A stroke patient in A&E urgently needs a mechanical thrombectomy; the key teams and colleagues – Stroke, Interventional Radiology, radiographers, anaesthetists, porters and nurses – respond…and only a select few know this isn’t a real emergency; the ‘patient’, is actually trainee radiographer Prashant Limbachiya.

Karen Peters, improvement lead for stroke, explains:

It was our first mechanical thrombectomy simulation scenario, aimed to help us find ways to reduce door-to-groin time (where the incision is made for the procedure). For every stroke patient, time is brain so the quicker we can get them to theatre, the less chance of life-changing disabilities.

We’ve already made a significant reduction in the time to CT scan, now 50% of patients have it within 20 minutes, before, it was 45 minutes. This simulation was about how we get them on the table for a mechanical thrombectomy quicker.

A mechanical thrombectomy is a minimally invasive, image-guided procedure to remove blood clots from the brain using wires and catheters to get to it, then specialist devices to remove it.

It currently takes around 95 minutes for a stroke patient to come to A&E and then arrive in theatre for a thrombectomy. Our aim is to reduce this to 60 minutes.

The simulation, which took place on Thursday 29 January at Queen’s Hospital, broke down the process into two, focusing on the second phase, getting the patient from A&E to the theatre, including setting everything up to complete the procedure. They managed it within 40 minutes.

Karen added:

We’d like to get it down to 30 minutes, and the same for the first phase, diagnosing stroke and doing the CT scan, to hit the target of 60 minutes total. It’s an ambitious target.

We had lots of challenges on the day. It was a really useful exercise to see how people react, break down processes, and look for opportunities to save time such as, can we bring the patient up while the theatre is being prepped? We got really useful feedback from everyone involved, including how our ‘patient’ found it.

Prashant found playing the patient very different to his day job, and it gave him an opportunity to put himself in a patient’s shoes.

He said:

As radiographers, we have a short interaction with patients. This gave me the opportunity to experience the entire scenario from their perspective. It can be quite daunting lying on a trolley without control over where you’re being taken. Every second counts for stroke patients and they are moved rapidly between departments, which can make them quite anxious and confused.

I was initially nervous about taking part, but I found it really interesting and enjoyable to work with a range of different teams. A simulation is an excellent way to identify where we can improve patient care.

Read about our work to improve access to this procedure for patients across north east London, including delivering a 24/7 service.

Pictured below is Prashant (right) in his role as 'patient', with colleague Maajid Abukar in the role of his rleative. Pictured top are colleagues getting Prashant onto the table in theatre to undergo the procedure.