Pre-hospital specialist triage of potential stroke patients using digital technology: a rapid service evaluation to capture learning and impact of innovations prompted by the COVID19 pandemic

Stroke is a major cause of death and disability, in the UK and internationally. Evidence from urban settings suggests that centralising stroke systems into a small number of hyper acute stroke units (HASUs, which offer rapid access to stroke specialist assessment and treatment, including clot-busting therapies if appropriate) is linked with better care delivery and outcomes.Such systems rely on effective collaboration between multiple stakeholders, including hospital stroke services and ambulance services, to ensure appropriate transfer of patients to HASU. The NHS Long Term Plan reinforces the role of networked stroke systems at regional level to improve care delivery and clinical outcomes. Integrated Stroke Delivery Networks (ISDNs) are made up of multiple health agencies, including ambulance Trusts, and aim to ensure that NHS stroke services comply with seven-day quality standards for stroke care and National Clinical Guidelines for Stroke. In addition, there is support at the highest level of the NHS to scale up technologies that improve the quality of stroke services, such as through the potential use of artificial intelligence to interpret CT and MRI scans and the implementation of telehealth. Digital technologies have potential to support more effective stroke care systems, such as at the pre-hospitalisation triage stage, through the utilisation of mobile devices or telemedicine that connects clinicians to patients remotely. For example, because of limited specificity of screening tools for stroke (e.g. FAST), acute stroke services commonly manage large numbers of potential stroke patients who turn out to have different conditions (so-called 'mimics').[10] Specialist stroke assessment via telemedicine has been found to support accurate triage of patients and has potential to identify patients who do not need urgent treatment in a specialist unit. However, to date, the piloting and implementation of such technologies has been limited in England. Reported obstacles to adoption include technical issues (e.g. reliable video-signals), and cultural barriers (e.g. anecdotally, paramedics' unwillingness to reach out for advice of this kind from stroke consultants)