The Royal London Hospital | Mechanical Thrombectomy External Referral Pathway |
Monday–Sunday 24-hour stroke service

Last updated 19th July 2021

Royal London Hospital Royal London hospital (Barts Health) we offer a 24/7 Mechanical Thrombectomy service

At the Royal London hospital (Barts Health) we offer a 24/7 Mechanical Thrombectomy service for acute stroke. Please read and follow our referral pathway guidelines. This will prevent repetition and variability, and ensure concise and rapid responses. If you have any queries please contact: o.spooner@nhs.net
 

Dr Oliver Spooner, Consultant Stroke Physician and Mechanical Thrombectomy Lead for Stroke Medicine

Click here for Pathway A
 

Non-AI assisted interpretation

of images

 


 

 

 

view PDF

Click here for Pathway B

 

AI-assisted CT interpretation and image transfer

&

CT Perfusion IS NOT available



view PDF

Click here for Pathway B

AI-assisted CT interpretation and image transfer

&

CT Perfusion IS available



view PDF

Select pathway above before continuing

Pathway (non-AI assisted)

 

Referral Criteria

  • Under 5 hours from stroke onset/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

 

Note: some cases not completely meeting criteria may be considered by the HASU team

NEXT STEPS (1-9) IF CRITERIA MET


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

2. Stroke consultant at referring centre to alert RLH stroke consultant by telephone.  RLH stroke consultant will phone back to confirm       suitability for mechanical thrombectomy. 
 

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

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

CLINICIAN WITH PATIENT

5. Open referral form here
 

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

Start copy

Time of initial  telephone referral to RLH:

Time imaging available for review:

Time of acceptance for transfer by RLH:

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: ***

End copy

***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.

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

8. 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.

9. 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.

INSTRUCTIONS FOR NURSE AT REFERRING CENTRE

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.

AFTER MECHANICAL THROMBECTOMY

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.

 

IMAGE EXCHANGE PORTAL (IEP)
 

Destination/ institution:

Barts Health Stroke and Trauma Network
 

IEP node: 

RNHB1_S_BB01
 

Priority:

Clinical emergency

RLH STROKE CONSULTANT (24 hrs)

Switchboard 020 7377 7000

Ask for the Stroke Consultant

RLH ON-CALL STROKE SHO (24 hrs)


Direct Dial 020 3594 5651 
 

RLH switchboard* 020 7377 7000 bleep 1230

*If can't get through ring RLH switchboard and ask for Stroke SHO

Pathway B (AI-assisted and CT Perfusion imaging IS NOT available)

 

 

Referral Criteria

  • Under 5 hours from stroke onset/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

Note: some cases not completely meeting criteria may be considered by the HASU team

NEXT STEPS (1-10) IF CRITERIA MET

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


2Transfer 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. 
 

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.

CLINICIAN WITH PATIENT

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?

Start copy

Time of initial  telephone referral to RLH:

Time imaging available for review:

Time of acceptance for transfer by RLH:

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: ***

End copy

***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.

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.

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.

INSTRUCTIONS FOR NURSE AT REFERRING CENTRE

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.

AFTER MECHANICAL THROMBECTOMY

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.

IMAGE EXCHANGE PORTAL (IEP)
 

Destination/ institution:

Barts Health Stroke and Trauma Network
 

IEP node: 

RNHB1_S_BB01
 

Priority:

Clinical emergency

RLH STROKE CONSULTANT (24 hrs)

 

Switchboard 020 7377 7000

Ask for the Stroke Consultant

RLH ON-CALL STROKE SHO (24 hrs)


Direct Dial 020 3594 5651 
 

RLH switchboard* 020 7377 7000 bleep 1230

*If can't get through ring RLH switchboard and ask for Stroke SHO

Pathway B (AI-assisted and CT Perfusion imaging IS available)

 

 

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 criteria may be considered by the HASU team

NEXT STEPS (1-10) IF CRITERIA MET

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


2Transfer 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. 
 

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.

CLINICIAN WITH PATIENT

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?

Start copy

Time of initial  telephone referral to RLH:

Time imaging available for review:

Time of acceptance for transfer by RLH:

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: ***

End copy

***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.

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.

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.

INSTRUCTIONS FOR NURSE AT REFERRING CENTRE

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.

AFTER MECHANICAL THROMBECTOMY

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.

IMAGE EXCHANGE PORTAL (IEP)
 

Destination/ institution:

Barts Health Stroke and Trauma Network
 

IEP node: 

RNHB1_S_BB01
 

Priority:

Clinical emergency

RLH STROKE CONSULTANT (24 hrs)

Switchboard 020 7377 7000

Ask for the Stroke Consultant

RLH ON-CALL STROKE SHO (24 hrs)


Direct Dial 020 3594 5651 
 

RLH switchboard* 020 7377 7000 bleep 1230

*If can't get through ring RLH switchboard and ask for Stroke SHO