London Medicine

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Revolutionising stroke care

    London’s stroke services have been transformed in an ambitious initiative that won the 2010 Health Service Journal award for reconfiguration of services.

    The second commonest cause of death in London, stroke, has been relatively neglected.  Now in the first major service redesign of its kind on this scale in the world, eight hyperacute stroke units (HASUs) have been established, five of which were classed by a Royal College of Physicians audit as in the top six for quality in the UK.  

    95% of Londoners with stroke now spend the majority of their hospital stay in a specialist stroke unit. The proportion receiving thrombolysis has risen to 12-14%, compared with 4-5% nationally. All suspected stroke patients are taken to one of the HASUs. They are investigated using the latest in imaging technology, often having a scan within 5-10 minutes of arrival. They are cared for by an expert multidisciplinary team.

    Consultants and specialist trainees from surrounding hospitals maintain their expertise by joining in the out of hours care rota. Trainees see a large volume of cases and the diversity of London’s population ensures that the whole spectrum of conditions associated with stroke or mimicking stroke will be seen within a relatively short time. Trainees also learn from the organisation of care and through e-learning packages and simulation training scenarios developed through collaboration among the centres.

    The quality of stroke research in London is among the best in the world and the volume and diversity of cases make London the ideal centre for clinical trials.

    London's stroke services in 2013

    The outcomes of streamlining London’s stroke services have now been analysed. The key findings of the 2013 study were:

    • The reorganisation has saved more than 400 lives since 2010
    • There was a small increase in the time it took to take patients to hospital but the proportion still alive at 90 days increased by over 7%
    • The new more intensive treatment model saves £5.2 million per year
    • The costs of implementing the new system were recouped in under two years
    • As London was high in population density and had a distribution of hospitals that minimised ambulance travel time the new system worked well

    More information on the outcomes of the new stroke services in London can be found in “Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: a comparative effectiveness before and after model” by RM Hunter et al. A link to the article on the BMJ website can be found here.