Partnership and innovation providing the best outcomes for stroke patients

South Yorkshire Integrated Stroke Delivery Network and Yorkshire Ambulance Service tells us about their telehealthcare

Stroke within South Yorkshire
Stroke strikes every five minutes and is a leading cause of death and disability in the UK. It’s vital that those with stroke symptoms seek urgent help and dial 999. This ensures urgent treatment is received in the correct stroke specialist centres.
South Yorkshire has a population of approximately 1.4 million, made up of 32 neighbourhoods, four Local Authorities and eight acute and NHS Hospital Trusts. The South Yorkshire region is predominantly urban and has relatively high levels of deprivation and health inequalities, in comparison with the rest of the country. Recent reviews of data have shown a strong social gradient and there are significantly more stroke admissions from the most deprived neighbourhoods across the region. The prevalence of stroke in the region is 2.1 per cent and there are around 33,115 people living with stroke or transient ischaemic attack. In 2021/22, there were around 2,565 new stroke hospital admissions within South Yorkshire and neighbouring area of Bassetlaw.
To support this increasing number of stroke admissions, regional stroke centres were developed. These centres provide hyper acute care, often referred to as Hyper Acute Stroke Unit’s (HASUs), and are in the areas of Sheffield and Doncaster, with some patients receiving treatment in Wakefield. Treatments offered here include the ‘clot retrieval’ treatment, Thrombectomy, and the ‘clot busting’ treatment, Thrombolysis.
These centres are supported by the South Yorkshire Integrated Stroke Delivery Network (SY ISDN). ISDNs are the key vehicle for transforming stroke care across the country, working with partners from across the region to help prevent stroke and improve access to treatment. Since 2020, the South Yorkshire Integrated Stroke Delivery Network (SY ISDN) has been working with partners to improve the quality of stroke care with the aim of improving clinical outcomes, patient experience and patient safety.

Stroke Video Triage
The South Yorkshire ISDN are continuously looking for innovative solutions that can benefit patients, solve problems and transform pathways of care. Of particular interest has been improving the prehospital pathway and how we can ensure that the right patients, arrive at the right place and at the right time. The use of technology such as video triage to modernise and improve the prehospital pathway is advocated for in key national guidance. These include: Carter Review (September 2018) recommendations, Stroke GIRFT (Getting It Right First Time) National Speciality Report (April 2022) and National Stroke Service Model: Integrated Stroke Delivery Networks (May 2021).
An opportunity to bid for some NHS England funding to implement a Stroke Video Triage Pilot presented itself in March 2022. The South Yorkshire ISDN seized this opportunity and brought key partners together to develop a collaborative bid which was successful. In total, eight pilot sites across England are striving to implement and evaluate stroke patients through video triage.  
To support the funding bid, the South Yorkshire ISDN Stroke Survivor and Carer Panel were consulted and strongly supported this being taken forwards. The Panel was developed to allow those who are living with stroke or caring for someone with stroke to share their views and help shape stroke services across the region.

Three NHS Trusts; Yorkshire Ambulance Service NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust and Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, committed to delivering the pilot with the assistance of GoodSAM providing the technology.
As well as being a platform used nationally to alert NHS Volunteers to help those who need support, GoodSAM provides advanced video technology to the 999 and 111 services, revolutionising how care can be given.
Preparations for the pilot commenced in May 2022 and it was officially launched on 15 August 2022, with successful calls being made that day.
The key to the successful implementation of the pilot has been collaborative working, engaging with front-line clinicians and patients. Yorkshire Ambulance Service (YAS) has been crucial in the delivery of this pilot by hosting the project infrastructure. In addition to the core project team, the team includes subject matter experts such as operational staff from YAS, ambulance crews, and the two partnering hospitals, stroke nurses/stroke consultants. This approach is beneficial in ensuring that the pilot is successful as the staff that are involved in planning are also implementing the changes.

How does it work?
When a patient experiences signs of a suspected stroke, and 999 is called, ambulance crews are dispatched to the scene. The attending crews then complete an initial assessment of the patient which may trigger the stroke video assessment pathway. Using YAS clinician phones, the attending crews will use the video triage technology to contact the stroke specialist teams at either Doncaster Royal Infirmary or Royal Hallamshire Hospital, Sheffield – whichever is nearest to the patient. Adding the ability to use video allows the stroke team to carry out an enhanced triage assessment as they will be able to see and communicate directly with both the patient and the paramedic. The attending crew can then determine whether the patient needs urgent conveyance to the stroke centre and the stroke team can prepare for their arrival.
Agile devices within the hospitals allow for stroke clinicians to receive calls anywhere throughout the hospital, as well as the possibility of receiving calls at home when ‘on call’.

Video triage will explore four key areas to monitor the success of the pilot, these include: Improved Assessment - enhance the existing ‘pre alert’ triage assessment and enable earlier access to stroke specialist assessment and treatment; better use of technology - effectively use ambulance and clinical resources, reduce pressure on Emergency Departments by using technology to reduce in-hospital assessment times and reduce handover times, releasing crews sooner to assist further calls; and improved outcomes - increase equity of access to urgent stoke care, improve patient outcomes by ensuring that the right patients, arrive at the right place and at the right time, reduce the presentation of ‘stroke mimics’ and reduce symptom onset to hospital arrival times leading to faster access to urgent treatment. Also included is experience and education - enhance decision making regarding conveyance, support or influence treatment decision making and preparations and impact patient or staff experience.

Early learning
Through ongoing evaluation, early learning opportunities have been presented. The automated roll-out of technology onto ambulance crew phones was challenging however, this was quickly resolved through direct text message and email communications to the devices. This direct communication also helped raise awareness of the pilot throughout ambulance crews, as well as through the 1:1 training provided by the project team.
Despite some early connectivity challenges, positive outcomes have already been seen. The pilot has provided more opportunities for education and training for clinical staff increasing their awareness of stroke. The communication and engagement plan developed to support the project has also ensured the pilot mobilised at pace and collaboratively across the whole region.
The impact of the pilot will be continuously monitored, and a final evaluation completed. We are already sharing learning across the community of practice that has been established for the pilot sites.

Future vision
Our vision is that if the pilot is successful, in the future, all stroke patients within the region will benefit from the introduction of stroke video triage and have improved outcomes should they suffer from a stroke.