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The preferred option

The preferred option following the appraisal for a new model for hyperacute stroke services is a single site based at University Hospital North Durham.

This recommendation follows a process of evaluating a range of options based on the information available at that time.

The focus of the consultation

Hyperacute stroke services are those that a patient should receive when they are at their most seriously ill and in need of quick assessment and treatment by a stroke specialist. The current hyperacute model is unsustainable for three reasons:

  1. Pressures in staffing and recruitment
  2. Too few direct admissions to stroke units
  3. To ensure service provision for TIA patients is also delivered 7 days a week

Following engagement events with patients, carers and clinicians and supported by all the evidence available to us at this time, NHS County Durham and Darlington believes that:

  • The current split-site model cannot continue
  • A new single site is the best model
  • Specialist care is more important than care closer to home
  • The preferred option (at University Hospital North Durham) is the best option

The proposed changes ONLY affect the hyperacute stroke services provided by County Durham and Darlington NHS Foundation Trust i.e. the hyperacute stroke services at the University Hospital of North Durham and Darlington Memorial Hospital. The proposed changes mean that the hyperacute element of the pathway would be delivered at one site whilst rehabilitation phases would be delivered from Bishop Auckland Hospital.

Benefits of the preferred option

By having a single stroke hyperacute service at the University Hospital of North Durham, patients will specifically benefit from the following:

  • Shortest travel times.
  • Emergency access to diagnostic services
  • Improved TIA services

What this will mean for patients

Consolidation of the two current hyperacute sites onto a single site at the University Hospital of North Durham will mean patients suffering a suspected stroke anywhere in County Durham and Darlington being taken by ambulance directly to UHND.

Analysis of ambulance travel times confirms that this will not delay arrival at hospital for the vast majority of stroke patients. Paramedics will alert the University Hospital of Durham’s stroke unit to the patient’s anticipated arrival to enable appropriate preparations to be made.

The patient will be directly admitted to the stroke ward, without waiting in Accident and Emergency or admission via the Medical Admissions Unit, which can delay stroke treatment.

He or she will be immediately assessed by a specialist stroke consultant before having the required tests, such as a CT scan, to confirm diagnosis.

Any further tests will be performed by a team of clinicians who will be specialists in using and interpreting scanning and imaging equipment.

What are the benefits to patients of consolidating hyperacute stroke services onto a single hospital site?

By consolidating stroke hyperacute services onto a single hospital site, irrespective of the site’s location, stroke patients in County Durham and Darlington stand to gain the following:

  • Consistent access to specialist stroke consultants, including out of hours
  • Direct access to a stroke unit
  • Immediate assessment by specialist stroke consultants and the necessary multi-disciplinary team
  • Access to a 7 day-a-week TIA service

What are the benefits to patients of being directly admitted to a stroke ward?

A single site stroke hyperacute service configuration will allow all patients to be directly admitted to a stroke ward. This will deliver the following benefits:

  • Faster assessment and diagnosis by a specialist stroke consultant without waiting in Accident and Emergency or Medical Admissions Units
  • Reduce the time it takes for a patient to receive vital thrombolytic drugs once they reach hospital, to no more than 20-30 minutes
  • More patients who need it receiving timely access to thrombolysis
  • More high risk TIA patients assessed within 24 hours

What are the benefits to patients of consolidating stroke hyperacute services at the University Hospital of North Durham?

By having a single stroke hyperacute service at the University Hospital of North Durham, patients will specifically benefit from the following:

Shortest travel times 90% of patients reaching hospital in 30 minutes with an average travel time of 17 minutes; this would drop to 60% should the service be based at Darlington with an increased average travel time of 24 minutes.

Emergency access to diagnostic services Some stroke patients may benefit from urgent surgery to clear a blockage in the carotid artery, one of two major blood vessels which supplies blood to the brain. Although this surgery is carried out at Darlington Memorial Hospital there is greater capacity more readily available at the University Hospital of North Durham for the ultrasound, CT and MRI scanning to support swift access and diagnosis both in and out of hours.

Improved Transient Ischemic Attack (TIA) Services A TIA service is currently only available at the University Hospital of North Durham and Darlington Memorial Hospital five days a week as oppose to the required seven-day-a-week standard. This means that the service is unable to assess all patients who are deemed to be a high risk TIA within the recommended time limit of 24 hours. The single site at UHND would extend this access.