The ‘Stroke – Act FAST’ campaign has seen a tremendous increase in suspected stroke cases being quickly identified and the patients transferred to hospitals for diagnosis and treatment. However, there remains the requirement for A&E departments to have the necessary specialist consultant available to make the correct prognosis, which is largely visual in nature, and implement the correct treatment plan for the patient. There is a significant cost involved with the initial treatment and ongoing care of stroke patients, and the NHS has been looking at how services could be improved to help reduce this at the same time the number of patients presented has increased.
The problem
Correctly diagnosed, certain types of stroke can be treated by the patient being thrombolysed which helps to thin the blood and remove the clot causing the stroke. However, only specialist stroke clinicians are qualified to make the correct prognosis and prescribe the treatment. There is a critical period of 4 hours from the time of a stroke occurring to treatment being started in order to effect a positive outcome for the patient.
Typically, by the time a patient has been identified as a potential stroke victim, transferred to a hospital and admitted to the A&E department, an hour of this window has been lost leaving less than three hours for the consultation, prognosis and treatment to be prescribed.
In Cumbria & Lancashire, hospitals are sufficiently resourced during the day time to quickly assess stroke patients, responding quickly to cases and meeting the government KPI. However, out of hours (OOH) there are not enough resources available to provide on-site stroke consultants across all sites all of the time.
Historically, one stroke consultant would typically be available on call OOH to respond to A&E admissions of suspected stroke.
The large geography across the Cumbria & Lancashire area, where the consultant lives and the location of the suspected stroke victim all have the potential to delay a clinical prognosis.
The solution
Realising the significance of this issue if left unresolved, the Cumbria & Lancashire Stroke Network decided to proactively engage specialist service providers to try and find suitable solutions to address the challenge. Approaching Virgin Media Business and Intercity, an existing supplier partnership to the Lancashire Care NHS Foundation Trust, the Stroke Network wanted to find a way of making stroke clinicians available 24/7 so that stroke patients could receive the same level of service and care during the night as they do during the day.
A leading innovator in this area, approved N3 supplier and recognised specialist in delivering IT security solutions to the public sector, Intercity was responsible for the design, implementation and the delivery of the Cumbria & Lancashire Telestroke service, working in partnership with Polycom and Virgin Media Business.
The solution developed by Intercity harnessed existing technology, some of which was already deployed within hospital sites, to deliver a high definition video conferencing service over a private network provided by Virgin Media Business.
A purpose built mobile telecart was deployed in each A&E department which can be accessed by clinician. The unit allows the clinician to conduct a full consultation and diagnosis with suspected stroke patients directly from their homes or other location where they are able to access the secure network, such as another hospital site. Being a mobile unit, the telecart can be brought to the patient bedside, and the clinician can then immediately dial in from a laptop or tablet device to consult with the patient.
“Telestroke has transformed the way we deliver patient care. By harnessing the power of technology we’ve removed geographic obstacles, to allow our staff to bring our patients cutting edge medical care.”
Stroke Consultant, Blackpool Teaching Hospitals. NHS Foundation Trust
The telecart solution includes a 10x optical zoom, full pan and tilt camera which can be operated remotely by the clinician. The system can also access PAC systems and present the remote clinician with test results in real time as the patient undergoes scans or other observations whilst in the A&E department. The private network to the clinician’s home also provides them with secure connectivity to services delivered over N3, including access to NHSmail and medical records.
Intercity’s secure telehealth Telemedicine delivers a 24/7 managed service to proactively monitor the status of the telecarts and private network to ensure any faults are identified and dealt with quickly, such as a flat battery or failed codec requiring upgrade. This is complemented with a 24/7 help desk service so that no matter what time of day or night a telecart is called into use there is someone at the end of a phone to guide the user through the operation and use of the system.
