Stroke induction booklet was contributed by the following;
written by Dr Asma Hassan
approved by Dr Ragunath Durairajan
updated by Dr Akinwale
Select the booklet titles below to expand the table to view more information.
Stroke Team
| Consultant | Secretary | Extension | Hospital |
|---|---|---|---|
|
Dr Shahid Kausar |
Karen Smith |
2184 |
Russells Hall Hospital |
|
Dr Abdul Salam |
Lisa Morris |
3554 |
Russells Hall Hospital |
|
Dr Ashim Bannerjee |
|
|
Russells Hall Hospital |
|
Dr Rafiq |
|
|
Russells Hall Hospital |
|
Dr Durarajan |
|
|
Russells Hall Hospital |
Each day a different consultant covers the hyperacute stroke unit (station 2). The acute stroke unit (station 1) is covered half by Dr Banerjee and the other half by Dr Salam.
One of the stroke rehabilitation wards (station 3) is split by Dr Kausar and Dr Rafiq. The patients in the other stroke rehabilitation station (station 4) are covered by the consultant who saw them before they moved to that station and also has a registrar ward round each morning.
REGISTRARS
There are typically two/three registrars – one covering the ward and the others in the TIA clinic. They cross cover to support the ward, and are always happy to help.
One of the registrars will be holding the bleep and they are responsible for new admissions either directly to the ward or from A&E.
SHOs
There is one FY2 who rotates in with you then several other SHOs on the team who will be based on the ward with you. They will also usually have on-call commitments.
WARD NURSES
Make friends with them. Respect their seniority. They will help you out a lot if you do. Lots of them have been doing this a lot longer than you. They can certainly help you with lot of tasks (cannulas, bloods, etc.) if you ask them nicely.
WARD CLERKS
The ward clerk is found near station 4 and she can help locate patients, fax details across and give you details of patients who have already been discharged.
Stroke Ward Timetable
| Day | Monday | Tuesday | Wednesday | Thursday | Friday |
|---|---|---|---|---|---|
|
AM |
Consultant ward round |
Consultant ward round |
Consultant ward round |
Consultant ward round |
Consultant ward round |
|
PM |
Ward |
Ward |
Department lunchtime meeting |
Ward |
Ward |
Most weeks are as above. Being on the on-call rota, you’ll have weeks away from the ward.
Stroke Ward
Ward Stations
Station 1:
Acute stroke unit (ASU). Patients are usually moved from HASU to this station once they are stabilised and a diagnosis is given.
Station 2:
Hyperacute stroke unit (HASU). New admissions and thrombolysis patients are found here.
Station 3 & 4:
Stroke rehabilitation. Patients who are deemed almost medically fit will be here. Patients who have also remained in the hospital for a long period of time.
Ward
There is one FY1 on stroke alongside one FY2 and the rest of the team.
The day starts at 08:00 with the consultant-led ward round that usually begins at HASU (station 2). Here is where the new patients with a stroke are admitted, either from ED or directly from the ward. The majority of the time, two juniors will cover HASU – the doctor who comes in at 8:00 can finish at 16:00 and the other starts at 9:00 and finishes at 17:00. This is usually decided between the juniors. If you are not covering HASU, you will be covering one of the other stations and the ward rounds normally start at 9:00 unless stated otherwise.
The ward also includes medical patients. They will also be reviewed by the stroke consultant and are usually located in stations 1, 3 or 4.
NerveCentre
If it gets to 5 o’clock and there are still jobs to do (e.g., chasing blood results/scan reports), these can be handed over on NerveCentre. If an investigation was done quite late during the day and you’re not expecting results before 17:00, try putting it on Nerve early, as this takes time (you can always undo this if needed).
Stroke - Further Information
When a new patient arrives, you can search ‘stroke’ on the order section on Sunrise and this will provide you with a set of bloods required as part of the initial work-up. If a patient is <55 years old, instead search for ‘young stroke screen’ and pick those bloods instead. Usually a 24hr ECG, US carotid (if indicated to r/o stenosis), CT head (if not yet requested) and/or MRI head (if CT head is nil but clinically patient has features of a stroke) are requested.
Handover Sheet
Handover sheet: unlike other wards, because of the fast turnover of patients, there is no formal handover sheet. The boards on the station are kept up to date. You can create your own list of patients to remind yourself at the beginning of the day and to be able to present when the consultant comes round.
Prioritising
Try to get TTOs done either just after the ward round (before about 11am), or after 1pm – when the ward pharmacist is around, as this means they get processed much more quickly. Also try and prioritise discussions with other teams earlier in the day. Most people finish at 5pm so won’t appreciate getting a referral late in the afternoon.
Calling outside numbers
Dial 9, then the number you want to call.
Medication
Almost all patients will be started on aspirin 300mg for 14 days (after a CT head rules out a haemorrhagic stroke), ensure that there is a stop date on sunrise when prescribing this. Also ensure you have discussed with the consultant which anti-platelet (usually clopidogrel) or anticoagulant they may need in the long run and ensure this is documented in the TTO. If a patient has atrial fibrillation they are usually started on a DOAC or continue their pre-admission one if already diagnosed.
Antibiotics
Rewrite these if you intend for them to continue. If you don’t it may be interpreted that the course has finished which can lead to missed doses.
Annual Leave
Discuss this amongst the other FY1 and SHOs. Ideally only take leave when there will still be two people covering the ward. Leave forms can be found on The Hub under Medical Workforce.
Discharge Summaries
Keep it concise, including discharge medications, diagnosis, what patient has been told, important investigations results such as renal function/ ABG on air/ CT / MR scans, and follow-up arrangements (patients will be reviewed by the stroke consultant in 3 months’ time unless stated otherwise).
If the patient is not known AF then they often have an outpatient 5-day Holter to look for pAF. It is important in a stroke discharge letter to provide information about the type of stroke, whether the patient was thrombolysed (and reason they didn’t), initial NIHSS score or power of limbs and any remaining deficits so the GP is aware of the baseline of the patient on discharge.
