Every year around 200 Milton Keynes residents are admitted to hospital following a stroke and each month there are, on average, 26 referrals for a suspected TIA, with around a quarter of these subsequently confirmed. We have made major improvements to Stroke services in Milton Keynes to reflect the national Stroke Strategy and the key features of effective stroke care. "Time is Brain" and the rapid access to specialised acute stroke services, including timely brain scanning, gives better outcomes. A delay in treatment increases the risk of death and disability. Here is a summary of actions for GPs and local stroke services:
Actions following a suspected Stroke or TIA:
Anyone reporting sudden onset of unilateral weakness or speech difficulty that has not resolved should call 999. All ambulance crews will undertake the F.A.S.T. assessment and, for patients in whom the stroke has occurred within around 3 hours, they will be conveyed directly to Luton and Dunstable Hospital for investigation, and if clinically appropriate, given thrombolysis. Other patients will normally be taken to MKHFT.
Anyone reporting sudden onset of unilateral weakness or speech difficulty that has resolved should be given an urgent GP appointment; Use the "MKHFT Fast Track TIA Clinic referral form" to assess risk factors and determine patient's risk against the ABCD2 algorithm given (Age, BP, Clinical features, Duration, Diabetes +/-). Full completion of the form is paramount as it determines the best clinical pathway.
Assess and refer to TIA clinic if indicated:
In hours (9-5 Mon-Thurs; 9-12 Fri) telephone 01908 826580 for appointment confirmation and fax form
Out of hours Fax form to 01908 826752. Northampton General Hospital undertakes high-risk TIA clinics at weekends.
High risk cases must be seen and investigations completed within 24 hours of referral (ABCD2 score >=4 and event)
Undertake blood tests & ECG: FBC, ESR, Glucose, Cholesterol; fax results to MKHFT when available
Commence treatment immediately: Aspirin (300mg od); consider warfarin if in atrial fibrillation (AF substantially increases the risk of stroke)
Hospital admission indicated if pt is on warfarin, has known bleeding tendency, fluctuating symptoms, severe headache at onset, neck stiffness or fever
Dr Yaw Duodu, Stroke Consultant at MKHFT also encourages GPs to contact him directly for clinical advice.
After an admission with confirmed stroke:
Patients treated at L&D will either be repatriated to the Stroke ward at MKHFT by day 3 or be discharged home or to a local setting.
The Milton Keynes Early Stroke Rehabilitation Team (ESRT) will be closely involved in post-stroke care, delivering rehabilitation to people in their own homes, following mild to moderate stroke, and from early December it is hoped that their remit will be extended to cover people who have had more severe strokes and people in care homes. The team can be contacted through the Single Point of Access number on: 01908 363070
Patients will also be contacted by the Community Stroke Team who have a Stroke Clinical Specialist and Social Workers. The team can be contacted on: 01908 650424.
Both community teams welcome referrals, for example if people have returned to Milton Keynes following hospitalisation elsewhere.