Front room FaceTime improves life-saving stroke care

·6-min read

Using FaceTime video calls to connect senior doctors with paramedics at the scene of emergencies has led to stroke patients getting quicker access to life-saving treatment.

A new “video triage” system for assessing potential stroke patients, brought on by necessity during the coronavirus pandemic, has been found to speed up care and ensure patients are sent to the right treatment centres.

The NHS in England said it is looking at how the system can be rolled out across the country.

Medics at University College London Hospitals (UCLH) were forced to think outside the box as the pandemic hit and came up with an innovative way of working out the best care for potential stroke patients.

Teaming up with London Ambulance Service (LAS), the team used Apple iPads to triage potential stroke patients at the scene of a 999 call-out.

Experts told the PA news agency that the use of the technology “brings the specialist into the patient’s front room”.

UCLH officials have said the new technique for assessing patients has meant they “consistently” end up in the right place first time, meaning they are able to be seen and treated more quickly and avoiding time-consuming transfers.

Strokes, which occur when the blood flow to part of the brain is cut off, are a medical emergency. Even short delays to treatment can be deadly or leave patients with life-altering disabilities.

The technique has proved so successful that LAS and UCLH have decided to keep using it to give patients the best quality stroke care and hope that similar programmes will be rolled out across the NHS.

When a paramedic arrives at the scene of a suspected stroke they use the iPad to FaceTime a consultant or registrar.

They then determine whether the patient needs emergency stroke care, assessment at a mini-stroke clinic, or potentially an emergency department for other critical illnesses.

Data suggests that the system has cut the number of patients with other conditions being sent to the hyper-acute stroke unit at UCLH by half – freeing up more time to deal with major stroke victims in need of life- saving stroke care.

Patrick Hunter, senior clinical lead paramedic at LAS in North Central London, told the PA news agency: “The innovation on the technology side isn’t that new – we’ve been using FaceTime to contact our grannies during the pandemic.

“The real innovation is connecting the ambulance service with the specialists in a way that’s never been done before.

“And it creates this ultra early triage where we bring specialists in to the patient’s front room, which is reassuring for them and also ensures they get the absolute right treatment and don’t go to a hospital unnecessarily.”

Mr Hunter said the programme could also be used for other conditions and other services – for instance, if a paramedic needed to speak to a GP or social care teams.

The system has already been extended to connect paramedics with specialist children’s doctors at Great Ormond Street Hospital so medics can assess the rare condition of strokes in children.

Dr Rob Simister, consultant neurologist and clinical lead for UCLH’s hyper-acute stroke unit at the National Hospital for Neurology and Neurosurgery, told PA: “We started this project in April last year. At the time we were really very concerned about Covid, and in particular the stress on the ambulance system.

“We wanted a tool that allowed us to make the ambulance service crews more accurate in deciding who they needed to take on a long journey to a specialist stroke service, and who would be better cared for in a much shorter journey to the local emergency department.

“It’s certainly made the care that all patients have received much much faster and much, much more efficient.

“So stroke patients have got to hospital quicker and been given quicker access to time-critical treatments, and patients with non-stroke have got to a specialist service more relevant to their condition much faster as well.

“And we think if you get access to time-critical treatments as fast as possible, the likelihood is you have a better outcome.”

He added: “We are very grateful to the National Brain Appeal, the charity dedicated to supporting the National Hospital, for funding the iPads that we are using.”

Professor Stephen Powis, national medical director for NHS England, said: “These devices are another tool for our highly skilled paramedics and doctors as they continue to respond to the country’s most critically ill patients.

“The NHS is looking at how this can be rolled out across England, alongside a series of innovations to improve patient care as part of the NHS Long Term Plan.”

Michael Dukelow had a major stroke in November 2020 and received specialist stroke assessment in his own home ( Sarah Collier, PA)
Michael Dukelow had a major stroke in November 2020 and received specialist assessment in his own home (Sarah Collier/PA)

One patient has already benefited from the triage system twice after suffering a major stroke in November 2020 followed by a transient ischaemic attack, or mini-stroke, in June.

Michael Dukelow, 62, from Hornsey, north London, said the scheme helped him by speeding up his care after paramedics used the technology to confirm he needed to be sent to the National Hospital for Neurology and Neurosurgery.

Once at the hospital, the stroke team quickly confirmed with a scan that he was having an ischaemic stroke, when a blood clot blocks the flow of blood and oxygen to the brain.

He was given thrombolysis – clot buster medicine – to dissolve the clot.

Mr Dukelow, who owns a roofing company, told PA: “I know it’s all about timing and they had it sussed out straight away.

“I have had a full recovery and live a normal life. I suffer no effects thanks to that quick technology and the speed of everyone, everything just worked out well for me.”

Dr Rubina Ahmed, from the Stroke Association, said: “Stroke is a brain attack and time lost is brain lost.

“It’s vital that if you’re showing the signs of a stroke you are assessed quickly and accurately. The quicker you can get specialist assessment and treatment the more of your brain may be saved.

“Using technologies such as FaceTime to triage and help diagnose stroke patients before they are taken to hospital can make this happen.

“It will also prevent unnecessary journeys to hospitals and ensure stroke patients are admitted to the right specialist treatment units to receive life-saving treatments.

“Telemedicine could transform the way paramedics treat acute stroke patients in an emergency by coordinating the response between paramedics and stroke-specific hospital clinicians.”

Some 100,000 strokes occur every year in the UK, leading to 38,000 deaths, and are a leading cause of death and disability, according to Nice.

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