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Referral Criteria​

• ​5–24 hours since last seen well

• CT scan: ASPECTS over 5

• CTA: confirms occlusion position ICA/M1/proximal M2

• NIHSS: over 5 or functionally disabling

• Pre-morbid mRS: 0–2

• Absence of severe life-limiting illness

• Stable airway

• CTP: favourable for reperfusion therapy

Note: some cases not completely meeting all criteria may be considered.

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NEXT STEPS (1-10) IF CRITERIA MET

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1. Make Brainomix images available to RLH via e-Stroke Suite app or share as e-Stroke case (PDF or cloud link).

2. Transfer CT and CTA images (arch to vertex) via the Image Exchange Portal (IEP) as an emergency. 
 

3. Stroke consultant at referring centre to alert RLH stroke consultant by telephone.  RLH stroke consultant will phone back to confirm       suitability for mechanical thrombectomy (an unstable airway requires ITU discussion). 
 

4. If patient is accepted, call ambulance immediately for critical transfer to the Emergency Department of The Royal London Hospital. 
 

5. Alert patient/next of kin about transfer to RLH for thrombectomy. Explain intended benefits and risks.

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CLINICIAN WITH PATIENT

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6. Open referral form here
 

7. Copy-paste the text below into the field What are the main Symptoms and Signs and when did these start?

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Start copy

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Time of initial  telephone referral to RLH:

Time imaging available for review:

Time of acceptance for transfer by RLH:

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Onset time:

Time last seen well:

CTH completed time: 

CTA completed time:

ASPECTS score:                                                           

(interpreted by Physician / Radiologists / AI      *please delete as appropriate)

Blood results: Hb, Cr, other results if abnormal:

Time started IV Thrombysis (if applicable):
 

Does patient have capacity to consent to MT procedure?

Has the referring team discussed MT risks and benefits with family?:

(*need to update family if not).

NOK contact details:

Time ambulance requested:

Departure time from local hospital: ***

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End copy

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***note if form completed prior to patient departure by Ambulance/ please then update us via Quick Message (or QCKmsg) on referapatient when the patient has departed and please state the time that they have left your centre via ambulance.

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8. You will receive a reply with a link and QR code to access your referral form.
 

9. After sending the referral form, telephone RLH on-call stroke SHO (020 3594 5651 24 hrs or RLH switchboard 020 7377 7000 bleep 1230) to let them know what is happening.

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10. Send ambulance departure time: go into your referral form via the link you received and use the instant messaging icon (arrow symbol) to give the time.

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INSTRUCTIONS FOR NURSE AT REFERRING CENTRE

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Please now call for nurse to nurse handover. Ring 07507 787001 or RLH switchboard 020 7377 7000, bleep 1229.
If accompanying patient in ambulance, ring again when 15 minutes away with arrival time. Ambulance crew should pre-alert ED resus when 15 mins away.

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AFTER MECHANICAL THROMBECTOMY

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The patient will be transferred back to their referring centre within 24–48 hours.

A local hyperacute stroke bed must be allocated at the time of initial referral for the patient's return.

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