Stroketelemedicine

The East of England Stroke Telemedicine Service uses secure video conferencing to connect hospitals with stroke consultants out of hours. The service has improved provision of stroke care across the region. More patients now receive life-saving thrombolysis treatment, and the region benefits from increased access to stroke expertise.

The East of England Stroke Telemedicine Service uses secure video conferencing to connect hospitals with stroke consultants out of hours. The service has improved provision of stroke care across the region. More patients now receive life-saving thrombolysis treatment, and the region benefits from increased access to stroke expertise.

About 85% of all strokes are ischaemic, meaning a blood clot is causing a blockage in the brain. These strokes can be treated with clot-busting medicine, known as thrombolysis, however this needs to be given within four and a half hours of the onset of stroke symptoms.

The service launched across a network of hospitals. While hospitals could all provide care supervised by a stroke consultant during weekdays, if a patient arrived in the evening or over a weekend, they would need to be transferred to one of a small number of 24-hour hyper acute stroke units in the area. Often by the time patients arrived it was too late to administer the drugs. Combined with a national shortage of stroke consultants, only 1% of patients were being thrombolysed across the region. To date, over 2,000 patients have been assessed via the service, with 40% of those receiving thrombolysis.

Someone dies from a stroke every 13 minutes in the UK. About 85% of all strokes are ischaemic, meaning a blood clot is causing a blockage in the brain.

These strokes can be treated with clot-busting medicine, known as thrombolysis, however this needs to be given within four and a half hours of the onset of stroke symptoms. It’s a dangerous treatment, so must be overseen by a stroke consultant. The sooner a person receives treatment, the less risk of death or disability.

While hospitals could all provide care during weekdays, if a patient arrived in the evening or over a weekend, they would need to be transferred to a 24-hour hyper acute stroke unit. Often by the time patients arrived it was too late to administer the drugs. Combined with a national shortage of stroke consultants, only 1% of patients were being thrombolysed across the region.

  • Telemedicine is used to connect hospitals with stroke consultants out of hours via secure video link. With the support of stroke nurses, consultants can be virtually present in a consultation. The software is accessed from carts which are wifi enabled and equipped with high quality webcams.
  • Carts can be wheeled to the patient’s bedside, enabling the consultant to speak to the patient and their family, and assess the patient visually. The consultant can also access CT scan images through a secure radiology system. If all clinical staff and the patient agree to thrombolysis, the safe administration of the treatment can be overseen by the consultant. The patient is then admitted to the hospital’s HASU for ongoing treatment.
  • Each hospital provides a consultant for the regional rota. Day to day management is undertaken by a stroke telemedicine manager and Eastern AHSN provide IT support.
  • Before the service, it was estimated that around 1% of stroke patients in the region were being thrombolysed. To date, over 2,000 patients have been assessed via the telemedicine service, with 40% of those receiving thrombolysis. This reduces the chances of patients being left with lifelong physical, cognitive and mental disabilities.
  • The team estimate 15% of all patients receiving thrombolysis will make a full recovery. As well as the positive impact on patient outcomes, this represents significant financial savings for the health service. The estimated cost to the NHS of caring for a disabled stroke patient over five years is between £15-30k. The increased number of patients receiving thrombolysis suggests a significant reduction in health costs across the region.
  • There are now seven hospitals using the service, which is hosted by Queen Elisabeth Hospital Kings Lynn NHS Foundation Trust.
  • As the hospitals share a rota of out of hours consultants they have collectively made savings of over £500,000 in consultant salaries.
  • £350,615 has also been saved since 2010 from avoided ambulance transfers across all of the eight hospitals.
  • Figures from Dec 2015 showed that the average time between the onset of stroke symptoms and administration of thrombolysis (onset to needle time) had been reduced by 48 minutes – improving recovery outcomes for patients.
© Eastern AHSN