Table 1 Care bundles for stroke 90:10

Early hours (Bundle 1)

1. Brain imaging within 24 hours of admission to hospital (CT scan) to confirm stroke type (ischaemic or haemorrhagic) and determine management.

2. Delivery of aspirin or an alternative antiplatelet (for patients where an antiplatelet is clinically indicated) within 24 hours of admission to modulate stroke complications and improve outcomes. For shorthand, we refer to this as ‘aspirin.’

3. Swallow screen within 24 hours of admission, to prevent unnecessary withdrawal of nutrition, support timely administration or modification of aspirin/antiplatelet delivery and highlight patients who need on-going management of swallow safety.

4. Weight assessment on admission, as a marker of the likelihood of repeated weighing and diligent management of nutrition.

Rehabilitation (Bundle 2)

1. Physiotherapy assessment within 72 hours of admission to improve early mobilization, and increased likelihood of targeted goal setting.

2. Occupational therapy assessment within 4 days of admission to support activities of daily living, memory, perception and cognition.

3. Mood assessment (during the in-patient stay) to screen for altered mood and other factors, given that post-stroke depression is known to affect the likelihood of long-term recovery.

4. Documented evidence of MDT goals set for rehabilitation as a marker of patient involvement in care and multidisciplinary team working.

5. 50% of the patient’s hospital stay on a stroke unit, defined using the National Audit criteria, given evidence that stroke units reduce mortality and improve patient outcomes.