Hyper acute stroke unit services

As Bob Dylan has said ‘The times they are a-changin’. Only a decade ago stroke patients in the UK would routinely wait two to three days for their emergency computed tomography (CT) scan following admission. Some thought that this delay was even advantageous as it allowed infarct changes to become well established. For ischaemic strokes, acute treatment was limited to aspirin. Moving forward 10 years, with the introduction of routine intravenous thrombolysis and the advent of interventional neuroradiology, Greater London has undergone a dramatic transformation of acute stroke services. Currently, eight hyper acute stroke units (HASUs) are being established across the capital, providing 116 monitored beds (Fig 1). The aim of this is to offer equitable, around-the-clock access to stroke specialists, investigations, imaging and, if indicated, thrombolysis. Thrombolysis, if given early enough, has been shown to significantly reduce stroke morbidity, with a number needed to treat of 3.1. 1 This has the potential to make serious inroads into a condition that afflicts 110,000 people yearly in the UK. If established infarct changes are seen on a CT brain, stroke physicians now would feel an opportunity had been missed. This paper describes experiences in the North Central London sector, which spans inner city areas to the northern green belt, with University College Hospital (UCLH) as the serving HASU. Transforming stroke services has been taxing at times and some of the key challenges faced and lessons learnt are discussed below.