North East stroke patients set to benefit from telemedicine expansion

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, having been one of five ambulance services nationally to be awarded funding from NHS England.

NEAS has a long track record with digital innovation and was one of the first ambulance trusts made a Global Digital Exemplar (GDE) in 2018. Part of the GDE programme involved trialling telemedicine in the NEAS Emergency Operations Centres, enabling clinicians working within its Clinical Assessment Service to video call 999 and 111 callers in order to ensure those patients receive appropriate care.

That 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 will 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 whether it’s likely to be a stroke mimic, and will then come to a conclusion about which hospital is most appropriate for that patient. That decision can then impact the care that patient receives.

The telemedicine project is expected to begin in August, starting with the Queen Elizabeth Hospital in Gateshead, and Darlington Memorial Hospital, which don’t currently have stroke units, followed by University Hospital of North Durham and the Royal Victoria Infirmary in Newcastle. It will then be evaluated, with support from Newcastle University, 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 and are both experienced paramedics with 21 years’ experience between them.

Working alongside on this joint project between NEAS and hospital trusts is 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.

He said: “Some of the research I have been involved in has highlighted the challenges NEAS staff have in identifying stroke patients, with around 40% of suspected stroke patients being stroke mimics. 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. 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 at the RVI and QEH, is the lead clinician for this project within the hospital trusts.

She said: “Our joint Newcastle/Gateshead stroke service has delivered real benefits to stroke patients in terms of faster treatment, and therefore reduced long-term disability,” she said.

“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.”

Dr Stuart Huntley, Clinical Lead for the North East and North Cumbria ISDN said: “It’s a great achievement to have been one of only a handful of collaborations to be awarded this funding to explore the possible benefits of an extended telemedicine interaction between paramedics and stroke specialists. Better access to effective treatments for stroke patients in the right place, at the right time is a priority for our ISDN and we look forward to seeing the results of this important project.”

NEAS Medical Director Dr Mathew Beattie added: “As an industry leader in research, particularly stroke research, and having been an early implementer of telemedicine, we were keen to work with our regional teams to understand whether introducing this technology within our ambulances can make a difference to the care we are able to provide to our patients.

“Graham’s research through his work with the Stroke Association was instrumental in informing our bid to NHS England and it’s testament to him that we are where we are. We look forward to seeing the results and to, ultimately, improve patient care within the North East.”

Dr Yvette Oade, Acting Medical Director for NHS England in the North East and Yorkshire, said: “The NHS committed to utilising technology to improve patient outcomes within the NHS Long Term Plan. It’s great to see NEAS adopting this system, which supports clinical decision-making so that suspected stroke patients get the right care at the right place - saving lives and preventing life-long disability in the process.”