Adapting stroke services

The COVID-19 pandemic presents major challenges to healthcare systems around the world. The initial focus has rightly been on reducing spread of the infection and managing people who develop complications of coronavirus infection, but this has had profound effects on other clinical services. Reduced numbers of stroke admissions, large declines in TIA referral numbers, outbreaks of COVID-19 in acute stroke units and the inability to sustain stroke services in some hospitals due to staff sickness have all been reported. Rapid changes in services are needed if people with stroke are to continue to receive sustainable high-quality stroke care. The immediate need is to minimise face-to-face interactions between patients and healthcare professionals where alternative models of care can be implemented. Coordinating innovations within and between the evolving integrated stroke delivery networks (ISDN) may facilitate a sustainable cohesive response.

Adapting stroke services during the COVID-19 pandemic: an implementation guide has been developed by three stroke physicians: Professor Gary Ford, Chief Executive of the Oxford AHSN; Dr David Hargroves, National Clinical Stroke Lead for Getting It Right First Time NHS England, and Dr Deb Lowe, NHS National Clinical Director for Stroke Medicine – NHSE&I, to provide practical and pragmatic guidance from clinicians who have been tackling these issues since the start of the COVID-19 pandemic.

The implementation guide includes three sections with guidance on:

  • implementing telemedicine to support specialist decision making in stroke care during the COVID-19 pandemic
  • delivering safe stroke care at hospitals without acute stroke units during the COVID-19 pandemic: guidance for clinical networks and acute trusts in England
  • developing virtual clinics for managing TIA and minor stroke during the COVID-19 pandemic

‘Implementing telemedicine to support specialist decision making in stroke care during the COVID-19 pandemic’ is aimed at stroke services that provide hyper-acute care (thrombolysis and decision making for thrombectomy) and that do not currently have telemedicine or a remote decision-making capability in place. It aims to provide pragmatic guidance to support rapid implementation of remote decision making during the COVID-19 pandemic.

‘Delivering safe stroke care at hospitals that do not have acute stroke units during the COVID-19 pandemic’ is aimed at clinical networks and trusts with hospitals (with emergency departments) that do not have acutely admitting stroke services. It provides pragmatic guidance on how to provide safe and effective protocol-driven stroke care, including thrombolysis, to patients who may be conveyed to such hospitals during the COVID-19 pandemic.

‘Developing virtual clinics for managing TIA and minor stroke during the COVID-19 pandemic’ is aimed at clinicians working in stroke/transient ischaemic attack (TIA) services who would normally assess and manage patients with suspected TIA or minor stroke in a TIA clinic. The COVID-19 pandemic requires services to be adapted to minimise face-to-face contact between healthcare professionals (HCPs) and patients when other means to deliver care can be put in place. The document provides pragmatic guidance and recommendations on how to deliver safe and effective care for patients with symptoms that indicate TIA or minor stroke during the COVID-19 pandemic.

This is intended to be an evolving guide. The authors therefore welcome examples of real-life solutions put into practice by other teams across the country to address these and other stroke service challenges now and during the recovery period. Please use the case study form to submit examples of your own solutions, which will be added to the guide’s resource hub for sharing of best practice.