Completed evaluations

Pre-hospital video triage for stroke patients

A rapid service evaluation to capture learning and impact of innovations prompted by the COVID-19 pandemic.

This is a RSET project (Rapid Service Evaluation Team), a collaboration between the Nuffield Trust and UCL and funded by NIHR.

Background

The NIHR Rapid Service Evaluation Team (NIHR RSET) worked with local stroke and ambulance teams to evaluate prehospital video triage for stroke (PVT): digital systems that allow stroke specialists to communicate with ambulance clinicians and patients to assess and prioritise (‘triage’) suspected stroke patients before they travel to hospital. These services were implemented in North Central London and East Kent in response to the COVID-19 pandemic.

Methods

We conducted a rapid mixed method service evaluation, which included:

  • Rapid reviews of evidence on remote PVT, focusing on implementation and outcomes.
  • Qualitative analysis of documents, interviews, and meeting observations to understand how PVT was implemented in North Central London and East Kent, and their perceived usability, acceptability, and safety
  • Survey to explore ambulance clinicians’ views of PVT at scale.
  • Quantitative analysis of local ambulance journey data and national stroke audit data to understand the impact of PVT on patient conveyance and delivery of stroke care.

Key findings

  • There was limited but growing evidence on PVT; important gaps included impact of PVT on patient destination, clinical outcomes, patient experience, and cost-effectiveness. Most research was based on simulation or single site pilots.
  • Clinicians in North Central London and East Kent saw PVT for stroke as usable, acceptable, and safe. Ambulance and stroke teams liked PVT and wanted it to continue.
  • Ambulance clinicians reported that PVT increased their confidence in decisions; they preferred more active/hands-on training (as used in NC London). Stroke physicians were positive about PVT, but described increased pressure resulting from having to perform PVT alongside their other duties.
  • Implementation was influenced by interactions between national context (e.g. the pandemic), local responses (such as facilitative governance systems and relocation of stroke services), and active, engaging clinical leadership.
  • Local ambulance data suggested that PVT saw a reduced proportion of suspected stroke patients being transferred to a specialist stroke unit (51% in East Kent, 39% in NC London). Many patients who underwent PVT either were transferred to a non-stroke service (36% in East Kent, 41% in NC London) or remained at home (13% in East Kent, 20% in NC London). Local audits suggested that almost every stroke patient was treated in a specialist stroke unit.
  • National stroke audit data suggested that there was no increase in time from symptom onset to arrival on a stroke unit, and the proportion of stroke patients who received timely care either increased relative to national control over time, or did not change significantly.

Outputs

Reports and round-ups

Project team
  • Angus Ramsay
  • Jean Ledger
  • Sonila M Tomini
  • Naomi Fulop

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