Unscheduled Care TIA & Stroke Telemedicine Service to Orkney

 

The previous patient pathway for acute transient ischaemic attack (TIA) in Orkney was to be referred to Aberdeen for consultation with the stroke physician at the next available clinic. The patient could not be referred for radiological or vascular investigations until the stroke physician has assessed them. This could take up to two weeks following the onset of symptoms and often meant two flights and an overnight stay in Aberdeen for the patient.

Current evidence suggests TIA patients should be seen by the specialist within 24 hours and commenced on the necessary secondary prevention treatment immediately (1). By using video consultations it is now possible the specialist will see all TIA patients on Orkney within the time scale. All GP practices in Orkney and the remote consulting site in Aberdeen Royal Infirmary have a Codec and monitor in place. Orkney link over ISDN via a gateway to the consulting site, which is IP)

There is currently no CT scanner on Orkney therefore thrombolysis following a stroke is not an option. However the time from onset of symptoms to consultation with the specialist in Aberdeen can be greatly reduced by having access to the on call physician using the video conferencing link. This is now taking place, allowing assessment by the specialist following contact through the on-call stroke radio page. Transfer to the stroke unit for further investigations and treatment can then take place as soon as possible after the event, which has been shown to greatly improve patient outcomes (1, 2, 3).

This service commenced in July 2008. The on call consultant's covering the service have seen all patients to date within 24 hours of the onset of their symptoms. Following their telemedicine consultation all patients were diagnosed or their diagnosis was confirmed, relevant treatment commenced and, where appropriate, timely transfer arranged for further investigations and management in Aberdeen. Three patients have avoided transfer to Aberdeen, after the specialist found they had not suffered a TIA.

Better Heart Disease and Stroke care Action Plan (2009) recommends that NHS Boards engage with SCT to consider this model of service redesign for TIA out patient redesign.

This project won the Improvement and Innovation Award at the Scottish Health Awards in November 2008. The team are shown above collecting their award. Left to right Nickie Milne (Stroke MCN administrator NHS Orkney), Anne Reoch (Service Development Manager, SCT), Bob Hazelhurst (GP, NHS Orkney), Mary Joan MacLeod (Acute Stroke Physician, NHS Grampain)

Project Roles & Contact email

Dr Mary Joan Macleod, Clinical lead - m.j.macleod @abdn.ac.uk 
Anne Reoch, Project Manager – anne.reoch @nhs.net 
Dr Bob Hazelhurst, GP Lead - bob.hazelhurst@googlemail.com
Nickie Milne, Project Coordinator, Orkney - nichola.milne@nhs.net
Andy Keldy, IT Lead, Orkney – andy.kelday@nhs.net

Anne Reoch (nee Duthie)
Telestroke Programme Manager
August 2010

References
1) National Stroke Strategy. DOH 2007 
2) Warlow C, van Gijn J, Dennis M, Wardlaw J, Bamford J, Hankey G, Sandercock P, Rinkel G, Langhorne P, Sudlow C, Rothwell P. Stroke: practical management. 3rd edition. Blackwell Publishing 2008 
3) Network Intercollegiate Guidelines Network (SIGN). 108 Management of patients with stroke or TIA: assessment, insvestigation, immediate management and secondary prevention. http://www.sign.ac.uk/guidelines/fulltext/108/index.html 4) Better Heart Disease and Stroke care Action plan http://www.scotland.gov.uk/Publications/2009/06/29102453/11