By April Cashin-Garbutt, BA Hons (Cantab)
Stroke is the third largest cause of death in England. (1) It is a condition that requires rapid assessment and treatment to reduce deaths, disability and the risk of having another stroke. (2)
Over recent years, medical and technological advances have transformed our understanding of the brain and given the ability to help patients recover from stroke. In order to capitalise on these advances it is
important that the symptoms of stroke are swiftly recognised and the patient is
brought straight to A&E in order to be treated by a senior stroke
I recently spoke with Seamus Watson, Head of Public Health Programmes & Public Health Workforce NHS South of England, regarding the use of Telemedicine in the treatment of Stroke patients. Here is what he said.
How important is the timing of stroke treatment?
Timing is very important in the treatment of stroke. As part of the aim to increase public awareness around the identification and treatment of stroke, an advertising campaign called FAST was released in the UK.
The FAST campaign educated people on the signs of stroke and the need to call for an ambulance if you spotted any of these signs.
The quicker you can expertly assess and treat a stroke patient, the more likely you are to stop them from having long-term negative health effects.
It is crucial that someone experiencing a stroke is taken to an A&E department quickly and is seen by a senior stroke specialist.
Why is there a need for telemedicine in the treatment of stroke?
One problem that occurs if you currently are admitted to hospital with signs of a stroke is that there may not be a senior stroke specialist immediately available to diagnose stroke and authorise treatment.
This is particularly a problem at weekends and overnight when senior stroke specialists are frequently not at work, having worked through the day.
An average district general hospital in the UK has only two stroke consultants. Imagine they both work full time; there is still a massive gap in the time when there may be no senior stroke specialists at the hospital.
Why is it so important that patients must see a stroke specialist?
A very effective treatment of stroke is the use of ‘clot-busting’ drugs (thrombolysis). These are given to treat stroke, but have risks associated with them if they are given to someone who is not actually experiencing a stroke.
This is particularly problematic in the diagnosis of stroke as there are many other conditions which may mimic the symptoms of a stroke.
Consequently, a stroke expert is needed to make a diagnosis and authorise treatment.
How have you used telemedicine to solve the problem of diagnosing and treating stroke patients quickly?
Here in the South East (Kent, Surrey and Sussex) we have used telemedicine in the form of computers and videoconferencing software to solve the problem of a having access to a stroke specialist 24/7. Telemedicine enables a stroke specialist to see and talk with the patient and team in A&E and to view brain images and scans remotely.
By pooling specialist stroke experts from across Kent, Surrey and Sussex and using telemedicine equipment we have ensured that there will always be at least one stroke specialist available to diagnose signs of a stroke 24 hours a day, 7 days a week and commence treatment quickly.
How does the process work?
When someone is suspected of having a stroke, an ambulance should be called for. The ambulance staff will make an initial assessment and phone ahead to the A&E department, informing A&E they will be arriving soon with a patient with suspected stroke.
When the patient arrives at the hospital, they are sent for brain scan straight away.
If the stroke specialist is on site then they will be called to the A&E department; if the specialist is not on site then the A&E department will contact the appropriate specialist (according to a rota) and inform them a patient with suspected stroke is about to arrive in A&E.
When not on site, the specialists in our region use high quality laptop computers to connect with A&E.
This allows the specialist to view the brain scan, and also allows them to have a 2-way conversation with both the patient and the treating team in A&E.
The specialist can then assess whether the patient is indeed having a stroke and make the decision on whether to administer thrombolysis or not, as if they were by the bedside.
How is the technology working?
So far the technology is working really well.
There has been a significant reduction in the length of stay required by patients following a stroke. Previously, stroke patients were in hospital on average of 24 days following stroke. This has now been reduced to around 12 days. More patients are now being discharged home following stroke, rather than having to be admitted to nursing or residential care homes. Most importantly patients are having less long term disability.
This reduction is as a result of ensuring that the appropriate treatment is being administered significantly faster than before.
This is as a result of the prompt treatment they receive. Consequently, the patients are not as severely disabled as they would have been if treatment was given at a later point.
The initial hour or two are really critical in treating stroke patients and this is where the telemedicine approach is adding value to the treatment process.
Will the use of this technology be hindered by its costs?
The cost of the technology is not too great, essentially the cost of laptops for each stroke specialist and the computer in A&E departments. It is also important to consider the cost in context.
On average it costs around £600 a day to care for a patient in a stroke ward, and around £600-700 a week to look after a patient in a nursing home.
When you consider the significant reductions in length of stay in hospital, and the reduced need for patients to enter nursing homes, then the technology will actually save money.
Are there plans to use telemedicine for other conditions?
There are plans to use telemedicine for other conditions.
A number of other specialists are now looking at how they too could use this technology to make sure patients have access to a specialist 24 / 7.
Telemedicine would be useful for most patients who attend A&E who require an expert assessment and treatment. For example patients who have been involved in major trauma, have cardiac or acute renal problems. Telemedicine would enable specialists to determine how best to proceed with treatment, or whether it is necessary to transfer the patient to a different hospital.
Where can people find more information on stroke telemedicine?
They can find more information at: http://www.improvement.nhs.uk/stroke/
About Séamus Watson
Seamus Watson is currently Head of Public Health Programmes and Workforce is Kent, Surrey and Sussex and has previously worked in NHS Children and Family and Mental Health services.
Seamus has had a career long interest in service innovation and lead the development of a clinical risk assessment tool which was awarded NHS Beacon status.
As Operational Director in mental health services he lead the introduction of Crisis Resolution and Early Intervention in Psychosis Services.
Seamus currently oversees public health programmes and the transition of public health services in line with health and social care policy.