PREHOSPITAL VIDEO TRIAGE FOR SUSPECTED STROKE: LESSONS FROM A RAPID, MIXED-METHOD EVALUATION OF SERVICES IMPLEMENTED IN TWO REGIONS OF THE ENGLISH NATIONAL HEALTH SERVICE

ABSTRACT

Background: In 2020, North Central (NC) London and East Kent introduced prehospital video triage, where stroke and ambulance clinicians used videoconferencing to assess suspected stroke patients on scene. The aim was to reduce conveyance of non-stroke patients to stroke services and reduce transmission of Covid-19. Methods: Rapid, mixed-method evaluation of prehospital video triage in NC London and East Kent (July 2020-September 2021), drawing on • Interviews with ambulance and stroke clinicians (n=27);observations (n=12);documents (n=23);• Survey of ambulance clinicians (n=233) in NC London and East Kent. • Descriptive statistical analysis of local ambulance conveyance data (n=1,400;April-September 2020). • Difference-in-differences regression analysis of team-level national audit data, to understand changes in delivery of clinical interventions in NC London and East Kent relative to the rest of England (n=137,650;2018-2020). Results: Interview and survey data suggested clinicians perceived prehospital video triage as usable, safe, and preferable to 'business-as-usual'. Several interrelated factors influenced implementation, including impetus of Covid-19, facilitative local governance, receptive professional values, engaging clinical leadership, active training approaches, and stable audiovisual signal;stroke clinician capacity was a potential risk to sustainability. Neither area saw increased time from symptom onset to arrival at services, while delivery of clinical interventions either remained unchanged or improved significantly, relative to the rest of England. Conclusions: Prehospital video triage in NC London and East Kent was perceived as usable, acceptable, and safe;it was associated with some significant improvements in secondary care processes. Key influences included national and local context, characteristics of triage services, and implementation approaches.