Enhancing stroke care with Prehospital Video Triage – a national pilot evaluation
Stroke Prehospital Video Triage (PVT) enhances urgent stroke response by ambulance crew, by enabling remote video stroke specialist assessment in the patient’s location, and faster, more accurate triage before hospital arrival.
Impact
- 848 patients across nine pilot sites in England received PVT for a suspected stroke.
- Improved patient safety and patient outcomes. Evaluation sites implementing a direct-to-CT scan pathway, particularly for time-critical patients, experienced faster imaging and treatment initiation, potentially saving time-critical brain function. One site reduced the time to transfer by 90 minutes for urgent thrombectomy cases.
- Enhanced knowledge and collaboration between ambulance and stroke clinicians. CPD events, joint simulations and shared patient feedback increased staff confidence and engagement.
- Strengthened involvement. The project was co-designed with clinicians across services and included feedback loops that helped ambulance staff learn from results and refine decisions.
- More effective triage. Sites reported fewer unnecessary transportations, improved triage of stroke mimics and more efficient use of stroke specialist teams.
- Remote digital innovation. Enabled remote stroke assessment at patients’ locations using platforms such as GoodSAM and FaceTime according to local capabilities.
Project summary
The national Stroke Prehospital Video Triage (PVT) Pilot was implemented across nine NHS sites in England to improve how ambulance crews identify and triage suspected stroke patients. It aimed to reduce time to treatment and avoid unnecessary stroke centre admissions for non-stroke cases (mimics) by introducing real-time video consultations with stroke specialists.
Health Innovation South West led the national evaluation across the nine pilot sites to understand how context influenced the impact and implementation of PVT for those with suspected stroke, the implementation processes employed by sites, and the mechanisms of impact. We also developed evidence-based recommendations for the future evaluation and spread of PVT for those with suspected stroke.
A significant reduction in time to treatment was reported due to improved prearrival information and specialists being armed with information to accelerate decision-making, and in particular, through a direct-to-scan pathway. Patients experienced faster and safer treatment, and were directed to the appropriate admission department, while staff gained confidence through feedback and learning.
Rationale
Stroke is a leading cause of disability and a significant cause of death in the UK, with over 100,000 strokes occurring annually. The number of people living with stroke effects is expected to reach 2.1 million by 2035, placing increased strain on the NHS and social care services. Stroke currently costs the NHS and Social Care £8.6 billion per year, and the wider UK economy £16 billion, mainly due to unpaid care.
Around two-thirds of stroke patients are brought to hospital by ambulance, where stroke is typically assessed via the Face Arms Speech Time (FAST) test. However, this method often results in the unnecessary transportation of stroke mimics. PVT enables ambulance crews to consult stroke specialists via real-time video, improving the accuracy of triage, speed of care and helping deliver patients to the right care setting, transitioning from face-to-face analogue to digital.
Key stakeholders
- Health Innovation South West led the national independent evaluation, capturing learning across sites and identifying key enablers for spread.
- NHS England funded the implementation and evaluation of this pilot.
- Ambulance Services and Stroke Units across nine pilot sites, including London, Greater Manchester and Wessex, providing operation delivery and clinical leadership.
- Technology partners supported the implementation of video triage platforms (GoodSAM, FaceTime).
Next steps
NHS England plan to spread the approach nationally, drawing on the recommendations developed in Health Innovation South West’s evaluation including:
- Developing 24-hour PVT capability to improve access and consistency.
- Extending PVT pathways to broader stroke services and other emergency presentations.
- Securing sustainable funding, particularly for staff and technology.
- Improving engagement and collaboration between ambulance crew and acute stroke services, providing training and feedback loops.
We’re getting patients to the care they need sooner. It improves confidence, reduces delays and gives us better information to treat patents right away. It’s direct patient care, improved.
Paramedic, PVT Pilot site
