The impact Of prehospital video triage on hyperacute stroke diagnosis and treatment and diverting mimics to other specialties at University Hospital Southampton (UHS)

Titmus, L., Baird, A., Stonehouse, W. and Marigold, R. (2024) The impact Of prehospital video triage on hyperacute stroke diagnosis and treatment and diverting mimics to other specialties at University Hospital Southampton (UHS). International Journal of Stroke, 19 (3 Suppl.). (doi:10.1177/17474930241300284).

Abstract

Introduction: The last two to three years have seen an unprecedented rise in referrals and admissions to the stroke service at a rate of 15% per annum. In 20220% of HASU admissions were mimics, and so there was an urgent unmet need to address this issue to maintain bed flow, but also ensure the team were reviewing appropriate referrals.
Method: UHS was awarded £130,000 from NHS England for a pilot project for prehospital stroke video triage (PSVT). Using the Good Sam app and working in close collaboration with South Central Ambulance, we established a prehospital video pathway and collected data about our outcomes.
Results: PSVT resulted in 50% of patients being seen by stroke8% being seen by ED or medicine and 12% of cases not being conveyed. The sensitivity was 70% and specificity 90% without any adverse outcomes. Door to imaging, needle and groin puncture times were similar, and 13% received thrombolysis in both arms. Time to lowering BP in ICH and seeing a stroke specialist was much faster than the control arm. If applied retrospectively to 2023's 850 ambulance referrals, the stroke team would have seen 350 fewer patients, and 229 stroke mimcs avoided a hospital admission, saving £206,000.
Conclusions: PSVT is a safe and effective method of prehospital diagnosis and triage. Problems with bedflow and capacity account for little difference in treatment times, but admission avoidance of non strokes enables the team to focus on those needing urgent reperfusion and ICH treatment.

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