Technology and Remote Working
Interviewee: Jaimie Shepherd, Network Manager for the South Yorkshire and Bassetlaw Stroke Hosted Network. The Network is hosted by Sheffield Teaching Hospital NHS Foundation Trust and supported by the SYB ICS.
Stroke services rely heavily on face-to-face patient contact but found ways to provide quality treatment to patients in vulnerable positions through remote provision of care.
Launched in January 2020, the SYB Stroke Hosted Network’s response to the pandemic involved bringing together services, managers, clinicians, and leaders from across the system to make tangible plans to ensure that stroke services continued to provide high quality care. This included responding to NHS England guidance on how to adapt stroke services during the COVID-19 incident. Three aspects of the Stroke Services that saw change were:
- Transient Ischaemic Attack (TIA) clinics – an urgent outpatient pathway that normally offers face to face assessments moved to using telephone and video consultations to triage. This ensured that only those who really needed face to face TIA assessment and investigations attended clinic.
- Stroke Review clinic – for 6-week reviews post-stroke, this also moved from an initial hospital setting to a remote approach with telephone and video consultations. Clinicians who were self-isolating were still able to provide care.
- Rehabilitation – community rehabilitation services adapted to reduce face-to-face contacts and used telephone and video conferencing solutions to provide remote rehabilitation.
In some places within the region TIA and stroke clinics were relocated and a ‘one stop’ approach was used to reduce patient movement through the hospital. Clinicians were able to provide remote consultation, triage patients and continue to provide vital services. Community based stroke services began to offer rehabilitation using remote technology which ensured that patients continued to receive the support, guidance and rehabilitation they needed. Feedback from clinicians was positive and they were willing to adopt the new approaches. However, it was acknowledged that remote consultation and rehabilitation is not the solution for all as some patients still require face to face, ‘hands on’ assessments and rehabilitation. Stroke Hosted Network was able to quickly share learning across the system and beyond, through webinars and workshops using platforms such as Zoom and Microsoft Teams. The first Webinar on remote technology was carried out in partnership with AccuRx and had over 100 attendees from across the country. The second Webinar which focused on the evidence base for remote technology in rehabilitation had approximately 300 attendees. These, numbers may not have been achieved in normal circumstances.
Learning shared included the practical uses of remote technology within the stroke pathway, how it could benefit patients for rehabilitation, the available evidence, new research and the need for further research into using technology to support patients. Regional workshops gathered learning from clinicians across the region on the adaptations made to stroke services in response to the COVID-19 incident.
Learning from the COVID-19 incident has been used to develop the Stroke Hosted Network work programme. The success of using remote technology to complement the stroke pathway has led to further prioritisation of digital innovation within the work programme. Further research and linking into the digital transformation programme will be required.
Further research into the benefits and limitations of remote technology within the stroke pathway would be helpful.
Clinicians and patients would benefit from more training and education on how to use remote technology to support consultations and rehabilitation. The Network has been talking to patients to gain further insight of experiencing a stroke during the COVID-19 incident.
Key Learning Points
The national guidance was useful in supporting the region to adapt in response to the COVID-19 incident. This did need applying within a regional context and through the network services were able to problems solve and adapt together. Organisations had to make adjustments to meet the needs of their local patients and services. This did lead to some variation across the region but the guidance and network supported consistency where possible. The Stoke Network enabled all partners to work collaboratively during the COVID-19 incident. The rapid introduction of remote technology enabled stroke and TIA services to continue throughout the COVID-19 incident. Rapid learning was shared using remote technology as a result of this. The use of remote technology can complement the stroke pathway but cannot fully replace face to face, ‘hands on’ assessment and rehabilitation.
“Everything that we try to do and every adaptation that we made has patients at the centre of it. We considered how we could we provide the best quality service to our patients and their families, how could we support them during this really critical time in terms of their stroke, but also in the background of what was happening in the world with COVID.’”
-SYB Stroke Hosted Network Manager