General Hospital and Trafford General Hospital.
DSCs do not provide hyper acute care and focus on delivering inpatient rehabilitation. The majority of their patients will have been treated first at a HASU, but some may be directly admitted to their stroke wards including inpatient strokes and patients presenting with symptoms >48 hours ago.
Eastern Cheshire patients are treated at Stepping Hill HASU for all their hospital care, however, some residents in the southern part of the county may be taken to North Midlands University Hospitals NHS Trust in Stoke for their hyper acute care, with Stepping Hill providing inpatient rehabilitation. The DSC at Wythenshawe Hospital was closed during the pandemic, with services moved to Trafford General.
Hyper Acute Stroke Units
- Salford Royal Hospital (blue)
- Fairfield General and Stepping Hill Hospitals (purple)
District Stroke Centres (teal)
- Manchester Royal Infirmary
- Royal Albert Edward Infirmary
- Royal Bolton Hospital
- Tameside General Hospital
- Trafford General Hospital
ADMISSION TO HOSPITAL
Evidence shows patients with suspected acute stroke do better when they:
- Are assessed by a stroke team on arrival
- Receive a CT brain scan urgently within 1 hour of hospital admission
- Are admitted directly to a stroke unit within 4 hours
TREATMENT OF STROKE
Time is brain in stroke – 1.9 million neurons die every minute a stroke is untreated.
The majority of strokes are caused by blood clots, with two treatments available. Both are time sensitive and give most benefit when provided as quickly as possible.
Advanced imaging is being increasing used to identify patients who may benefit from treatment outside of the traditional time windows.
Thrombolysis uses drugs to dissolve blood clots and is only delivered at our three HASUs.
Currently around 11-12% of stroke patients assessed receive thrombolysis.
A surgical treatment to remove clots called thrombectomy is now available in the UK and in time we aim to provide the procedure to 10% of all stroke patients.
NHS Choices – treatment of stroke
THROMBOLYSIS
The treatment is only suitable for ischaemic strokes and carries a risk of bleeding (2-13%).
Traditionally the drug is given up to 4.5 hours after onset of stroke symptoms, although advanced imaging is now being use to identify patients who may respond to treatment beyond this time window.
Patients are assessed by a HASU team for suitability when they arrive by ambulance in the Emergency Department.
Aspirin should not be given in the acute stroke phase to anyone who may be suitable for thrombolysis.
1 in 5 people show significant improvement following thrombolysis, with 1 in 4 showing moderate improvement and 30% may show no improvement at all.
THROMBECTOMY
Thrombectomy is a highly effective surgical procedure only suitable for ischaemic strokes with a large vessel occlusion.
The treatment is usually provided within 6 hours of the onset of stroke symptoms. However, growing research evidence is extending the time window for some groups of patients, with the use of advanced imaging helping determine who will benefit.
The procedure involves inserting a catheter into an artery, often in the groin. A small device to remove the clot is passed through the catheter into the artery in the brain.
The region now offers a 24/7 service for thrombectomy which is delivered by a specialist team at the Manchester Clinical Centre for Neurosciences at Salford Royal Hospital. Eligible patients who present at Fairfield General or Stepping Hill HASUs are urgently transferred to Salford Royal for the procedure.
TRANSIENT ISCHAEMIC ATTACK (TIA)
The World Health Organisation defines a Transient Ischaemic Attack as a sudden, focal dysfunction (rarely global), vascular origin, lasting <24 hours.
It is a brief episode of neurological dysfunction resulting from focal temporary cerebral ischaemia and is not associated with cerebral infarction.
It is often described as a “mini stroke” and can be a warning that a stroke may be about to occur.
NHS Choices – Transient Ischaemic Attack
REHABILITATION
Rehabilitation after a stroke commences in hospital and is provided by an inpatient based team including therapists, nurses and psychologists. On discharge, the responsibility for ongoing rehabilitation is passed to a community team who continue at home or in a nursing/care home and support prevention of another stroke. The voluntary sector may also be involved in supporting life after stroke care.
You will need to successfully complete this multiple choice quiz to progress to the next session. The pass mark is 75% and you have 3 attempts