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Supporting best practice in TIA and minor stroke clinics

The Oxford AHSN and National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Oxford and Thames Valley have successfully secured £275,000 from the NHS Insights Prioritisation Programme to support roll-out of good practice relating to care of people who have had a transient ischaemic attack (TIA) or minor stroke. Different service models including virtual, face-to-face and hybrid clinics will be evaluated. The NIP programme is enabling AHSNs and ARCs to work together to test and evaluate new and improved ways of running services incorporating learning from the pandemic.

Prior to the pandemic patients with symptoms of suspected TIA or minor stroke were usually seen face-to-face by a healthcare professional in a dedicated clinic. At the start of the pandemic, the Oxford AHSN and the Getting It Right First Time (GIRFT) programme produced guidance to help stroke services rapidly adapt and reduce the risk of infection. This included advice on developing virtual clinics based on the experience of early implementers in the NHS.

Each stage of the pathway could be managed remotely – referral, initial triage and consultation –  with patients only attending hospital for essential investigations when needed such as brain imaging, electrocardiogram (ECG) and blood tests.

Some services have now reverted to pre-pandemic ways of working while others have retained all or some virtual care provision. There is an urgent need to understand the benefits and potential risks of the virtual model of care – and the reasons behind some services returning to pre-pandemic care models.

The project team is working closely with the five Integrated Stroke Delivery Networks (ISDNs) which cover the South East region – and the NHS organisations within them.

The aim is to produce a ‘rapid insights’ guide for healthcare staff, service providers and NHS commissioners highlighting good practice and opportunities for quality improvement. It will include:

  • what a good care pathway looks like in face-to-face, virtual and hybrid models for TIA and minor stroke clinics
  • experiences of healthcare professionals and patients
  • benefits for patients of the different models taking account of health inequalities and digital exclusion
  • environmental impact in the light of the NHS net zero carbon emissions ambition
  • suggested data requirements to enable routine monitoring of services