Getting to Hospital in a Single Stroke

Long term conditions

Partner Organisations

  • NIHR

Themes

  • Innovation and adoption
  • Education and skills

Date Initiated

31 March 2014

Project Status

Regional rollout

A stroke happens when blood supply to part of the brain is cut off and brain cells are damaged or die. It is important because patients who suffer from a stroke can experience significant and lasting disability if they are not treated by a specialist in hospital immediately. Early diagnosis and treatment in a specialist hospital unit can improve a patient’s chances of survival and their quality of life post-stroke. National awareness campaigns such as the NHS’s Act FAST initiative are designed to help the public recognise symptoms and call an ambulance, but studies show more than 20% call their GP first.

The RECEPTS study was designed to understand how GP reception staff recognise and respond to patients with stroke symptoms. Conducted by researchers at the Universities of Birmingham and Oxford, the study suggests more specialist training for reception staff - as well as clearly defined policies on how to deal with potential emergencies - could help stroke patients get to hospital quicker. This in turn could save lives and minimise the impact of stroke. The study was published in the British Journal of General Practice in June 2015.

RECEPTS involved 52 family practices across the West Midlands, using questionnaires, focus groups and ‘mystery shopper’ telephone calls. Each practice received ten calls from actors mimicking between one and three symptoms of stroke. The receptionist was not aware the situation was simulated until the end of the call. If taking a call from a suspected stroke patient, receptionists should ask the caller to dial 999 immediately or immediately transfer the call to a GP.

The study found that:

  • In 69% of simulated calls were judged to be correctly referred for immediate care - receptionists told the caller to contact 999 or transferred the caller directly to the GP
  • Difficult to recognise calls (where symptoms were not obvious) were 85% less likely to be immediately referred than easy to recognise calls
  • Calls with fewer or no symptoms used in the Act FAST campaign - Has their face fallen? Can they raise both arms? Is their speech slurred? - were less likely to be immediately referred than calls with all three FAST symptoms
  • Almost all receptionists (96%) were able to name at least one stroke symptom but 40% reported one or more incorrect symptoms.

The Getting to Hospital at a Single Stroke programme aims to deliver a training package for general practice reception staff in the West Midlands, designed to:

  • improve recognition of acute stroke
  • develop skills in communication and handling of emergency calls
  • prompt practices to consider and develop policy in this area
  • training will be accessible to practices in two forms to maximise flexibility: eight training sessions available across the West Midlands - places will be available for 800 staff and an online e-learning module available in the longer term.

It is based at the University of Birmingham, and supported by the WMAHSN in partnership with the NIHR CLAHRC West Midlands. Educational value, trainee experience, patterns of uptake and usage and impact on policy and practice will be evaluated.

Programme Outcomes

  • The project website, the hub for information, registration, the e-learning module and project evaluation, has been launched
  • Relevant contacts have been engaged at the majority of the 22 CCGs in the West Midlands and registration invitations disseminated to all practices. The programme has been publicised in the national and regional medical press
  • Contact has been made with a variety of organisations with an interest in stroke, including liaison with a team who have developed a similar programme for ambulance dispatchers
  • Practice recruitment is underway. Registration is a two stage process to allow building of engagement while the programme is under development
  • The programme material has been developed and the online training module is nearing completion. A case-based approach has been taken to the learning material and the training is interactive
  • Ethical approval has been granted for the project evaluation by the University of Birmingham
  • Developed understanding of how to build engagement and deliver a regional programme of training within the recently restructured NHS primary care environment.

Programme Lead

Dr Elizabeth Bates
e: e.bates@bham.ac.uk
t: 0121 371 8061