Saudi Stroke Standards

ED assessment Purpose To ensure that immediate assessment is carried out in the ED to diagnose stroke and TIA, to enable urgent and accurate treatment. To standardize the stroke pathway that reflects up to date clinical practice guidelines; and to shorten the duration for obtaining timely brain imaging-based decisions for management of stroke patients. Rationale  Acute Stroke Protocol (stroke identification, ED evaluation, stroke team activation, stroke decision of care, post stroke care) can be used to improve outcomes.  Hypoglycemia can mimic stroke symptoms and early identification of hypoglycemia can help to provide appropriate management.  Effective clinical assessment of the patient with acute stroke, and decision making for timely appropriate therapy, is paramount for improving patient outcomes.  Rapid and standardized ED assessment is important to provide safe and appropriate treatment.  NIHSS is a standardized scale that quantifies the degree of neurological deficit, facilitates communication between different groups of healthcare providers, assists the decision for reperfusion therapy, and is an objective measure of clinical outcome.  Immediate ED assessment of stroke related swallowing problems can help reduce the risk of aspiration in an acute stroke patient.  It is important to increase staff knowledge and improve the quality of stroke care. Standards 1. All hospitals must implement a protocol for acute stroke care assessment. 2. All hospitals must have an immediate triage process in ED for patients with acute stroke symptoms. 3. All patients with acute stroke symptoms must have blood glucose checked. 4. All hospitals must have a designated stroke team to assess and manage acute stroke. 5. Every patient with FAST positive results must have urgent access to neurological expertise. 6. All patients with stroke symptoms must be evaluated by using a standardized evaluation for stroke assessment tool (FAST). 7. National Institution of Health Stroke Scale (NIHSS) should be used by all hospitals to determine the severity of the stroke. 8. All patients with acute stroke symptoms will be restricted from having oral intake until they pass the swallowing assessment. See 10. QM 4.2.4 Swallow screening . 11. ED staff must be trained to detect acute stroke symptoms. For example, in neurological assessment - STARS competencies: (http://www.strokecorecompetencies.org/node.asp?id=home) QM