Stroke patients across the North East of England are set to benefit from the expansion of a new telemedicine project in the hope of speeding up care and improving patient outcomes.
North East Ambulance Service (NEAS) is working with the region’s Integrated Stroke Delivery Network (ISDN) to implement audio-visual calling from the ambulance to the stroke unit to improve emergency stroke care.
The ambulance service was made a Global Digital Exemplar (GDE) in 2018 and part of the programme involved trialling telemedicine in the NEAS Emergency Operations Centres. The move enabled clinicians working within its Clinical Assessment Service to video call 999 and 111 callers in order to ensure those patients receive appropriate care.
The same technology is now being expanded to allow ambulance clinicians to video call the stroke units directly, allowing the receiving stroke specialist to assess the patient face to face before they enter the hospital doors. By doing so, it is hoped more stroke patients will receive appropriate care faster.
Currently, if a paramedic suspects a patient has had a stroke, they usually contact their nearest stroke unit by telephone. During that conversation, they will discuss the patient’s symptoms and relevant medical history to assess whether it is indeed a stroke or a stroke mimic. They then will come to a conclusion about which hospital is most appropriate.
The new telemedicine project is expected to begin in August, starting with the Queen Elizabeth Hospital in Gateshead, and Darlington Memorial Hospital, followed by University Hospital of North Durham and the Royal Victoria Infirmary in Newcastle. It will then be evaluated to inform whether the process will be rolled out region wide.
The stroke specialist will receive a telemedicine call from paramedics, with the video to review the patient enabled once privacy can be assured. A decision will then be made whether to admit the patient directly to the stroke unit, or whether the patient can be safely seen elsewhere, such as the emergency department.
The project will be delivered by paramedics Sarah Hepburn and Abbie Tutchings, who will lead on paramedic training alongside a large team of specialist nurses, consultants and other clinical teams who are training hospital staff, assessing all the patients by video, making clinical decisions and recording patient outcomes.
Dr Graham McClelland, a research fellow at NEAS and currently funded by the Stroke Association to explore telemedicine for prehospital stroke care, is supporting the project.
“Some of the research I have been involved in has highlighted the challenges NEAS staff have in identifying stroke patients, with around 40 per cent of suspected stroke patients being stroke mimics,” he says. “We do know that rapid identification, rapid transport to specialist stroke care and pre-alerting the hospital about the stroke patient are the best things NEAS clinicians can do for stroke patients.
“Because stroke is such a time critical condition, we hope to demonstrate that video triage improves communications between NEAS and the stroke services and therefore informs better decisions about the right destination and care for each patient.
“Getting the stroke team involved with the patient before they even get through the front door of the hospital should also reduce the time it takes for the patient to be seen when they arrive at hospital,” the researcher explains. “Even if it’s only a five minute reduction in time, this could make all the difference to a patient’s outcome.”
Dr Louise Southern, consultant stroke physician and the lead clinician for this project within the hospital trusts says: “Our joint Newcastle/Gateshead stroke service has delivered real benefits in terms of faster treatment, and therefore reduced long-term disability.
“We hope that this project will build on that success, by allowing RVI stroke clinicians to see patients with suspected stroke when they are still in the ambulance or the Emergency Department at QE hospital. Pilot projects elsewhere have suggested that this can lead to better decisions about triaging patients to the right place for them. Both RVI and QEH teams are proud to be delivering this project for residents in Newcastle and Gateshead.”
