How should stroke services be organised?

Abstract

1This interest mirrors an increased awareness of the public health implications of stroke—especially in developed countries where stroke is often the third commonest cause of death, and the commonest cause of acquired adult disability. 2 There has also been a recognition that the way services are organised can have an important effect on patient outcome. 3 In this article, I will draw upon research evidence to develop an outline of a comprehensive, integrated stroke service. What are the aims of an integrated stroke service? Services should aim to meet the needs (and wishes) of patients and carers in an effective, efficient and equitable manner. From a professional perspective, we would aim to meet these needs through the provision of rapid diagnosis and secondary prevention, in addition to appropriate acute care, rehabilitation, and ongoing support. An integrated stroke service should provide these components in a closely coordinated and comprehensive manner to provide a joined-up service for the majority of patients. Some services designed to meet these needs could be outlined as follows. l A fast-track outpatient clinic. This would aim to provide rapid assessment, diagnosis, and secondary prevention measures for patients with TIA. Ideally, the service would have a rapid one-stop facility and incorporate specialist neurology input. Secondary prevention measures are currently available to reduce the risk of recurrent stroke. 2