Transcript Changes in Radiology in preparation for the CSC

Changes in Radiology in
preparation for the CSC
Jonathon Priestley
Acting Directorate Superintendent
Aims
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Discuss the CSC
Discuss the requirements of the
CSC
Discuss the radiology service
changes
The Disease
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Strokes usually occur completely without
warning.
Mortality is high: 20-30% death rate
within the first 30 days.
For those who survive, they have a 50%
chance of being significantly disabled at 6
months.
Patients may require many weeks of
inpatient rehabilitation;
13% of patients nationally require “new”
institutionalisation, which represent a
significant social care cost.
Why a CSC?
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Improvement of acute stroke
services in the Greater Manchester
will allow
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Patient centred
Effective
Safe
Timely
Efficient
Equitable
Comprehensive Stroke Centre
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April this year, SRFT’s
bid to be the CSC was
supported
PSC
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Stockport NHS
Foundation Trust
Pennine Acute NHS Trust
(Fairfield)
DSC
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Commissioned enhanced
DSC in all localities
What is required?
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Comprehensive Stroke Centre
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2 Primary Stroke centres
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Thrombolysis 24/7
Neuroradiology, Neurosurgery
Access to all other necessary services
Deliver Thrombolysis 9am – 5pm weekdays
District Stroke units
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Take patients after hyperacute period
Maintain existing services/expertise
Raise standards generally
Thrombolysis service requirements
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Requires a rapid transfer by the GMAS to
A+E
Within 3 hours of the onset of stroke
symptoms
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Expert assessment including a brain scan
and administration of the thrombolytic drug
Critical to this form of acute stroke care is
the development of multidisciplinary
acute stroke teams with
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24/7 availability of emergency CT scanning,
emergency access to a stroke specialist
and the administration of t-PA when
appropriate.
Radiology specific requirements
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“Instant” scanning
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Good communications with GMAS
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Call to be made by GMAS to radiology
Increased resources in staffing
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24/7 immediate imaging on site to plain brain
scan
8am ->8pm provision of specialist
radiographer
Resident radiology SpR between 8am and 9pm
Recruitment ongoing
Teleradiology
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Consultant Neuro Radiology opinion
Why?
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The process of diagnosing a
stroke involves several
steps:
 confirming that the
problem is stroke
(eliminating the
possibility of another
medical condition that
has similar symptoms)
 determining the type of
stroke (ischaemic (85%)
or haemorrhagic)
 determining the location
and severity of the stroke
Current position? Pts receiving brain
scan within 24 hours?
FAST test
Single Entry Point?
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Process mapping of SEP
Discussion taking place
Change to referral pattern for GP’s for
stroke
Minimum dataset required:
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Time of onset of symptoms
Warfarin?
GCS
Observations
Summary
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The value of the pharmaceutical
intervention with tissue plasminogen
activator is only as good as the
performance of the rest of the
processes of care.
Conclusion
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Exciting time for stroke services
Responsive
Manage change effectively
Any Questions?