ࡱ>  /bjbj .'!8 tdh , "$r  4"  (8 0h ,D%D% h D% :     Template for Stroke (HASU+SU) Discharge Summaries to be used in conjunction with ICHT Electronic Discharge Communication (EDC) system Copy and paste into separate relevant boxes of EDCPatient nameHospital numberReason for AdmissionMain Condition (choose from ICD-coded diagnosis list below this table, then add free text detailing specific final diagnosis, including laterality)ICD code : Full diagnosis:Other diagnosis Other Past Medical History (other comorbidities)From here on, copy and paste into Treatment box of EDCClinical Narrative (Treatment/Operation) Mode of admission, progress, management, and complicationsClinical Narrative: Social history Include e.g. driving, usual place of residence, PoC, family input, mobilitySocial history: Vascular Risk factors Select from: Previous stroke or TIA Atrial fibrillation New diagnosis Y/N Diabetes New diagnosis Y/N Hypertension Hypercholesterolaemia Ischaemic heart disease Smoker Alcohol excess Increased BMIVascular Risk factors: Physical Examination On admission On discharge BP on discharge:Physical Examination: On admission: On discharge: BP on discharge:National Institutes of Health Stroke Scale (NIHSS) score On admission Pre-discharge NIHSS: On admission: Pre-discharge:Treatment and procedures eg: Thrombolysis Aspirin/clopidogrel Antibiotic course Thrombectomy NG tube PEG tube Catheterisation PICC line Trial participation Treatment and procedures:Relevant Investigations and Results CT brain MRI brain CTA Carotid Dopplers Echocardiogram ECG Telemetry CXR Bloods: (abnormal or relevant normal) Glucose Random/fasting Cholesterol Random/fasting Urine: (if positive) Discussion from Neuroradiology meeting (where applicable; include date)Relevant Investigations and Results: CT brain MRI brain CTA Carotid Dopplers Echocardiogram ECG Telemetry CXR Bloods Glucose Cholesterol Urine Physical Ability e.g. level of mobility, swallowing, continence Barthel score Prior to admission Pre-discharge Modified Rankin Scale score Prior to admission Pre-dischargePhysical Ability: Barthel score Prior to admission Pre-discharge Modified Rankin Scale score Prior to admission Pre-dischargeCognition If applicable: Abbreviated mental test Montreal Cognitive Assessment (MoCA) scoreCognition:Psychological assessment Specify if mood screen score available and assessment tool.Psychological assessment: Relevant Legal Information (e.g. was an independent Mental Capacity Act Advocate required)Relevant Legal Information: Discharge Arrangements (please select from below, modify if required) Discharged to usual place of residence Discharged home, no services required Discharged home, package of care arranged Discharged to residential home Discharged to nursing home Transferred to local Acute Stroke Unit for ongoing management Transferred to ______ ward under ____ team Other Discharge Arrangements: Advice, recommendations and future plans Specify if differing target BP advice Also include where applicable: If AF/PAF and anticoagulant not commenced: document reason why not, or plan for future consideration Any other recommendations to GP (eg monitoring renal function) Unresolved issuesAdvice, recommendations and future plans: Where appropriate, individualised advice has been given regarding stopping smoking, alcohol consumption, a healthy diet and exercise. Targets: BP 130 /80 Hb1Ac % 6 8 Cholesterol: TC less than 4 and LDL less than 2  Driving Include unless diagnosis non-stroke, or not applicable for other established reasonDriving: DVLA guidelines state that you are not allowed to drive a private vehicle for at least four weeks after the onset of a transient ischaemic attack (TIA) or stroke. Imperial College Healthcare NHS Trust recommends seeking medical advice prior to returning to driving. Taxi drivers or holders of a special licence will require additional advice. Flying Include unless diagnosis non-stroke, or not applicable for other established reason Flying: Imperial College Healthcare NHS Trust recommends that you do not fly for six weeks after the onset of a TIA or stroke.Patients expressed wishes or concerns: Include any expressed patient wishes or concerns regarding their management Patients expressed wishes or concerns: Actions and Outstanding Investigations Awaited investigations or results Next INR check: when, where and subsequent plan (if applicable) Community & Specialist Services (e.g. nursing, therapy, home care) Hospital follow-up plan The follow-up plan will be decided upon by the Consultant but, in general, will be 6-8 weeks from discharge for patients admitted with a stroke or TIA. In general, patients repatriated from HASU to local stroke units will not be followed up in CXH Stroke Clinic, however exceptions will be determined by the Consultant. Actions and Outstanding Investigations: Follow up plan:  ICD Code for Main Condition (As per Stroke Database) InfarctionInfarct - Middle cerebral artery (TMCAS or PMCAS) ischaemic stroke - G460Infarct - Anterior cerebral artery territory ischaemic stroke - G461Infarct - Posterior cerebral artery territory ischaemic stroke - G462Infarct - Brain stem stroke syndrome - G463Infarct - Cerebellar stroke syndrome - G464Infarct - Pure motor lacunar syndrome - G465Infarct - Pure sensory lacunar syndrome - G466Infarct - Other lacunar syndromes - G467Bleed/haemorrhageSubarachnoid haemorrhage - Sequelae of subarachnoid haemorrhage - I630Haemorrhage - Intracerebral haemorrhage in hemisphere, subcortical - I610Haemorrhage - Intracerebral haemorrhage in hemisphere, cortical - I611Haemorrhage - Intracerebral haemorrhage in hemisphere, unspecified - I612Haemorrhage - Intracerebral haemorrhage in brain stem - I613Haemorrhage - Intracerebral haemorrhage in cerebellum - I614Haemorrhage - Intracerebral haemorrhage, intraventricular - I615Haemorrhage - Intracerebral haemorrhage, multiple localized - I616Haemorrhage - Other intracerebral haemorrhage - I618Haemorrhage - Intracerebral haemorrhage, unspecified - I619Vascular/infectiveDissection - Dissection of cerebral arteries, non-ruptured - I670Aneurysm - Cerebral aneurysm, non ruptured - I671Progressive vascular leukoencephalopathy - Progressive vascular leukoencephalopathy - I673Hypertensive encephalopathy - Hypertensive encephalopathy - I674Moyamoya disease - Moyamoya disease - I675Cerebral Venous/Sinus thrombosis - thrombosis of intracranial venous system - I676Vasculitis - Cerebral arteritis, not elsewhere classified - I677Viral encephalitis - Unspecified viral encephalitis - A86XUnspecified viral encephalitis - Unspecified viral encephalitis - A86XEpilepsy/SeizureEpilepsy - Locl-rel(foc)part)symp epilep/ epilptic syn simple part seiz - G401Epilepsy - Locl-rel(foc)part)symp epilep/epilptic syn complex part seiz - G402Epilepsy - Generalized idiopathic epilepsy and epileptic syndromes - G403Epilepsy - Other generalized epilepsy and epileptic syndromes - G404Epilepsy - Epilepsy, unspecified - G409TIATransient cerebral ischaemic attacks - Vertebro-basilar artery syndrome - G450Transient cerebral ischaemic attacks - Carotid artery syndrome (hemispheric) - G451Transient cerebral ischaemic attacks - Multiple and bilateral precerebral artery syndromes - G452Transient cerebral ischaemic attacks - Amaurosis fugax - G453Transient cerebral ischaemic attacks - Transient global amnesia - G454Transient cerebral ischaemic attacks - Other transient cerebral ischaemic attacks and related synd - G458Transient cerebral ischaemic attacks - Transient cerebral ischaemic attack, unspecified - G459MigraineMigraine - Migraine without aura [common migraine] - G430Migraine - Migraine with aura [classical migraine] - G431Migraine - Status migrainosus - G432Migraine - Complicated migraine - G433Migraine - Other migraine - G438Migraine - Migraine, unspecified - G439NeoplasmMalignant neoplasm of, cerebral meninges - Malignant neoplasm of meninges - C700Malignant neoplasm of, cerebral meninges - Malignant neoplasm of brain - C715Secondary malignant neoplasm of brain & cerebral meninges - Secondary malignant neoplasm of other sites - C793Disorders of vestibular functionDisorders of vestibular function - Meniere's disease - H810Disorders of vestibular function - Benign paroxysmal vertigo - H811Disorders of vestibular function - Vestibular neuronitis - H812Disorders of vestibular function - Other peripheral vertigo - H813Disorders of vestibular function - Vertigo of central origin - H814Disorders of vestibular function - Other disorders of vestibular function - H818Disorders of vestibular function - Disorder of vestibular fucntion, unspecified - H819Delirium/Mental healthDelirium not induced by alcohol and other psychoactive subs - Delirium not superimposed on dementia, so described - F050Delirium not induced by alcohol and other psychoactive subs - Delirium superimposed on dementia - F051Delirium not induced by alcohol and other psychoactive subs - 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