hiicp_logo

Clinical Informatics

Pre-hospital Thrombolysis and Telemedicine in the NHS: A Business Case and Appraisal of the Literature

Index:

  1. Introduction and Definitions of Business Case, Telemedicine and Thrombolysis

  2. Strategic context in the NHS

  3. Objectives and Stakeholders of Pre-hospital Thrombolysis

  4. Available Options for Pre-hospital Thrombolysis

  5. Tabulated Appraisal of Short List

    1. Option 1
    2. Option 2 and 3

  6. Summary of Appraisals and Executive Summary

  7. References

Available Options for Pre-hospital Thrombolysis

These are the available options, in the forms of a long list, the criteria for a short list and the short list itself.

Long List

  1. Do nothing.

  2. Make full use of present system.

  3. Increase accessibility to in-hospital thrombolysis by building more district hospitals with Coronary Care Unit and cardiologist support.

  4. Decrease the median call to door time by increasing the number of Ambulance Trusts, Ambulances and Paramedic crew to cover all geographical areas (urban and rural) and ensure a transit time of less than 30 minutes at all times.

  5. Advance alert to Coronary Care Unit in patients with clinical and ECG changes by the paramedic crew without any telemedicine support.(36, 37)

  6. Advance alert as above but with transmission of the ECG and clinical information to the CCU.(38)

  7. Advanced alert as above with transmission of clinical data and remote physician decision support via the Mobimed System to facilitate pre-hospital thrombolysis if the patient meets the pre-specified criteria/check-lists.(25, 29, 30)

  8. Thrombolysis by an accompanying physician in the ambulance,(28) analogous to the French SAMU (Emergency Medical Services) Network model.

  9. Autonomous pre-hospital thrombolysis by trained paramedic crew.(34, 35)

  10. Pre-hospital thrombolysis by General Practitioners in the GREAT Study model.(27)

Criteria for short-listing

The criteria for short-listing, based on principles of delivering best care to national framework targets, innovation, investing in staff development, risk management and long term feasibility, is as follows:

  1. Achievable target of thrombolysis within 60 minutes of call for help, in both urban and rural areas as per Standard Six of the NSF for Coronary Heart Disease.

  2. Utilize information technology in line with the modernisation of the NHS and national Connecting for Health Projects; in order to deliver best quality care.

  3. Minimise clinical risks, especially in the initiation phase with remote physician support.

  4. Encourage new ways of working and extended roles of clinical staff, supported by new investment and professional training as set out in the NHS Plan.

  5. Funding feasible and can be sustained.

In view of the above criteria, only options 6, 7, 8 and 9 are feasible. Option one is not valid from the start. Option 2 does not meet the NSF targets as this is currently set at 68% for 2005-2006 when only 33% is being achieved in the past year.

Option 3 and 4 may meet the targets but the numbers required would be prohibitive in terms of costs and additional man-power needed. Option 5 would still not meet the target in rural areas. Also, the potential of Information Technology would not be realised.

Although there is evidence to support option 10 from the GREAT Study, the unique organisation of the GP service in the countryside of Scotland will not be reproducible all over England and Wales. Also, thrombolysis was carried out without any recording of the ECG in the study. It is uncertain if the risks involve with this approach would still be acceptable today.

Hence, the resulting short-list is as follows.

Short-list

  1. Advanced alert as above with transmission of clinical data and remote physician decision support via the Mobimed System to facilitate pre-hospital thrombolysis by trained paramedic crew, if the patient meets the pre-specified criteria/check-lists.(25, 29, 30)

  2. Thrombolysis by an accompanying physician in the ambulance,(28) analogous to the French SAMU (Emergency Medical Services) Network model.

  3. Autonomous pre-hospital thrombolysis by trained paramedic crew.(34, 35)

 

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.

 

arrow_left arrow right

Page Updated: 17 May, 2017

About Us | Site Map | Privacy Policy | Contact Us | Disclaimer | Acknowledgement | Top of Page |