Stroke services

The golden hour is a term commonly used as the benchmark for intervention following trauma or injury and is seen as a critical timeframe in which any such patients should be seen.    It is also loosely used as a broader term for timings in which a patient with a particular presenting condition must be seen, for example, stroke.

 For patients who have experienced a stroke, the formal clinical target is related to treatments such as thrombolysis, which should been given within the first 4.5 hours following a stroke.  In this scenario the "golden hour" would relate to the 4.5 hour window to treatment time, though it is always best to be given as soon as possible. Thrombolysis is an appropriate treatment for approximately 20% of people who suffer a stroke.

It is important to remember that, as the majority of patients who have suffered a suspected stroke are attended by an ambulance, treatment commences once the trained paramedics arrive, and continues throughout the ambulance journey until they reach the hospital. The stroke team currently communicate closely with the ambulance crew throughout this journey time, and use it to order investigations, review past medical history and many other necessary actions that then save time when the patient arrives at the hospital.

It is also important to consider the other aspects of patient care for stroke. Rehabilitation is an extremely important aspect, and our consultants stress what a difference getting this care right can make to people’s quality of life after suffering a stroke. We believe this proposal will mean patients across the county will benefit as a result of improvements to the care package as a whole.

For seriously ill patients requiring emergency treatment who are determined as ‘category 1’ (critically ill), target ambulance response times are 7 minutes.  For those whose condition is acute but not necessarily life threatening, ‘category 2’, the target time is 18 minutes. 

In these situations, as soon as the paramedics arrive with the patient, stabilisation and treatment (where appropriate) commences.

We recognise that a proportion of people will have to travel further to visit friends or relatives in hospital for the relatively short period of care that involves hospitalisation. About 1-2 people per day would receive care at a different hospital to now. Importantly, everyone in the county would benefit from shorter average length of stay in hospital, which would significantly reduce the associated visiting travel. And most important is the overall improved patient outcomes delivered by the service as a whole.

Patients will go home (or as close to home as possible depending upon their circumstance) to receive rehabilitation via the Stroke Rehabilitation Team in the community, which aims to get people home as soon as possible, providing a better quality of care and outcome for the patient.

Yes. Within the proposal, there is a commitment to expanding the stroke unit at Lincoln County Hospital with additional beds, which will accommodate the increased numbers expected.

Pilgrim Hospital, Boston provides many other highly specialised services and there is a strong commitment to the future and sustainability of this important acute hospital in the county. Please read the summary of investment and plans for Pilgrim Hospital, Boston on our website.​​​​​

Much consideration has been given to the proposed location of the hyper-acute services, and the final proposal was based on the below summary of considerations.

The advantages of Lincoln being the proposed site are:

• Co-location with cardiology - Cardiology team support stroke team to deliver optimal front door service, as co-location with cardiology enables access to more important time-critical interventions like bubble echocardiograms and implantable loop recorders.
• Co-location with cardiology - Established Advanced Care Practitioner (ACP) service and pathway (noted as a regional example of excellence by GIRFT review).
• Co-location with cardiology - Benefit from using the Cath Lab facilities to directly access acute imaging, thus bypassing A&E and further reducing door to needle time.
• Co-location with cardiology - Provides increased opportunity for Lincoln Hospital to provide mechanical thrombectomy in the future, as cardiologists may be considered appropriate to deliver this service .
• The nearest access to mechanical thrombectomy services to the county is currently at Nottingham University Hospital. Should a patient arrive at a hyper-acute stroke service in Lincoln and require this treatment, the journey time will be c.30 mins shorter compared to a patient in the same scenario at Pilgrim Hospital.
• Larger ‘catchment population’ of NHS Lincolnshire CCG population, when compared to consolidation at Pilgrim Hospital.
• Experience has shown recruiting to Lincoln County Hospital is generally more successful than Pilgrim Hospital.

As part of the future delivery of stroke services we anticipate needing more staff than we have now. However, we recognise that teams may be configured differently in order to meet the needs of this proposal.

Staff are being invited to have their say on these proposals as part of this public consultation. There will also be formal engagement with staff before any service changes are implemented.