This pathway is currently under intense review in the current Covid crisis. The below Covid pathway is not finalised and will be updated as soon as is possible. Until then:
please consider discussing with Geriatrician of the Day on the Silver phone 01872 252161
we have to publish both the pre-Covid advice, as well as the developing Covid pathway
The eldercare consultant for stroke is available through RCH switchboard if further discussion is needed
Office hours: Monday-Friday 09:00-17:00. Referrals are picked up and actioned seven days a week. Clinics are held daily (see below).
Contact telephone 01209 318120
These are no longer accepted by fax. Instead email the completed form to . Remember to inform the patient to AVOID DRIVING UNTIL SEEN IN TIA CLINIC where they will be advised further.
Reminder - ADMIT via ED if:
Ongoing symptoms - Patients with ongoing stroke symptoms should be admitted to the emergency department for stroke pathway, typically via 999 ambulance if less than 6hrs or awaking with symptoms.
>1 TIA in a week - If patients have had more than one episode of neurological deficit within a week, this should be treated as a crescendo TIA and admitted to ED.
What does the TIA clinic do?
The Cornwall Stoke Service will see patients in the TIA clinic after triaging their priority based on your referral, usually to be seen within 24hrs of onset of the transient ischaemic attack for those at high risk, up to 7 days for those at lower risk. ABCD2 score is being removed from local and national guidelines (1)
They will also see patients with new onset stroke which has not resolved and has resulted in a minor disability, for example slurred speech or minor limb weakness. These patients must be safe at home pending their appointment.
Each TIA clinic is staffed by a consultant, a stroke care coordinator, a nurse and a vascular studies clinician.
In the clinic the patient will be fully investigated, including carotid duplex scanning. Risk factors will be assessed and secondary prevention medication.
The patients may be started on anticoagulation, referred to occupational therapy, speech therapy or physiotherapy from the clinic. Most patients are followed at six weeks time by the stroke team.
If patients have had symptoms suggestive of a TIA they should be referred to the TIA clinic and should be started on Aspirin 300mg as long as their symptoms have completely resolved(1).
1. Revised RCP Guidelines for the management of Transient Ischaemic Attack (October 2016)
It is now recommended that patients are not risk stratified into high or low risk categories using the ABCD tool and all patients whose event is less than 7 days ago is classed as high risk and offered an appointment within 24 hours of referral receipt
* If patients have persistent neurological signs: these patients should be referred to the Emergency Department for stroke pathway or neurology ward depending on diagnosis following scanning.
* If patients have symptoms or signs of Bell’s palsy: these patients should be treated in primary care, no need for referral.
* If the history suggests transient global amnesia: these patients should be considered for referral to the Neurology team via the Referral Management System.
* If history suggests migraine, consult the following guidelines: http://rms.kernowccg.nhs.uk/rms/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/neurology/migraine
* Please refer patients with probable syncope as the main presentation to the falls and syncope clinic through the Referral Management System.
* Driving guidance can be found at https://www.gov.uk/guidance/assessing-fitness-to-drive-a-guide-for-medical-professionals
* If your patient is very frail, difficult mobility/ transport logistics, acute treatment would either not be recommended or tolerated, would not be a surgical candidate or already on secondary prevention – please consider managing pragmatically in primary care.
* Some patients or relatives of those patients, who are lacking capacity, do not wish to endure the transport logistics to come to clinic when there is little to gain– please consider managing pragmatically in primary care.
Developing Covid TIA Pathway