Model A | Model B | Model C | |
---|---|---|---|
AST comprising consultants, middle grades, advanced care practitioners and specialist nurses | AST present from 8am to 5pm, OOH stroke assessment by medical or ED staff | AST present from 8am to 5pm, OOH stroke assessment by medical or ED staff | AST present from 8am to 8pm, OOH stroke assessment by medical or ED staff |
Ambulance pre-alerts | 8am to 5pm | 8am to 5pm | 8am to 8pm |
Decision to enter patient into the MT assessment pathway | AST WH and in consultation with the network / remote stroke consultant OOH | AST WH and in consultation with the network / remote stroke consultant OOH | AST WH and in consultation with the network / remote stroke consultant OOH |
CTA interpretation and reporting | In-house radiologist WH and in-house or outsourced radiologist OOH | In-house radiologist WH and network / remote stroke consultant OOH | In-house radiologist or AST WH and network / remote stroke consultant OOH |
Referral to NSC | Via hospital switchboard WH and OOH | Via mobile phone hotline WH and OOH | Via mobile phone hotline WH and OOH |
Ambulance call category for transfer to NSC 15 | Ad hoc (usually category 3) | Ad hoc (usually category 3) | Category 2 (average response time 18 minutes) |
AST = acute stroke team; CTA = computed tomography angiography; MT = mechanical thrombectomy; NSC = neuroscience centre; OOH = out of hours; WH = within hours (8am to 5pm or 8am to 8pm).