A mixed-methods evaluation of pre-hospital video triage for suspected stroke in the NHS
More than 50 NHS stroke teams in England now use pre-hospital video triage, connecting ambulance crews with stroke specialists to help decide where suspected stroke patients should go. Our rapid mixed-methods evaluation explores how these services are being implemented nationally and their impact.
Background
Stroke is a major cause of death and adult disability. Timely access to specialist stroke care can improve outcomes. However, stroke screening tools (such as FAST) result in many false positives, causing many non-stroke patients to be taken to stroke units. This leads to non-stroke patients facing delays in getting the care they need; it also puts additional pressure on stroke teams, with potential implications for quality of stroke care.
What is pre-hospital video triage for suspected stroke?
Pre-hospital video triage (PVT) for stroke allows ambulance clinicians who suspect they may be treating a stroke patient to connect with the local stroke service by video or telephone. A stroke specialist can then triage the patient and recommend whether the patient should be conveyed to a stroke unit or be discharged from the stroke pathway (then either conveyed to a local emergency department, referred to a TIA clinic or their GP, or advised to stay at home).
PVT may support more effective conveyance and reduced pressure on stroke teams. It may also help stroke teams prepare in advance of the patient’s arrival, potentially speeding up delivery of key ‘front door’ interventions (e.g. brain scan, thrombolysis, and mechanical thrombectomy). RSET previously conducted a mixed method evaluation of two PVT services piloted in London and Kent early in the COVID-19 pandemic: this evaluation involved a systematic review of evidence available up to 2021 and provided empirical evidence demonstrating that PVT was perceived as usable, acceptable, and safe. Members of our team also led PHOTONIC, an in-depth, mixed method study of four PVT services, funded by NIHR Health and Social Care Delivery Programme.
Since then, NHS England has supported a major national pilot of PVT. Recent national data suggest that over 50 NHS stroke teams in England are now using PVT for at least some of their stroke patients.
Our approach
We propose to build on our previous work by extending our focus to more widespread PVT implementation across the English NHS and drawing on newly available data. We will conduct a rapid evaluation of the organisation, delivery, and impact of PVT services across England. Our evaluation will include a rapid systematic review and a nationwide empirical study of implementation and impact of PVT, using quantitative, qualitative, and health economic methods.
Protocol
Link to be added, once published.
Timeline
August 2026 – September 2027
Research team
- Dr Angus I G Ramsay, UCL (Project Lead)
- Dr Holly Walton, UCL
- Chris Sherlaw-Johnson, Nuffield Trust
- Bea Taylor, Nuffield Trust
- Prof Stephen Morris, University of Cambridge
- Dr Kevin Herbert, University of Cambridge
- Holly Elphinstone, UCL
- Pei Li Ng, UCL
- Raj Mehta, Public contributor
- Fola Tayo, Public contributor
- Gareth Gault, Public contributor
- Prof Naomi J Fulop, UCL