Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report
Introduction Stroke is a leading cause of mortality and morbidity, demanding prompt and accurate identification. However, prehospital diagnosis is challenging, with up to 50% of suspected strokes having other diagnoses. A prehospital video triage (PHVT) system was piloted in Greater Manchester to im...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/14/1/e002954.full |
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| author | Christopher Ashton Adrian R Parry-Jones Lisa Brunton Ibrahim Alghamdi David A Jenkins |
| author_facet | Christopher Ashton Adrian R Parry-Jones Lisa Brunton Ibrahim Alghamdi David A Jenkins |
| author_sort | Christopher Ashton |
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| description | Introduction Stroke is a leading cause of mortality and morbidity, demanding prompt and accurate identification. However, prehospital diagnosis is challenging, with up to 50% of suspected strokes having other diagnoses. A prehospital video triage (PHVT) system was piloted in Greater Manchester to improve prehospital diagnostic accuracy and appropriate conveyance decisions.Method A service evaluation of a PHVT pilot was conducted to assess PHVT efficacy and identify facilitators and barriers. The pilot (October–December 2022) was a collaboration between the North West Ambulance Service, Greater Manchester Neurorehabilitation and Integrated Stroke Delivery Network and stroke clinicians at Salford Royal Hospital. The service evaluation was mixed methods, including qualitative semistructured interviews with stroke clinicians, paramedics and patients (and/or caregivers). Interviews were analysed using a thematic approach.Results Out of 46 PHVT calls during the pilot, eight (18%) were diverted to local emergency department, 1 (2%) was left at their usual residence and 37 (80%) were transported to Salford Royal Hospital. Final diagnosis for PHVT patients was stroke in 15 (33%) of cases, non-stroke in 20 (43%) and transient ischaemic attack in 11 (24%).Patients/caregivers found PHVT beneficial in directing them to appropriate hospitals and streamlining admission and treatment. However, some reported delays as a result. Clinicians expressed mixed opinions regarding PHVT’s utility. Paramedics found PHVT improved confidence in managing stroke patients. Hospital clinicians believed it provided valuable prearrival patient information, enhancing preparation. Others found PHVT less effective due to on-scene delays, challenges conducting comprehensive assessments over video and inability to identify all non-stroke cases.Conclusion PHVT was viewed favourably by most patients for enhancing the care quality. Paramedics and hospital clinicians acknowledge PHVT’s support in making appropriate conveyance decisions and improving the preparation process before the patient’s arrival. Participants, however, suggested prearrival registration, 24-hour availability and clinicians' buy-in for a more effective future rollout. |
| format | Article |
| id | doaj-art-a9bda6a077684bfa85b1c03f83f043ae |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Quality |
| spelling | doaj-art-a9bda6a077684bfa85b1c03f83f043ae2025-02-03T19:55:09ZengBMJ Publishing GroupBMJ Open Quality2399-66412025-01-0114110.1136/bmjoq-2024-002954Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project reportChristopher Ashton0Adrian R Parry-Jones1Lisa Brunton2Ibrahim Alghamdi3David A Jenkins4Greater Manchester Neurorehabilitation & Integrated Stroke Delivery Network, Northern Care Alliance NHS Foundation Trust, Manchester, UKDivision of Cardiovascular Sciences, The University of Manchester, Manchester, UKSchool of Health Sciences, The University of Manchester Division of Population Health Health Services Research and Primary Care, Manchester, UKDivision of Cardiovascular Sciences, The University of Manchester, Manchester, UKDivision of Informatics Imaging and Data Sciences, The University of Manchester, Manchester, UKIntroduction Stroke is a leading cause of mortality and morbidity, demanding prompt and accurate identification. However, prehospital diagnosis is challenging, with up to 50% of suspected strokes having other diagnoses. A prehospital video triage (PHVT) system was piloted in Greater Manchester to improve prehospital diagnostic accuracy and appropriate conveyance decisions.Method A service evaluation of a PHVT pilot was conducted to assess PHVT efficacy and identify facilitators and barriers. The pilot (October–December 2022) was a collaboration between the North West Ambulance Service, Greater Manchester Neurorehabilitation and Integrated Stroke Delivery Network and stroke clinicians at Salford Royal Hospital. The service evaluation was mixed methods, including qualitative semistructured interviews with stroke clinicians, paramedics and patients (and/or caregivers). Interviews were analysed using a thematic approach.Results Out of 46 PHVT calls during the pilot, eight (18%) were diverted to local emergency department, 1 (2%) was left at their usual residence and 37 (80%) were transported to Salford Royal Hospital. Final diagnosis for PHVT patients was stroke in 15 (33%) of cases, non-stroke in 20 (43%) and transient ischaemic attack in 11 (24%).Patients/caregivers found PHVT beneficial in directing them to appropriate hospitals and streamlining admission and treatment. However, some reported delays as a result. Clinicians expressed mixed opinions regarding PHVT’s utility. Paramedics found PHVT improved confidence in managing stroke patients. Hospital clinicians believed it provided valuable prearrival patient information, enhancing preparation. Others found PHVT less effective due to on-scene delays, challenges conducting comprehensive assessments over video and inability to identify all non-stroke cases.Conclusion PHVT was viewed favourably by most patients for enhancing the care quality. Paramedics and hospital clinicians acknowledge PHVT’s support in making appropriate conveyance decisions and improving the preparation process before the patient’s arrival. Participants, however, suggested prearrival registration, 24-hour availability and clinicians' buy-in for a more effective future rollout.https://bmjopenquality.bmj.com/content/14/1/e002954.full |
| spellingShingle | Christopher Ashton Adrian R Parry-Jones Lisa Brunton Ibrahim Alghamdi David A Jenkins Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report BMJ Open Quality |
| title | Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report |
| title_full | Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report |
| title_fullStr | Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report |
| title_full_unstemmed | Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report |
| title_short | Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report |
| title_sort | prehospital video triage of suspected stroke patients in greater manchester pilot project report |
| url | https://bmjopenquality.bmj.com/content/14/1/e002954.full |
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