Effectiveness: We found that Brainomix 360 Stroke is associated with a significant increase in rates of MT and a reduction in DIDO times at ASCs. There is a relationship between time since implementation and time to treatment, with ASCs using Brainomix 360 Stroke for longer observing a bigger decrease in DIDO time. Qualitative findings suggest that Brainomix 360 Stroke is not systematically used to identify patients for thrombolysis which may be why rates of IVT and time to IVT to do not appear to be affected by the introduction of e-Stroke.

Accuracy and Safety: The technology is seen as straightforward to use and reliable, processing over 97% of scans in an average time of 4 minutes. Brainomix 360 Stroke is perceived as a useful clinical decision support tool and despite some concerns with accuracy, most clinicians opt to continue using the software with use increasing over time. Other studies investigating how the introduction of Brainomix 360 Stroke supports clinical decision making have found that Brainomix 360 Stroke improves the accuracy of ASPECTs scoring and the identification of LVOs of clinicians with a range of experience and backgrounds. A systems approach to implementation has been adopted widely, ensuring that multiple activities such as training, stakeholder engagement, quality impact and clinical safety assessments, assure the safe adoption of the technology. The technology company are praised for providing comprehensive support that is recognised by the system as robust and high quality.

Value: Brainomix 360 Stroke is associated with a financial benefit in the region of 1.25 to 1.4 times the cost of implementing the technology, and with health benefit in the region of 1.17 to 1.35 times the cost of implementation

Fit with site, feasibility and sustainability of scale-up: The continued and consistent use of Brainomix 360 Stroke across evaluation sites demonstrates acceptance and usability by clinicians, with many benefits being noted to its introduction and we have found that Brainomix 360 Stroke merits scale up. Brainomix 360 Stroke demonstrates significant value to stroke services and as the number of patients having a stroke is projected to increase substantially in the future, AI decision support will be an essential adjunct to clinical expertise

Implementation considerations: Engagement and training with all stakeholders and potential users of the technology is key to implementation. Expectations of the impact of the technology should be realistic – Brainomix 360 Stroke is not intended to replace any part of the stroke pathway or radiological expertise but as an addition to specialist clinical expertise. Radiology clinicians reported concerns about the increasing number of scans generating more workload, but this could be associated with better adherence to the NOSIP rather than solely through the introduction of Brainomix 360 Stroke. Implementing Brainomix 360 Stroke at a network level, rather than individual sites will ensure effective adoption.