D2D Report from Emerging Leader Rytis Masiliunas

My two-week observership under the mentorship Dr Alastair Webb at Imperial College Healthcare NHS Trust was immensely rewarding, both in terms of expertise and personal insight. The Trust – one of England’s largest – spans several hospitals, and I was fortunate to gain firsthand experience at three of them: Charing Cross Hospital, Hammersmith Hospital, and St Mary’s Hospital.

Most of my time was spent in Charing Cross Hospital, which is the primary teaching hospital for stroke at the Imperial College School of Medicine, as well as one of the largest comprehensive stroke centres in London. It encompasses all levels of stroke patient care, including the Hyperacute Stroke Unit, Acute Stroke Unit, and multiple secondary stroke prevention clinics.

I am extremely grateful to Dr Sohaa Jamil – clinical lead for the specialty for stroke at Imperial NHS – and Dr Soma Banerjee – the Clinical Director for Stroke and Neurosciences at the Imperial NHS trust, as well as their welcoming colleagues, who have generously carved out time to walk me through the finer details of their stroke care pathway from on-call decision-making and hyper-acute patient care to specialty meetings and the subtleties of discharge planning. As a neurologist, responsible for acute stroke patients in Vilnius, I was keen to discover how optimising patient flow and updating standard operating procedures for acute stroke treatment could raise the standard of care for patients in Lithuania.

I also had a chance to see video triage in action. In West London, a specialised nurse conducts a live video assessment of most of the acute stroke patients before choosing the most appropriate stroke-ready hospital, supplementing the usual prenotification. I’m grateful to Jonathan Hayton for letting me observe the workflow and for explaining the tool’s evolution and future potential. Beyond video triage, I explored additional digital systems that keep patient care moving smoothly – most notably the NHS mobile app, which, among other things, lets clinicians share discharge summaries and schedule follow-up visits while giving patients timely access to the same information.

Dr Alastair Webb also welcomed me into the Department of Brain Sciences at Imperial College London’s Hammersmith Hospital to observe the Imperial Small Vessel Disease Research Group at work. His programme is dedicated to clarifying the condition’s underlying mechanisms, refining the tools used to measure its burden, and developing new therapies.

Finally, I got a chance to witness how the Urgent & Emergency Medicine team at St Mary’s Hospital turns real-time data into concrete quality-improvement action. Imperial College Healthcare NHS Trust deploys some of the UK’s most sophisticated automated dashboards, converting raw metrics into instant, actionable insights. Because I lead Vilnius University Hospital’s Clinical Quality Group, this glimpse of best practice was very useful and provided many ideas to take home.

Dr Alastair Webb and his colleagues welcomed me with exceptional warmth. They patiently unpacked the “why” behind their workflows, from organisational design to moment-by-moment clinical decisions. I am very grateful to Dr Webb for arranging the chance to study some of Europe’s finest stroke-care practices and for pairing inspiring mentorship with genuine hospitality. The ESO Department-to-Department Visit in London – a full two weeks of observation and dialogue – was both energising and eye-opening, and the insights I bring home will be invaluable as we refine acute stroke services in Lithuania.

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