Saudi Stroke Standards

STROKE CLINICAL ADVISORY GROUP Vision Realization Office SAUDI STROKE PATHWAY STANDARDS Table of Contents A. B. Foreword Stroke has been defined as a sudden interruption in the blood supply of the brain. Most strokes are caused by an abrupt blockage of arteries leading to the brain (ischemic stroke). Other strokes are cause by bleeding into brain tissue when a blood vessel bursts (hemorrhagic stroke). Because stroke occurs rapidly and requires immediate treatment, stroke is called a brain attack and sometimes referred to as ‘earthquake in the brain’. When the symptoms of a stroke last only a short time (less than 24 hours), this is called a transient ischemic attack (TIA) or mini-stroke.1 There are approximately 24,000 strokes in Saudi Arabia annually.2 Inefficient use and distribution of available resources, inconsistent provision of services and sometimes lack of evidence-based urgent stroke care services impacts on patient outcomes across the Kingdom. Urgent and acute care is not the only aspect of care that needs to improve, lack of inpatient and community rehabilitation, long term care and community support services has a significant impact on the patients with non-acute phase of stroke, this also impacts on the providers of acute services who are unable to transfer the patient to a safe environment to receive appropriate care. Lack of long term and community services limits the capacity in our existing acute hospitals to treat those most in need of acute care. Yet we know that for months or even years after a stroke, there may be a need for specialized therapeutic help – for example to improve speech or mobility – and that enabling people to participate in work, leisure and education improves well-being, combats depression and often aids recovery. The input and commitment of rehabilitation services, primary care teams, of social care professionals and wider community services is absolutely critical to delivering improved outcomes for people with stroke. These standards aim to address the urgent care and wider aspects of stroke care. Medical and technological advances have transformed our understanding of stroke, there have been advances in the treatments available for restoring blood flow and improving brain function. However, time is critical for restoring brain function following a stroke – the faster someone reaches expert help, the greater their chances of making a full recovery. We need to make use of the latest advances in stroke treatment, implement evidence-based stroke care, and improve quality, efficiency and consistency of the services to improve patient outcomes. We need to develop the rapid response systems that get people to a hospital of expertise quickly and onwards to provide appropriate treatment and stroke unit care. We need to develop stroke networks to ensure improved access of services to the patients and better utilization of resources. Working across the stroke networks, we need to deliver integrated stroke care that liberates rather than constrains the talents and energies of the doctors, nurses, therapists and their wider teams. The stroke standards create a strong foundation, supported by expert guidance, for continued innovation and progress in stroke care. Many strokes are preventable, most are treatable, and the harm done by stroke can be greatly reduced if we act quickly on important warning signs like transient ischemic attacks or ‘minor strokes’, deploy effectively 1 https://stroke.org.sa/understand-stroke/ 2 Based on expert opinion and available data: https://journals.sagepub.com/doi/full/10.1177/2396987316654338