A partnership between local hospitals in the East of England was created to provide swift access to out of hours stroke expertise.
The use of telemedicine technology meant that people could have rapid, direct access to stroke expertise and treatment.
This helped improve the delivery of treatment for patients experiencing an acute ischaemic stroke (AIS) including those in rural areas.
The East of England Stroke Telemedicine Partnership is a unique and innovative remote consultation service across network of seven acute NHS trusts. It supports urgent and timely treatment for stroke patients presenting out of hours and weekends 365 days a year.
The aim of this service is to provide high standard of stroke care through multi-professional approach.
East of England stroke telemedicine partnership
What was done and why
The recommended amount of time between someone first experiencing AIS symptoms and receiving treatment such as thrombolysis is four and a half hours. Thrombolysis is the breakdown of blood clots forming in blood vessels using medication. The East of England has difficulty achieving this goal as many people with AIS live too far from their local Hyper Acute Stroke Unit to receive treatment. There is also a shortage of consultant and physicians in the area.
Telemedicine is where video conferencing is used to deliver medical care remotely. It has been used in clinical areas such as dermatology, emergency medicine and in the armed forces for many years.
An improved stroke pathway was implemented using telemedicine that would help address some of the issues around stroke care. This included accessing computerised CT scanning and thrombolytic treatment.
A stroke nurse was chosen as the pathway champion and a contract ensured that a stroke consultant would join the telemedicine rota.
A secure online video conferencing system by IOCOM (now called Visionable) was also chosen. It provides the telemedicine technology and it runs on PCs in the telemedicine carts.
Outcomes and impact
The telemedicine service started with 4 regional hospitals and 4 stroke consultants on the regional telemedicine rota.
Since 2011, 3 more hospitals have started using the service, and 2 more hospitals are looking to change their out of hours stroke care services.
Since it began the service has:
- Assessed over 3,500 patients.
- Advised thrombolysis treatment for an average of 40% of patients with symptoms.
- Treated patients within a time of 58 minutes representing a 37% improvement.
This means that many more patients have been treated closer to home. This reduces risks and costs to them and their families.
The improved thrombolysis rate can also reduce both the length of hospital stay and the number of rehabilitation issues experienced by service users.
What was learnt
Good communication and an understanding of how each hospital’s local system is made up is key to making a telemedicine stroke service work.
The staff required for the running of a telemedicine stroke pathway include:
- A dedicated telemedicine manager with an operational view of the service.
- A clinical or nursing lead to provide support as required.
- Local nurses who are able to deliver the suggested care.
Stroke education and training are important in ensuring that staff are updated and feel confident using telemedicine.