The East Midlands Ambulance Trust will present the Commission will a verbal presentation on a current Digital Pilot Project.
Minutes:
The East Midlands Ambulance Service Senior Manager for Quality presented the digital programme pilot for stroke recovery which is a collaboration with University Hospitals of Leicester.
As part of the presentation, key points noted were:
· The programme aimed to improve patient safety and equality. Stroke had been the 4th largest cause of death and was the biggest cause of gained disability.
· Stroke was hard to diagnose. A definitive diagnosis required a CT scan in hospital. The role of the paramedic was to recognise the symptoms and pre-alert the hospital. In 2022/23, data showed that 69% of cases were stroke mimics.
· The pilot was intended to allow pre-hospital video triage. All ambulance technicians were provided with an iPad which allowed a direct video call with a stroke consultant when the team suspected a stroke. This allowed better preparation on the stroke ward and reduced the time for definitive treatment.
· The technology allowed use of the shared care record allowing clearer signposting and pathways, reducing the burden on the Emergency Department.
· The streamlining of the service through the video triage allowed ambulances to be back in the community faster, improved service efficiency, provided strong staff satisfaction, whilst patients received optimum care and experiences.
· The pilot was launched in January 2024 and was intended to last 12 months. It was reviewed in January 2025 and funding was received to continue the project and launch it across further areas in the East Midlands.
· Half of paramedics and technicians had been trained to use the technology in Leicester, Leicestershire and Rutland so far.
· In September 2024 the pilot was moved to a 24/7 model, with 293 successful consultations completed.
· The technology had prevented 28% patients being needlessly conveyed to hospital.
· There was a higher occurrence of stroke in correlation with deprivation in Leicester. The pilot had therefore helped address health inequalities and offered an opportunity to improve health outcomes.
· The accuracy of the video triage raised no risk or safety concerns for patients.
· Barriers for the pilot included:
o the challenge of linking 2 organisations on Microsoft Teams, particularly with consideration for data governance issues and information security.
o Difficulty providing 8 different stroke consultants with access.
o The support needed to be provided quickly for potential stroke patients. This had led to the development of a one touch button for the ambulance technicians. If this failed to be answered by a consultant, the crew would revert to the pre-alert method. High levels of unanswered calls were an issue and reduced motivation so staff training was provided for crews and consultants and incentives were put in place until the process was fully embedded into the system.
· A national move was now underway to embed this system in all ambulance services.
In response to questions and comments from members, it was noted that:
· The pilot was a fantastic initiative.
· The software used by the ambulance crews allowed roaming across different networks to maximise location use. There had been 3 cases where the signal could not be optimised, and in these instances the crew pre-alerted the hospital and made the call once the signal had improved.
· The Integrated Stroke Delivery Network (ISDN) provided oversight to stroke provision across healthcare and optimised treatment availability. The initial grant was £100,000 initially and this covered provision of training, staff to look at data and the equipment.
· Stroke services had been particularly challenged due to stroke mimics.
· A lot of work had been done into remote triage and NHS pathways which would allow seamless movement across systems. This technology provided the opportunity for lots of development and could be applied across other areas.
· There were issues initially in the pilot with Microsoft Teams and consultants not picking up calls. This reduced, with a small number of calls were going unanswered – around 3 or 4 calls per week. There were also cases where strokes would be attended by crews who had not yet been trained.
· Consultant Connect, a previous project had been embedded into the system.
· High levels of staff turnover had caused difficulties, but new staff are trained in this as standard practise now. More work is required to embed it as there had been instances where staff reverted to previous methods.
· It was hoped the initiative would become regional which could allow access to more consultants. However, it was important to be mindful of centres not becoming overwhelmed as well as the importance of local knowledge of bed and wards, as well as the consultant who had been alerted to be on hand on arrival.
· EMAS used 2 sub-contracts for private ambulance providers. It was being considered how to provide these with access to the triage system. The training for the staff was ready to go, it was the digital aspect that required finalising.
· There was a national challenge around availability of ambulances. This had led to a lot of work to ensure that signposting was optimised for appropriate pathways which would reduce unnecessary demand on Emergency Departments.
· Consideration was ongoing for how triage could be used to reduce the need for ambulances or to ensure priority was met appropriately when they were dispatched.
· Concerns were raised that the support and care following a stroke was a postcode lottery.
· There was a quandary of where the limited resources should be invested, whether it was in preventative work, emergency departments or rehabilitation.
· It was hoped that the technology could soon be applied to other emergencies.
· Concerns were raised around the resilience of the system in emergency situations. Members were reassured that lots of work was done around responses in emergency planning.
· The equitability of the initiative was questioned, particularly as ambulance call out response rates for EMAS were lowest in Rutland. EMAS was working with Health Watch Rutland on this.
AGREED:
1) Information to be provided by EMAS on how many private crews and ambulances were being used.
2) Slides to be shared with Members.
3) Report was noted.