When should I consider referring a patient with ischaemic stroke for specialist assessment or rehabilitation?

Consider referring a patient with ischemic stroke for specialist assessment or rehabilitation:

• Immediately upon suspicion of acute ischemic stroke, arrange emergency admission to a specialist acute stroke unit for urgent specialist assessment and management, including brain imaging and consideration of thrombolytic treatment if appropriate ¹,².
• After hospital discharge, ensure follow-up by a specialist stroke rehabilitation team within 72 hours for patients with disabilities related to stroke ¹.
• Refer to specialist stroke rehabilitation services if the patient has ongoing complex rehabilitation needs, swallowing difficulties, nutritional or hydration problems, or deteriorating swallowing function ¹.
• Consider referral to specialist teams for management of post-stroke complications such as continence problems, fatigue significantly affecting daily life, cognitive dysfunction, mood disorders (e.g., depression, anxiety), and hearing difficulties ¹.
• Patients with symptomatic carotid stenosis identified after specialist assessment should be urgently referred for carotid endarterectomy according to national standards ².
• Rehabilitation should be provided by a specialist multidisciplinary stroke team either in a stroke unit, specialist inpatient neurorehabilitation unit, or community stroke team, depending on the patient’s needs and discharge pathway ³.
• Ongoing review of health and social care needs, including rehabilitation goals, should occur at 6 months and annually, with referral to community participation programmes or specialist services as appropriate ³.