Every five minutes someone in England has a stroke, yet less than 1% of patients receive the clot-busting drug thrombolysis that must be given within three hours of symptoms starting. This programme aims to change that by identifying the best way to reorganise ambulance and hospital services to get more patients treated faster. Stroke costs the NHS £2.8 billion annually and is the third leading cause of death. The problem is twofold: the public and health staff often fail to recognise symptoms quickly enough, and ambulance and stroke services are not coordinated to deliver thrombolysis within the tight time window. The researchers will test a community awareness campaign, model five different ways of delivering thrombolysis across the North East, and evaluate whether paramedics can safely deliver hyper-acute stroke treatments themselves. If successful, effective implementation of thrombolysis could save the NHS £16 million per year. More importantly, it would mean fewer stroke patients die or are left permanently disabled. The work builds on the team’s previous development of the FAST test now used by paramedics to diagnose stroke, and their experience running clinical trials and implementing thrombolysis in routine care.
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The aims of this integrated programme of research are to identify the optimal organisation of pre-hospital and acute stroke care and to improve outcomes for stroke patients by enhancing the evidence base for future health service interventions. Stroke is the 3rd leading cause of mortality. Every 5 minutes someone in England has a stroke. Stroke costs the NHS £2.8 billion per year. Effective implementation of thrombolysis could provide net saving of £16million a year. Our research will provide evidence to address two major recommendations of the NAO report on Stroke; raising public and professional awareness, and assessing costs and benefits of different approaches to providing thrombolysis. Thrombolysis is an effective but underused treatment which must be given within a 3 hour time window from onset of symptoms but it is used in less than 1% of cases. Partnership between the ambulance and stroke services is key to achieving rapid hospital admission and there is the potential to involve paramedics in delivering acute stroke treatment such as neuroprotection. Active engagement of patients, carers and the public is essential to develop quality stroke care and identify the best methods to provide information to enable them to make informed decisions about accessing services and receiving treatment in the hyper-acute situation. We have previously developed and evaluated specialist stroke services, patient education, decision support tools and other preventive interventions, as well as developing the FAST test for paramedic early diagnosis of stroke. We also have extensive experience of clinical and community trials, the implementation of thrombolysis in routine care, and economic evaluation and modelling of service development and reconfiguration. In this integrated programme of research we will: determine the effectiveness of a multi faceted community programme to increase awareness of and response to symptoms of stroke by the public, patients and health service staff; seek the views of clinicians, public, patients and next-of-kin about the risks and benefits of thrombolysis and other hyper-acute treatments and identify how to best engage patients/next-of-kin in decision making; establish the cost effectiveness of five models of delivering intravenous thrombolysis to the population of the North East Strategic Health Authority (SHA) through modelling, and to implement and evaluate one or more models of care across the SHA; and evaluate the feasibility of paramedic delivered hyper-acute stroke treatments. This ambitious programme of work will be led and delivered by an experienced multi-disciplinary team with international renown for research on acute stroke, preventive interventions, health economics and decision making and public engagement. Our programme of research will build on the extensive experience of our multidisciplinary team and benefit from the support of the 5* research environment provided by the Faculty of Medical Sciences, Institute for Ageing and Health and Institute for Health & Society at Newcastle University. The facilities, infrastructure and staff of the University work hand-in-hand with the NHS providing an optimal research environment for applied clinical research. Implementation of the research findings will achieve better quality of care, better patient experience, and better value for money for patients with acute stroke. Our extensive experience of patient and public engagement in clinical research and practice will ensure their involvement in every aspect of this programme and meet present health department guidelines. We will consider applying for waiver of consent for the paramedic hyper-acute trial under the new regulations for research in emergency settings. Although representing a significant investment of funds, this proposal offers outstanding value for money, offering 4 interlinked programmes of research within an integrated package that we are confident we can deliver on time and to budget.
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