Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report

Stroke is a leading cause of mortality and morbidity, demanding prompt and accurate identification. However, prehospital diagnosis is challenging, with up to 50% of suspected strokes having other diagnoses. A prehospital video triage (PHVT) system was piloted in Greater Manchester to improve prehospital diagnostic accuracy and appropriate conveyance decisions.

A service evaluation of a PHVT pilot was conducted to assess PHVT efficacy and identify facilitators and barriers. The pilot (October-December 2022) was a collaboration between the North West Ambulance Service, Greater Manchester Neurorehabilitation and Integrated Stroke Delivery Network and stroke clinicians at Salford Royal Hospital. The service evaluation was mixed methods, including qualitative semistructured interviews with stroke clinicians, paramedics and patients (and/or caregivers). Interviews were analysed using a thematic approach.

Out of 46 PHVT calls during the pilot, eight (18%) were diverted to local emergency department, 1 (2%) was left at their usual residence and 37 (80%) were transported to Salford Royal Hospital. Final diagnosis for PHVT patients was stroke in 15 (33%) of cases, non-stroke in 20 (43%) and transient ischaemic attack in 11 (24%).Patients/caregivers found PHVT beneficial in directing them to appropriate hospitals and streamlining admission and treatment. However, some reported delays as a result. Clinicians expressed mixed opinions regarding PHVT's utility. Paramedics found PHVT improved confidence in managing stroke patients. Hospital clinicians believed it provided valuable prearrival patient information, enhancing preparation. Others found PHVT less effective due to on-scene delays, challenges conducting comprehensive assessments over video and inability to identify all non-stroke cases.

PHVT was viewed favourably by most patients for enhancing the care quality. Paramedics and hospital clinicians acknowledge PHVT's support in making appropriate conveyance decisions and improving the preparation process before the patient's arrival. Participants, however, suggested prearrival registration, 24-hour availability and clinicians' buy-in for a more effective future rollout.