Exeter clinicians and researchers help shape proposals to improve stroke services in Northern Ireland

Every year, there are almost 3,000 stroke-related hospital admissions in Northern Ireland and more than 1,000 people die from stroke. Stroke services in Northern Ireland, as with other parts of the UK, struggle to meet national standards in a number of areas.

A public consultation on reshaping stroke services in Northern Ireland sets out plans to create specialised hyper-acute stroke units offering 24/7 access to fast diagnosis and cutting edge treatments. The central aim is to significantly reduce disability and save more lives.

Professor James and his team, funded by the National Institute for Health Research (NIHR), have undertaken ground-breaking research to identify the best possible treatments and outcomes for stroke patients alongside the best use of resources and facilities. This research, together with the contribution of stroke charities, local patients and staff, has informed the Department of Health’s options to create a sustainable network of hyper-acute stroke units intended to deliver better outcomes. 

NHS Guidelines in England recommend that when reconfiguring stroke services patients should ideally be within 30 minutes of a hyper-acute stroke unit, and no more than 60 minutes away. A stroke is a serious life-threatening medical condition that occurs when the blood supply to part of the brain is cut off and the sooner a person receives treatment for a stroke, the less damage is likely to happen.

The innovative research by Professor James and the Exeter team looks at the best way to deliver the combined life-saving treatments of thrombolysis and thrombectomy for stroke patients. Thrombolysis is a powerful clotbusting medicine and in thrombectomy the doctor uses a tiny stent to snare the clot that can then be removed from the blood vessel in the brain.

Thrombectomy is a powerful new treatment that can significantly increase the chances of a good outcome for patients who suffer a major stroke, and is the appropriate treatment for about 1 in 10 people who suffer a stroke. But this procedure requires expert clinical services that can only be provided at a relatively small number of centres in the UK.

The University of Exeter Medical school team developed complex models to test a range of options that took into account speed and quality of service, travel times and access to the single thrombectomy centre at the Royal Victoria Hospital (RVH) in Belfast. The research team tested a range of options whereby a patient either directly attends the specialist thrombectomy centre at the RVH first or attends a more local hyper-acute stroke unit for thrombolysis, and is then transferred to the thrombectomy centre if appropriate.

The Exeter research team found that the current service provision across 8 acute hospital sites could be optimised. Not all stroke units are able to offer the same level of service, and patients benefit most when they get the faster access to thrombolysis achieved in the larger units coupled with the use of thrombectomy for appropriate patients. The research has found that this combination can be expected to nearly double the clinical benefit for the population of Northern Ireland compared with current performance.

Prof James and his team looked at options that included three, four or five hyper-acute stroke units - all including the thrombectomy centre at the RVH. The three-month public consultation was launched on Tuesday 26^th March at Stormont by the province’s Chief Medical Officer, Dr Michael McBride.

Professor Martin James says: “There is strong clinical evidence and research that shows by providing stroke care in specialist centres with the right clinical experts and new treatments we can save lives and prevent serious disabilities. Our sophisticated modelling work is designed to give policy makers, clinicians and communities in Northern Ireland the quality information they need to make some major decisions about how to provide stroke services for the future.”