TTA has an open invitation to industry leaders to provide a personal perspective on issues of importance to readers. This week, Lynda Sibson, telemedicine manager for the East of England Stroke Telemedicine Partnership, reflects on how the coronavirus pandemic enabled its successful service to move into new areas at speed.
Interested contributors should contact Editor Donna. (We like pictures and graphs too!)
The East of England Stroke Telemedicine Stakeholder Partnership was set up in 2010 after a review found the region was struggling to meet national target times for delivering ‘clot busting’ drugs to patients with acute ischaemic stroke.
A shortage of consultants made it impossible to offer a 24/7 consultant-led thrombolysis service at all of the region’s hospitals, but long journey times made it difficult to transfer patients quickly to specialist centres.
Now, when a suspected Acute Ischaemic Stroke (AIS) patient arrives at one of the seven hospitals that we support out of hours, a telemedicine cart is taken to their bedside by the local stroke team. The stroke nurse specialists quickly establish the video link to a specialist, on-call consultant, using technology from our partner Visionable.
Since the telemedicine service commenced 10 years ago, up to the end of March 2021 we have assessed over 4,300 patients. Of these, 1,846 were thrombolysed, and just a fifth of those who weren’t had missed the national 4.5 hour target (the rest saw their condition change or were not experiencing a stroke).
A health economic analysis by the University of East Anglia showed that the service is cost-effective and delivers clinically effective outcomes for patients, with reduced length of hospital stay. So, we have been looking to expand.
Pilots and frustrations:
Supported by the Eastern Academic Health Science Network’s (AHSN) Digital Pioneer Programme, we were able to run a feasibility study undertaken with East of England Ambulance Service NHS Trust. In conjunction with Ipswich Hospital, we have been exploring how we can utilize the existing telemedicine system to assist paramedics in the assessment of ‘stroke mimics’ more effectively. Up to 40% of stroke presentations are ‘stroke mimics, and commonly include mini-strokes (known as Transient Ischaemic Attacks) and migraines, amongst others.
The paramedics were provided an iPad with the Visionable app loaded on it, so they could use it to contact the stroke consultant for advice and the aim was to avoid admission to A&E since most strokes mimic patients can be safely managed in a less urgent setting than A&E. In our feasibility study, all but one patient (who had a chest infection) avoided this trip to A&E, with most patients being managed in a follow-up hospital clinic or by their GP.
We plan to roll this project out across the region, commencing initially with Ipswich, Norfolk & Norwich and The Queen Elizabeth Hospital King’s Lynn. We are also currently running a daily pilot at Ipswich Hospital, and later with The Queen Elizabeth Hospital Kings Lynn, of a virtual ward round for low-risk stroke patients who need consultant review within 14 hours of admission, to meet government targets. Early data suggests that this is working well, with positive feedback from both stroke consultants and the stroke specialist nurses.
Let’s learn lessons and keep up momentum:
Virtual consultations and just one of the many tools that can be used to address healthcare challenges, and it is important to make sure that they are deployed appropriately, safely, and effectively.
In ten years, we have learned a lot about IT infrastructure, technology, and its associated governance: we use Visionable because it enables the consultant to see the patient, is user-friendly, and meets IG because no patient identifiable data is transmitted over the video link.
We have also learned that finding clinical champions, supporting the consultant team, and training junior doctors and base teams are essential. However, we have also shown that digital consultations work; and the wider NHS has just learned the same lesson in the pandemic.
Let’s keep using technology-enabled care to support clinicians and make sure patients have access to safe, high-quality care they need, when and where they need it.
Always remember FAST – if ANY of the following – FACE, ARMS, SPEECH are affected, it is TIME to call the emergency services for help.
Hat tip to Chloe Bines of Highland Marketing