Working with partners across the stroke pathway, we have identified a number of areas where there are opportunities to improve outcomes for stroke survivors, carers and communities across our region. Our current priorities include:
Research shows that a faster emergency response to stroke reduces mortality and disability:
‘Time is Brain’
The majority of suspected stroke patients arrive at hospital by ambulance after calling 999, which is undoubtedly the fastest and safest way to access the appropriate help. Therefore, ensuring that paramedics and ambulance clinicians swiftly recognise stroke symptoms, take patients to the appropriate hospital and use the correct pathway for their patient’s needs remains a key area of our focus.
We are working on improving the efficiency of this part of the stroke pathway by:
The number of patients self-presenting at hospital with stroke symptoms rather than via ambulance is increasing. Work is ongoing in collaborating with A&E departments and stroke teams to ensure these patients are quickly identified on their arrival through education and training.
Hyper-acute care after stroke typically covers the first 72 hours after admission. Every stroke patient should gain access to an acute stroke unit within 4 hours and receive a specialist clinical assessment, rapid multi-modal brain imaging and if appropriate intravenous thrombolysis and transfer or treatment for thrombectomy. Mechanical Thrombectomy (the removal of the blood clot in an acute ischaemic stroke) is carried out at Nottingham Universities Hospitals' Qunees Medical Centre (QMC), which is able to offer this incredibly important intervention 24 hours a day, 7 days a week
All stroke units in the East Midlands have use of Artificial Intelligence (AI) to review Computerised Tomography (CT) scans in real time and identify potential strokes almost instantaneously. This very valuable tool can help to speed up the process of stroke diagnosis, leading to quicker intervention and treatment. This AI is able to interpret a range of CT scans including CT Angiogram (CTA) and CT Perfusion (CTP). Recent studies show the benefit of thromolysis may be extended to patients beyond the traiditonal 4.5 hour window if supported by CTP imaging.
We are working to ensure all patients in the East Midlands are able to access these services by:
All stroke patients discharged from hospital should be seen and supported in a timely way by an integrated and stroke specialised multi-disciplinary team. Historically, services have developed different models of care in different regions. In February 2022, The National Service Model for Integrated Community Stroke Service was published with the aims of bringing these existing service configurations together into one seamless service.
We are working to ensure all patients receive equitable, timely and effective community rehabilitation services by undertaking the following:
The ICSS model states that all stroke patients should receive longer term support that promotes wellbeing including secondary prevention of stroke. This is because there is robust evidence that screening and optimal blood pressure (BP) management is effective in the prevention future strokes.
The East Midlands ISDN introduced a BP@Home service across most of the region by providing blood pressure monitors to Community Stroke teams to in turn loan to hypertensive stroke patients (i.e. patients with high blood pressure). This service has demonstrated many positive outcomes including greater medication compliance and reduced rates of hypertension and this service is now embedded within those Community Stroke teams.
We continue to support those teams in offering this service, as well as supporting those teams who have not yet been able to participate but are keen to do so. We submitted a poster to the UKSF Stroke Forum detailing the work in order to share the idea with other ISDNs and inform future guideline.