Connecting Healthcare
High definition video conferencing
makes for much faster and more
effective diagnosis of stroke patients
CASE STUDY
NHS Surrey
QIPP
The NHS Surrey Telestroke service supports the QIPP
agenda in the following ways:
Image
„„ Innovation: Pioneering use of video conferencing for stroke
assessment and diagnosis, both at A&E and on the ward
„„ Patient experience: Far more rapid out-of-hours diagnosis, significantly
improving clinical outcomes. Ninety more patients per annum are
receiving clot-busting treatment
„„ Productivity improving: One consultant provides out-of-hours remote
service to five hospitals without travel time or costs
„„ Cash releasing: Better and faster diagnosis means lower ongoing care
costs, calculated at saving over £500,000 per annum for Surrey
Challenge
Every year around 1,800 patients attend Surrey
accident and emergency (A&E) units with
suspected strokes. Rapid assessment and correct
diagnosis is vital and means the difference
between life and death. A stroke is caused by
a blocked blood vessel which can be effectively
treated with a clot-busting drug, but if that were
given to a patient with a brain haemorrhage
bleeding would increase.
“For the best
chance of
recovery a
patient needs to
be diagnosed and
treated within
four hours.”
Adrian Blight
Clinical director
Surrey Telestroke
Royal Surrey County Hospital
“Time is critical when treating strokes,” explains
Adrian Blight, Surrey Telestroke clinical director
and the lead consultant for stroke medicine
at the Royal Surrey County Hospital. “For the
best chance of recovery a patient needs to be
diagnosed and treated within four hours.”
However, clinical assessment of patients
potentially with stroke is a specialised area.
Adrian continues: “Face-to-face assessment is
vital, but out-of-hours a senior consultant with
the necessary skills would not always be onsite.”
Although hospitals in Surrey had various oncall arrangements, many found it difficult to
cover 24/7 rotas with the resources available.
In addition consultants needed to travel to the
hospital to assess patients, losing time in those
vital early moments following a stroke. Research
has shown that patients with conditions such as
stroke admitted out-of-hours are more likely to
die, to a large extent due to the unavailability of
senior doctors1.
Adrian and fellow clinicians across Surrey had a
vision. He engaged with colleagues in the Surrey
Heart and Stroke Network, local IT specialists,
and the N3 Service Provider (N3SP)2 team to
explore the possibilities.
Solution
The Surrey N3-based Community of Interest
Network (COIN) replaced multiple N3
connections in the region with a single resilient
solution encompassing inter-site networking,
security, and access to the core N3 network. As
well as providing higher bandwidth connectivity,
the COIN delivers the technical capability to
securely share applications and data, such as
Picture Archiving and Communication System
(PACS) images from any N3-connected site or
remote location with broadband access.
Following Adrian’s lead, five hospitals in
and around Surrey joined forces to create a
centralised out-of-hours stroke assessment
service using high definition (HD) video
conferencing technology over the Surrey COIN.
It uses two trolley-mounted video conferencing
units at each of the region’s five acute hospitals:
one in the A&E department, and the other in the
stroke unit to enable patient monitoring.
The trolleys are equipped with video
conferencing units, HD cameras, microphones,
and screens. Connected via wireless broadband
to the Surrey COIN, a centralised server
runs the Polycom Converged Management
1. Dr Foster Hospital Guide, November 2011
2. N3SP – N3 Service Provider is managed by BT on behalf of NHS Connecting for Health
Application software. Wherever the consultant
may be, a client application installed on their
laptop enables connection to the bedside via a
secure broadband link.
About N3
N3 is an enterprise-class
wide area network that
runs over a high-speed
IP-based multi-protocol
label switching (MPLS)
backbone. Over 43,000
connections link 1.3 million
NHS employees through 62
points of presence across
England and Scotland.
The NHS N3 network is
helping to reduce cost
and carbon emissions. The
potential is to lower NHS
expenditure by over £115.2
million per annum. Aside
from the figures quoted
above, each year it could
also save around 250,000
tonnes of CO2, 100,000
trees, and 100 million litres
of water.
N3 is provided to NHS
Connecting for Health
by BT through N3 Service
Provider (N3SP) – a
company independent of BT
that was set up to ensure
value for money by using
an array of suppliers to
provide discrete segments
of network services against
strict specifications.
Core N3
Products
and Services
„„N3 professional services for
design and implementation
„„N3 Community of Interest
Network
Colin Lee, senior project manager at National
Health Service (NHS) Surrey, who oversaw
implementation of the Telestroke project, says:
“Implementation proved to be technically
challenging, but working closely with the N3
team everyone pulled together to overcome any
difficulties as they arose. We’re very pleased
with the results. The project’s probably been one
of the most satisfying that I’ve worked on.”
Value
Being able to work remotely is enabling fast
diagnosis and effective treatment of Surrey
stroke patients at any time of the day or night.
“I can review scans and test results online, see
and talk with the patient over the HD video link,
and speak face-to-face with the onsite medical
team and worried family members – all without
leaving my home office,” says Adrian Blight.
“Many conditions masquerade as a stroke. Being
able to thoroughly assess patients more rapidly
and prescribe the right treatment saves lives and
improves the chance of a full recovery.”
The Telestroke service has proved its value and
is now fully launched across all five sites. Initially
deployed as a proof-of-concept trial at the Royal
Surrey County Hospital, this is the first use of a
potential N3 reservationless video conferencing
service. The Surrey results are impressive. During
the first few months the Telestroke service
has been used 50 times with 20 clot-busting
treatments administered.
One such instance was 20-year-old Victoria
Oatham who was rushed to the Royal Surrey
County Hospital having suffered a stroke at
home. Adrian Blight was at her side within
seconds, in a virtual sense, despite being at home
20 miles away.
“With a stroke, it’s really important that you get
prompt treatment,” recalls Victoria. “Without this
system it would definitely have taken longer.”
Adrian’s fast clot-busting treatment saw a full
recovery in prospect; feeling returned to Victoria’s
left leg within hours.
Aside from the obvious advantages for patients,
the Telestroke service offers efficiency benefits for
NHS Surrey too. A single on-call consultant can
now cover all five hospitals and make far more
productive use of their time through avoiding
travel. There are further benefits from ambulance
travel time and costs, less carbon emissions,
and reduced ongoing care costs from improved
patient outcomes.
“There are nine senior consultants on the Surrey
rota,” confirms Adrian Blight. “The N3-enabled
Telestroke service has reduced the burden on
each of us and it’s proving to be a practical and
cost effective way to provide a fast response for
stroke patients.”
The Surrey hospitals are continuing to refine
Telestroke processes and are considering extending
its use to the assessment of patients suspected of
a transient ischaemic attack, often referred to as
a mini-stroke. The Surrey experience is providing
valuable input and helping refine processes for
other initiatives such as N3 Telehealth. Equally,
reservationless video conferencing could have
applications in other fields, such as the assessment
of people with trauma or for monitoring patients
during rehabilitation.
Adrian Blight concludes: “Early diagnosis
enables treatment plans to be determined
more quickly, enabling a better outcome for
everyone.” Colin Lee sums up the financial
benefits: “NHS estimates suggest that care costs
for each stroke patient average £60,000 over
ten years. By improving patient clinical outcomes
the Telestroke service will be a major contributor
to NHS cost savings.”
In fact, Surrey has increased the number of
patients receiving clot-busting treatment from
15 per cent to 20 per cent based on a total of
1,800 patients per year. That means that 90 more
patients are getting this treatment and do not
require lots of ongoing treatment. Working back
from Colin Lee’s 10-year per-patient figure, that
clinical improvement equates to an annual saving
of £540,000.
“I can review scans and test results online, see and talk with the patient over the HD
video link, and speak face-to-face with the onsite medical team and worried family
members – all without leaving my home office. Many conditions masquerade as a
stroke. Being able to thoroughly assess patients more rapidly and prescribe the right
treatment saves lives and improves the chance of full recovery.”
Adrian Blight
Clinical Director Surrey Telestroke
Royal Surrey County Hospital
N3 managed on behalf of
the NHS by
„„Polycom video
conferencing equipment
and support services
British Telecommunications plc
Registered Office: 81 Newgate Street, London EC1A 7AJ