Frimley Park Hospital is a specialist centre for acute stroke providing a 24 hour, 7 days a week service.

This includes assessment, and treatment which may involve giving drugs to break down blood clots (thrombolysis) and mechanical clot removal (thrombectomy). If appropriate you could be transferred to either Kings College Hospital or St Georges Hospital for further assessment and treatment.

Following your arrival and initial assessment, you may be admitted directly to the stroke unit if you have had a stroke or are suspected of having one.

You may undergo further tests to confirm a stroke diagnosis and determine the cause.

These could include:

• CT (computerised tomography) head scan
• CT (computerised tomography) angiogram to review the blood vessels both within the brain and going into the brain
• Carotid artery doppler
• ECG (electrocardiogram)
• MRI (magnetic resonance imaging) scan
• Blood tests

The stroke unit has access to interventional equipment and a wealth of expertise. We also work closely with vascular surgery.

Our stroke unit

The hyper-acute and acute stroke unit are based in ward G3 at Frimley Park Hospital.

Visiting times

Monday to Sunday, 11am-8pm. In exceptional circumstances the nurse in charge can make the decision for visiting to be permitted outside these hours. Only 2 visitors are allowed per patient.

We have an additional space and access to a small garden which patients and visitors are welcome to use when not in use for therapy sessions or meetings. 

Inpatient care

Some people who come to Frimley Park for specialist stroke care are from another area. If Frimley is not your local hospital, you will be transferred to your own hospital as soon as you are ready for transfer. We will keep you and your family updated and will continue with your care and treatment in the meantime.

If your diagnosis is not a stroke or TIA (transient ischemic attack) you may need to be transferred to another more appropriate ward.

After your stroke diagnosis you may meet or be referred to different services during your recovery including specialist stroke services, social services and other community services. We aim for transfers of care between teams and organisations to happen without delay and ensure that all the relevant information is shared and that you are involved.

Possible treatment and discharge plans

• In addition to medical assessments, the therapists on the stroke unit will assess for changes after stroke and if there are rehabilitation needs.
• If you have had a stroke without any resulting problems you could be discharged from hospital quickly.
• If appropriate, you may be referred to a stroke early supported discharge team, who can provide rehabilitation at home.
• If you need to stay in hospital for treatment and ongoing rehabilitation, you may be referred to stroke rehabilitation at Farnham (Runfold ward) or Bradley Neurorehabilitation Team at Woking Community Hospital. Your transfer to these units depends on when you become medically well enough and when a bed becomes available.
• You are likely to need new medications to try and prevent a further stroke. The nurses and pharmacists will provide information on these new medications and a discharge summary will be sent to your GP.
• You may need cardiology investigations as an outpatient. These could include: prolonged heart monitoring (7-14 days), an echocardiogram, or repeat brain imaging. We will either write to you with the result or discuss this with you in clinic.

Unfortunately, some strokes are devastating, and we will ensure appropriate end of life care on the ward if this is necessary.

Stroke outpatient services

• One-stop clinic for transient ischaemic attack (TIA). A TIA is a 'mini stroke' where the blood supply to the brain is only briefly interrupted and symptoms of stroke are temporary.
  • Our clinic is run five days a week, held both in person and by phone. All referrals are triaged as high-risk or low-risk. We aim to see high-risk patients within 24hrs and within a week if considered low risk.
  • In the TIA clinic you are likely to have blood tests, an electrocardiogram to check your heart rhythm, ultrasound of your carotid arteries to see if there is any significant narrowing and you may benefit from surgery, lying and standing blood pressure, and -dependent on assessment- a brain scan (either CT or MRI).
  • The clinic starts at 8:45am and you may be at the clinic for up to 6 hours depending on the investigation needed.
• Follow up clinics for patients who have had a stroke.
  • This includes a first follow up clinic that is generally by phone. There is one face to face clinic for those with communication difficulties or new referrals.
  • You will be offered a 6 month stroke follow up to address prevention and returning to everyday activities. This will be nurse led or delivered by the community stroke team.
  • We provide nurse-led follow ups for Nepalese speaking patients. 
• A spasticity management clinic for those with problematic spasticity as a result of the stroke. Spasticity (stiffness) of the affected stroke arm/leg increases in frequency over the first 6 months and you can be referred to this clinic by your GP if you have been discharged from the stroke service.
• A stroke psychology clinic where the team can assess and advise on stroke-related psychological changes in the first six months after discharge from hospital. The appropriateness of this service can be discussed in your stroke follow-up clinics or with your GP.

Consultants

We have a team of consultants and occasionally employ locum stroke consultants.

Stroke specialist nurses

The stroke specialist nursing team at Frimley Park Hospital provide a 24 hour, 7 days a week service for early assessment with ambulance services (using video triage), in accident and emergency, and for referrals throughout the hospital and from GP's. The stroke nurses also provide assessment and care post-thrombolysis treatment and may escort you to our thrombectomy centre if needed. The stroke specialist nurses also support nurse-led clinics and our TIA service.

Ward nursing team

Our ward nurses are responsible for assessment, delivery of care, prevention, and identification of complications post stroke, monitoring, and rehabilitation from your stroke. They are supported by nurse associates and healthcare assistants.

At Wexham Park Hospital we work with Buckinghamshire Healthcare NHS Trust to provide a comprehensive 24/7 service.

The Acute Stroke Unit (ASU) is based at Wycombe General Hospital and provides acute stroke assessment, assessment for thrombolysis, (clot-busting treatment) and early rehabilitation. It also provides a 7-day high risk transient ischaemic attack (TIA) service.

The first 10 days of acute stroke care are completed at Wycombe Hospital. If further rehabilitation is needed then Wycombe will transfer you to Wexham Park rehabilitation service.

Ward 16 stroke rehabilitation unit

Stroke rehabilitation is the process of working to restore functional ability and quality of life to people who experience new disabilities as a result of their stroke.

This rehabilitation process usually begins as soon as a person is well enough to work with nurses and therapists. Following your assessment period an individually tailored programme of rehabilitation is started. Therapy goals are often set as part of this process, representing graded steps to help you maximise your recovery.

The team include speech and language therapists, occupational therapists, physiotherapists, doctors, nurses and a dietitian. Other professionals e.g. psychiatry/psychology or pharmacy may be involved if needed.

You will be looked after by a team of nurses, therapists and doctors who are highly experienced in caring for patients needing rehabilitation.

Wexham stroke rehabilitation service offers weeks of intensive rehabilitation for stroke patients. During this time individualised goals will be set with patients, their families and therapist to guide treatment plans and to facilitate discharges from hospital to home. Treatment is provided in one to one sessions as well within therapeutic groups and self-management.

Visiting times: 9am to 9pm daily. Only 2 visitors are allowed per patient.

Stroke outpatient services

• Follow up clinics for patients who have had a stroke.
• This includes a first follow up clinic on discharge.
• You will be invited to receive a 6-month stroke follow up to address prevention and returning to everyday activities from the stroke association team.
• A spasticity management clinic for those with problematic spasticity caused by the stroke. Spasticity (stiffness) of the affected arm or leg increases in frequency over the first 6 months and you can be referred to this clinic by your GP if you have been discharged from the stroke service.

Consultants

Ward 16 is led by Dr Derek Hilton, stroke consultant. Dr Hilton works at both Wycombe General Hospital and Wexham Park Hospitals.

Ward nursing team

Our ward nurses are responsible for assessment, delivery of care, prevention, and identification of complications post stroke, monitoring, and rehabilitation from your stroke. They are supported by nurse associates and healthcare assistants.

The stroke unit has a team of specialist therapists to assess, support and provide rehabilitation to patients. The team will work with you and your family to identify goals and work with you throughout your hospital stay to help you progress.

The therapists you see will depend on the difficulties you are experiencing after your stroke.

Therapy sessions can be carried out in groups and we ask that visitors do not attend these group sessions.

A stroke can cause a range of difficulties. These can include physical deficits, cognitive impairment such as memory and thinking, visual and perceptual changes and changes to emotion or mood. These difficulties can make it challenging to complete everyday activities.

The occupational therapists will complete a thorough assessment looking at all of these aspects. Depending on your difficulties, they will work with you to improve your skills and confidence. This may include:

• Functional task practice for example washing and dressing, feeding, kitchen tasks
• Rehabilitation of the upper limb including tone management
• Cognitive and visual rehabilitation
• Consider appropriate seating and positioning to encourage engagement in function
• Advice on new ways of doing things to increase your independence and safety
• Considering how you will manage in your own home and what help or equipment you may need
• Advice on returning to work, driving or leisure activities

We encourage patients to wear their own clothing in hospital and ask that you have a selection of your own toiletries and comfortable clothing. Familiar items such as a blanket, photos, and magazines can be of comfort while in hospital, and can help engagement with therapy.

These sessions may be 1 to 1 interventions or may be done as part of a group.

A stroke can affect the part of your brain that controls movement. It can cause weakness or paralysis on one side of the body.

The physiotherapy team will assess all the components required for movement, including strength, range of movement, sensation, tone, balance and co-ordination.

They will then devise rehabilitation programs to improve any difficulties you may have as a result of the stroke. Our aim is to help you regain as many as possible of the functional tasks and hobbies you were doing prior to the stroke, though residual difficulties will remain for some.

Physiotherapists will work with you directly in 1 to 1 and group sessions. We may also leave exercises or advice for things you can be doing independently or with your friends and family which may help the rehabilitation process.

The physiotherapists and occupational therapists also provide recommendations about positioning in the bed and chair to ensure this also aids your rehabilitation and minimises the risk of developing complications.

A stroke may cause difficulties with communication or swallowing. If you are experiencing these difficulties, you will be referred to the speech and language therapists (also referred to as speech therapists).

The speech therapists will assess your swallowing and provide recommendations to try and make eating and drinking as safe as possible. Some people have severe difficulties with swallowing after a stroke and may require feeding via a tube either short or long term. The team will discuss this with you in more detail if needed.

Communication problems are common after a stroke. The speech therapists will assess your speech and language to identify any difficulties. They will provide exercises and strategies to help you communicate. They may provide you with picture, word or alphabet charts to help you communicate your needs if you are struggling to talk.

The speech therapists also work with your relatives on strategies to help you communicate.

If you have difficulties in eating or swallowing, you may be referred to a dietitian. The dietitian will assess your dietary requirements and guide your nutritional health by monitoring your weight and food/fluid intake.

The dietitian's role includes:

• If your swallow is impaired they'll advise on alternative feeding methods- for example a nasogastric feeding tube. The dietitian will provide an appropriate feeding regimen to best meet your nutritional needs and will continue to review your progress during your stay in hospital.
• Providing nutritional support if you have a poor appetite or weight loss. A high protein high energy diet may be recommended to improve your nutritional status and additional nutritional supplements may also be needed.
• Providing guidance on suitable food and drinks to make sure your nutritional needs are met when on a modified texture diet.
• Reducing your dietary risk factors by providing advice on a healthy diet if you have diabetes, hypertension, high cholesterol or are overweight.

The dietitian will also liaise with your family/carers and community services including your GP to ensure that specific nutritional intervention is continued following your discharge from hospital.

A stroke can cause a range of psychological changes. These can affect emotion, thinking, memory, personality or behaviour. These ‘hidden’ aspects of stroke can have as much impact as the physical changes. These changes can be in addition to the emotional effects many people experience after having a serious and unexpected health event.

Clinical psychologists working in stroke services aim to support people to cope with the effects of their stroke in a variety of ways. You may be referred to clinical psychology for further assessment to better understand the nature of any changes, and we can offer advice to manage the changes. We may work jointly with your therapy or care team. We can offer information and support to families.

Sometimes these changes are not evident until someone has left the hospital. We also have a small outpatient service where we can assess and advise on stroke-related psychological changes after your discharge from hospital.  This can be discussed in your stroke follow-up clinics. The service can be used up to six months following your discharge from hospital. 

Therapy assistants are core members of the stroke team. They work alongside the therapists to deliver your therapy. They may practice exercises and activities with you to help you to progress. They provide feedback to the therapists who are leading on your care so that your exercises can be adjusted.