Royal Stoke University Hospital Impact Story

Royal Stoke University Hospital Impact Story

Royal Stoke University Hospital Impact Story

A healthy outlook

The Royal Stoke University Hospital (RSUH) is a world-class centre of clinical and academic achievement, where patients receive the highest standard of care and healthcare professionals and students come learn, work, and research. In its commitment to becoming a successful, competitive partner in the healthcare industry, the organisation is constantly re-evaluating existing procedures to improve its services. It was this mindset that encouraged Royal Stoke to open discussions about the geko™ device – a battery-powered, daily disposable device around the size of a wristwatch and worn at the knee.

The geko™ device gently stimulates the common peroneal nerve activating the calf and foot muscle pumps, resulting in increased blood flow in the deep veins of the calf equal to 60 percent of walking without a patient having to move.

Initial introductions

When first introduced to the device, Royal Stoke was aligned with the National Institute for Health and Care Excellence (NICE) Guidance for acute stroke patients. NICE recommends intermittent pneumatic compression (IPC) as the primary venous thromboembolism (VTE) prophylaxis intervention post-stroke and does not recommend anti-coagulation due to bleed risk.

However, according to recent findings from the Clots in Legs Or sTockings after Stroke (CLOTS3) study, more than 30 percent of patients are non-compliant to IPC, and there is an 8.7 percent increased risk of developing VTE if no VTE prophylaxis prescribed. Realising they may not be providing the most effective VTE prophylaxis care to all its patients, and conscious that their own IPC non-compliance rate may be as high as 30 percent, the Royal Stoke staff opted to conduct a real-world audit of clinical practice to determine whether the geko™ device could be a suitable alternative to anti-stasis intervention when IPC cannot be prescribed.

Going to trial

The hospital subsequently commenced a formal audit of its practices that allowed it to judge its IPC patient compliance. It took approximately one year to collect data methodically from 1,000 patients, observing and measuring VTE events at 90 days post stroke. The report concluded the following:

  • A 29.5 percent contraindication or intolerance to IPC in those requiring mechanical prophylaxis – much higher than anticipated and almost equal to the CLOTS3 findings
  • Although staff did their best to ensure the correct fitting of IPC and conducted regular checks throughout wear time, the audit exposed prior IPC fitting challenges
  • Importantly, there was a zero VTE incidence in patients prescribed solely with the geko™ device, compared to 2.4 percent in patients prescribed IPC

     Overcoming obstacles

    When it comes to triggering change, there will always be hurdles. It requires leadership, energy and collaboration. In Royal Stoke’s case, the close collaboration and support of key stakeholders, including Governance, the pharmacy and nursing staff, and, most importantly, patients enabled the organisation to embrace innovation for VTE prevention.

    It was by no means an easy undertaking, and took considerable investment of staff time, effort and dedication. Because geko™ was being considered as a prescribed device, it was critical that the hospital received permission from the hospital pharmacy to add it to the drug chart (DC), alongside the existing standard care therapies listed for VTE prevention.

    The pharmacy was first required to exhaust the existing stock of paper DCs before ordering a reprint, which took several months. User training also had to be delivered to familiarise ward staff in how to correctly fit the geko™ device. For this, Sky Medical Technology provided competency based, RCN-accredited geko™ device user training – it provides Continuing Professional Development (CPD) points to staff who can demonstrate they have applied what they have learnt when back on the ward.

    Speaking of the geko™ device, Clinical Nurse Specialist at The Royal Stoke University Hospital, Jodie Williams, said: “For acute stroke patients unable to be prescribed IPC (intermittent pneumatic compression) there is a very real danger of serious, sometimes fatal, blood clotting. We therefore welcomed the opportunity to quantify the level of our unmet need and to examine the role of the innovative geko™ device as an alternative mechanical intervention. Now in routine use, our findings show the geko™ device is safe and well-tolerated and can be used to protect high-risk acute stroke patients, who otherwise would have no Venous Thromboembolism (VTE) prophylaxis available to them.”


    The real-world data has prompted change not only to its own clinical practice but other NHS stroke units. Having overcome initial apprehensions, the geko™ device has now been incorporated into its standard of care, meaning staff can offer 100 percent VTE prophylaxis to patients who previously would have had no other intervention available to them. The positive outcome of the audit has also encouraged the Royal Stoke team to build out its data set, which now stands at 1,383 and the results are currently being drafted for publication.

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