Challenge
To improve stroke diagnosis and subsequent transfer of suspected stroke patients to appropriate hospital.

Solution
Develop an ‘ambulance app’ to support decision making and help clinicians make the right choice of hospital more rapidly by:

• Ensuring more patients are correctly identified as a stroke mimic through appropriate use of assessments;
• Ensuring pathway exclusions are followed and inappropriate patients are taken to their local/nearest hospital as required by the protocol.
• Co-designing the app with end users, so that it is accessible to a diverse population and focuses on delivering the most significant benefit in terms of outcomes and cost savings.

Impact

• Reduced the % of stroke mimics attending the Hyper Acute Stroke Units (HASUs). This saves clinician time and creates health benefits for other stroke patients.
• Increased the % of ‘pathway exclusion patients’ (people who are deemed to be too sick to make an extended journey to a HASU) being quickly transferred to nearest accepting hospital.
• Reduced uncertainly for ambulance staff, particularly when they are working in areas where they have poor geographical knowledge.
• Improved patient experience.

It will result in cost savings at four levels:

1. HASU: Reduction in less poorly 'out of area' medical patients being admitted to the medical or general wards.
2. HASU: In terms of increased assessment time availability due to a reduction in presentations.
3. Ambulance service: Reduction in the number of repatriations back to the patient’s local hospital (double ambulance journeys).
4. Wider NHS: Additional availability of ambulances for responding to other 999 calls due to efficiency gains in

Feedback
“The app comes across as a brilliant, simple and effective idea that reduces the need for paramedics to carry around pieces of paper and allows them to instantly decide on the most appropriate place of care based on the symptoms they may be presenting with. Having experienced a stroke myself, I vividly remember the paramedic on that day trying to work out and discuss where he should take me. This app would have made that decision clearer and faster for him on that occasion.” - Ann Bamford, stroke patient and chair of the Greater Manchester Stroke Operational Delivery Network (GMSODN) patient and carer group.

Next steps
The app is currently on trial with more than 70 paramedics/technicians across the region and we will be looking to rollout to all GM and bordering staff after the first few months of phase 1 are complete. Currently, analytical usage is being recorded within the app and feedback from users being gathered. Once sufficient data is obtained (projected 2 months), we will then roll out the innovation to the whole Greater Manchester pre hospital workforce at phase 2 of the project, with the support of the North West Ambulance Service.

This case study was written by Chris Ashton, Greater Manchester Stroke Network coordinator & HCPC registered paramedic.


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