Telestroke service will save 40 lives and £7m a year, say Northern NHS trusts

Lancashire and Cumbria NHS trusts believe that having a managed telestroke is ‘invaluable’.

Lancashire and Cumbria cardiac and stroke network expects about 40 stroke victims each year to recover without a significant disability because of fast administration of clot-busting drugs, enabled by the telestroke service set up by local NHS trusts.

Telestroke went live in July of last year after two to three years of preparation. It relies on a Virgin Media Business community of interest network, based on a £9m contract set up in May 2010 with seven healthcare trusts across Lancashire.

The network provides a live out of hours link between stroke consultants and patients in emergency wards equipped with a Polycom “telecart”, or mobile video conferencing unit, which includes a camera through which consultants can remotely examine patients.

Dr Mark O’Donnell, a senior stroke consultant at Blackpool Victoria hospital, explains: “I can remotely control the camera at the patient’s end so that I can zoom in on particular features if I wish to, and particularly to see the movement of the eyes and facial muscles.”

Managing the service is the responsibility of IT infrastructure services supplier Imerja. “There are other telestroke services, including East of England, Yorkshire and Humber, but we think this is the only one with a managed service and help desk, which we find invaluable,” claims Kathy Blacker, director of Lancashire and Cumbria cardiac and stroke network.

Speed and ease of use

She explains that, for example, if it’s the middle of the night and a nurse can’t quite remember how to use some part of the equipment, she or he can be talked through the issue. “So it’s invaluable for an out of hours service,” Blacker says.

O’Donnell argues that the system is very easy to use. “It’s essentially Skype messaging. The difference is that we have a very high specification because in addition to the telemessaging, we are also transferring a lot of data in the form of brain scans, and that takes up a very high bandwidth for transmission.”

He says the speedy treatment the service offers is crucial: “Something like 80% of patients will have had a blood clot causing their stroke, and if we can catch those people within the first four and a half hours from the onset of the clot, then we have a good chance of improving treatment with a clot-busting drug.”

In addition, the six NHS trusts involved in the service – Blackpool, Lancashire, East Lancashire, North Cumbria, Southport & Ormskirk, and Morecambe Bay – along with local care services can expect savings of £7m a year through the avoidance of long-term damage.

Between them the trusts’ eight hospitals have 16 stroke specialists responsible for a large and rural geography with 1.6m inhabitants. They would previously carry out assessments at the bedside, but some hospitals are without stroke consultants and most were unable to offer this type of service out of hours.

Taking the virtual consultant to the bed

“So we took the view that the best thing to do was to treat people in their local hospital if we could and virtually take the consultant to the bed, rather than bring the patient to the consultant,” says Blacker.

Since it started, the service has helped assess some 500 patients and nearly 5% of those have been treated with thrombolytic, clot-dissolving treatment. One of those is Howard Thomas who was 69 years old and on a caravan holiday with his wife when he had by a stroke which left him unable to speak. Although he recalls little of his treatment at Lancaster hospital, he is thankful for the speed with which medical staff were able to diagnose and administer thrombolysis.

“I was 90% right the next day,” says Thomas. “Without the telestroke service I would not have had the treatment that quickly and it would have been much worse for me.”

O’Donnell maintains that other patients are positive about the services too: “In an era of smartphones and Skype and all the rest of it, it is not an intimidating experience for patients.”

Asked about any technical problems he admits to very occasional issues with the internet service: “If the internet goes down we are scuppered, but it has happened rarely.”

The trusts had expected some problems around the change of culture needed to use this new technology in a clinical setting, according to Blacker. But they invested in a lot of training, education and communication with staff “so that people really wanted it to happen”.

Blacker admits to “the odd firewall issue”, but adds that because it is a managed service, Imerja have been able to deal with issues as they arise.

“We are hoping to get our 100th patient treated this week, and it will be a terrific achievement,” she enthuses.

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