East Kent Hospitals University NHS Foundation Trust

Clinical challenge
East Kent Stroke services admit 1,200 stroke patients per year, providing 24 hour acute stroke care to a population of 800,000 in South East England. Historically this was provided at two smaller Acute Stroke Centres (ASCs), with 600 patients each/yr that were co-located with Emergency Departments (ED) at William Harvey Hospital and Queen Elizabeth Queen Mother. The units struggled with poor performance for over 5 years, achieving overall SSNAP ratings of C-D.

During the COVID-19 pandemic, there was an urgent need to generate additional acute medical beds at the two ED hospital sites to care for COVID patients.  

Solution
The two ASCs were merged into a larger ASC and temporarily relocated onto a non-ED acute hospital site at Kent and Canterbury Hospital. This site had an ITU and access to 24/7 CT imaging, 14hr/day access to MRI and 24/7 middle grade junior doctor cover. It was imperative to ensure the early and correct identification of stroke patients to be transferred to the new ASC, given it did not have an ED and was further away than the local ED for ⅔ of patients.
Innovations introduced:

• Prehospital. Tele-triage assessment between stroke specialist and ambulance crew; improving sensitivity and specificity of triage to support time critical access to Thrombolysis and Thrombectomy
• Adherence to a National Optimal Stroke Imaging Pathway (NOSIP). 24/7 access to CTA, CTP with AI support and 14hr access to MRI
• Standardised 9 step process to reduce Door In Door Out times.
• 7-day MDT working

Impact

• SSNAP process scores significantly increased from D to A
• Thrombolysis rates of >20% (national average 11%)
• Successful Mechanical Thrombectomy (off site) 5.4% (National average 1.92%)
• 38% reduction in length of stay to 11 days (national average 19)
• Statistically significant relative mortality reduction of 60%, resulting in 65 more patients alive each year.
• NHS people promise Staff satisfaction survey scores above trust and national average in all 7 domains.

Reflection
Processes of patient care, outcomes and staff satisfaction have significantly improved and been sustained in East Kent, through the system optimisation of stroke services inspired to support the wider COVID general medical response. The pandemic facilitated the realisation and introduction of novel innovative technologies at pace. 

Consideration is being made to the benefit of continued non-ED sited ASC location.