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Guide outlines how stroke services can adapt during and after Covid-19

GIRFT and AHSN Covid-19 report authorsGuidance for adapting stroke services during the Covid-19 pandemic – and reshaping them afterwards – has been made available in a collaboration between the Getting It Right First Time (GIRFT) programme and the Oxford Academic Health Science Network (Oxford AHSN).

Oxford AHSN Chief Executive Professor Gary Ford, who is also a consultant stroke physician, co-authored the guide with GIRFT’s joint stroke leads, Dr Deb Lowe and Dr David Hargroves. It aims to help counter the impact of the crisis on NHS stroke services and build on changes adopted by teams across the UK which will be beneficial in the post-peak phase of the pandemic.

The guide also includes case studies of good practice and resources for implementing recommended practices. Stroke teams are encouraged to share their own experiences via a case study form to promote ongoing learning.

Adapting stroke services during the COVID-19 pandemic: an implementation guide is hosted on the British Association of Stroke Physicians (BASP) resource hub and provides guidance on:

  • telemedicine for remote decision-making about thrombolysis/thrombectomy
  • care at hospitals without acute stroke units
  • virtual clinics for transient ischemic attack (TIA) and minor stroke.

BASP president Professor Rustam Al-Shahi Salman, said: “The silver lining of this coronavirus cloud is that we may well find benefits and efficiencies in adopting or adapting the proposed service models, which may endure after the pandemic subsides.

“In particular, we have an opportunity to implement efficient virtual approaches to hyperacute stroke care pathways and rapid access outpatient clinics that can still involve face-to-face contact to keep the person with stroke at the centre of the service.

“This distinguished team from the Oxford Academic Health Science Network and Getting It Right First Time are to be congratulated for burning the midnight oil at their homes and hospitals during the lockdown phase of the pandemic to distil sensible and practical recommendations.”

Professor Ford said: “Rapid changes are needed in some hospital and regional services if people with stroke are to continue to receive sustainable high-quality stroke care. Coordinating innovations within and between the evolving integrated stroke delivery networks (ISDNs) may facilitate a sustainable cohesive response.

“Sharing experience across our community is key to the rapid spread of best practice. We must capture the learnings from these new models of care, including understanding the patient and carer experience.

“We need to grasp the opportunity to maintain beneficial changes in our clinical pathways as we return to more normal working during the recovery and restoration period of the pandemic. We hope this guide provides some help and reassurance to colleagues who are reshaping their stroke services across the UK.”

Joint GIRFT lead Dr Deb Lowe, who is also the National Clinical Director for stroke medicine for NHS England and NHS Improvement, said: “We anticipate that the recommendations in the guide will evolve over time as experience of developing and running virtual TIA clinics and acute stroke services broadens. We encourage stroke teams to share their own experiences of best practice so that we can continue to build on the lessons learned during the pandemic.”

Other contributors to the guide included Dr Guy Rooney, medical director, and Hannah Oatley, clinical innovation adoption manager at Oxford AHSN, Dr George Harston, a consultant physician at Oxford University Hospitals, and Jemma Lough, independent medical writer and author.