Having a stroke is one of the more alarming and devastating things that can happen to a person, and will happen to a quarter of us over the age of 45. Only 20 years ago there was a rather nihilistic attitude to management. The situation today could not be more different.

Not only is there much that can be done, but there is evidence that active care leads to less deaths, and less disability for those who do survive. Best care begins with proper assessment and continues, usually within a specific stroke unit, with active management.

A key change over the last decade is that care has become a team effort. A stroke patient is likely to be treated during the course of their illness by many different people, ranging from the doctors and nurses in the emergency department, a wide array of professionals on the stroke unit, to therapists, doctors, nurses and social services staff in the community. One of the aims of these guidelines is to equip health and social care professionals – wherever they work – with the knowledge of what best care should be.

Keeping abreast of emerging evidence in a field such as stroke is a difficult task for busy practitioners. Since the first edition of these guidelines appeared four years ago, many hundreds of new references have been published, several requiring major changes in the way stroke care should be delivered. High quality treatment may save a patient’s life or result in reduced disability. Guidelines can never provide the answers for every situation and do not replace sound clinical judgement and common sense. These guidelines do, however, provide a framework for such care and are intended to be just as practical and relevant for non-specialists as for specialists.

There have been a number of developments in stroke medicine over the past four years since the first edition was published. Stroke medicine is now a recognised specialty within medicine and all hospitals have been advised by the Department of Health that they should have a dedicated stroke unit. The roles of the nurse, physiotherapist, occupational therapist and speech therapist are also developing and companion publications drawing from this guideline provide each profession with specific guidance.

The results from the sentinel audit of stroke care demonstrate that while care has improved significantly over the last six years, there is no room for complacency. There is more that can be done. Professional groups involved in stroke care in hospitals and the community (separately and together) should use this guideline to reconsider their role within the care team and how they can work together to improve outcomes for patients and their families.

Download: National Clinical Guidelines for Stroke (PDF)