Guide outlines how stroke services can adapt during and after COVID-19

Image showing the authors of the report, Dr David Hargroves, Dr Deb Lowe and Professor Gary Ford

Guidance for adapting stroke services during the COVID-19 pandemic – and reshaping them afterwards – has been made available in a collaboration between the Getting It Right First Time (GIRFT) programme and the Oxford Academic Health Science Network (AHSN).

GIRFT’s joint stroke leads, Dr Deb Lowe and Dr David Hargroves, with Oxford AHSN chief executive Professor Gary Ford have co-authored the guide to help counter the impact of the crisis on NHS stroke services and build on changes adopted by teams across the UK which will be beneficial in the post-peak phase of the pandemic.

Adapting stroke services during the COVID-19 pandemic: an implementation guide is hosted on the British Association of Stroke Physicians (BASP) resource hub and provides guidance on:

  • Using telemedicine to support specialist decision-making in stroke care: for trusts seeking to establish a system of 24/7 virtual assessment rather than face-to-face assessment for thrombolysis
  • Delivering safe care at hospitals without acute stroke units: practical advice and protocols to enable the delivery of safe stroke care, linked into regional networks for specialist decision-making for thrombolysis
  • Developing virtual clinics for managing transient ischaemic attack (TIA) and minor stroke: advice on managing TIA and minor stroke in the COVID-19 environment, with changes which may be sustainable after the pandemic ends.

The guide also includes case studies of good practice and resources for implementation of the recommended practices. Stroke teams are encouraged to share their own experiences via a case study form to promote ongoing learning.

Dr David Hargroves, GIRFT joint lead for stroke and a consultant physician for stroke medicine at East Kent Hospitals University NHS Foundation Trust, said: “It is important at this time that we share our experiences across the stroke community to capture what we have learned and maintain the most beneficial changes as we return to more normal working. Our aim is to offer some help and reassurance to colleagues who are reshaping their stroke services across the UK.”

Joint GIRFT lead Dr Deb Lowe, who is also the National Clinical Director for stroke medicine for NHS England and NHS Improvement, added: “We anticipate that the recommendations in the guide will evolve over time as experience of developing and running virtual TIA clinics and acute stroke services broadens. We encourage stroke teams to share their own experiences of best practice so that we can continue to build on the lessons learned during the pandemic.”

Co-author Professor Gary Ford, chief executive of Oxford AHSN and a consultant stroke physician, said: “Rapid changes are needed in some hospital and regional services if people with stroke are to continue to receive sustainable high-quality stroke care. Coordinating innovations within and between the evolving integrated stroke delivery networks (ISDNs) may facilitate a sustainable cohesive response.”

The guide was put together with input from Dr George Harston, a consultant physician at Oxford University Hospitals NHS Foundation Trust; Dr Guy Rooney, medical director at Oxford AHSN; Hannah Oatley, clinical innovation adoption manager at Oxford AHSN; and medical writer Jemma Lough. It is supported by the British Association of Stroke Physicians.

BASP president Professor Rustam Al-Shahi Salman, said: “The silver lining of this coronavirus cloud is that we may well find benefits and efficiencies in adopting or adapting the proposed service models, which may endure after the pandemic subsides.

“In particular, we have an opportunity to implement efficient virtual approaches to hyperacute stroke care pathways and rapid access outpatient clinics that can still involve face-to-face contact to keep the person with stroke at the centre of the service.”

Read the guide in full on the BASP website here.

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