Changes in Radiology in preparation for the CSC

Jonathon PriestleyActing Directorate Superintendent

Aims

Discuss the CSC Discuss the requirements of the CSC Discuss the radiology service

changes

The Disease

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?

Improvement of acute stroke services in the Greater Manchester will allow Patient centred Effective Safe Timely Efficient Equitable

Comprehensive Stroke Centre

April this year, SRFT’s bid to be the CSC was supported

PSC Stockport NHS

Foundation Trust Pennine Acute NHS Trust

(Fairfield) DSC

Commissioned enhanced DSC in all localities

What is required?

Comprehensive Stroke Centre Thrombolysis 24/7 Neuroradiology, Neurosurgery Access to all other necessary services

2 Primary Stroke centres Deliver Thrombolysis 9am – 5pm weekdays

District Stroke units Take patients after hyperacute period Maintain existing services/expertise Raise standards generally

Thrombolysis service requirements

Requires a rapid transfer by the GMAS to A+E

Within 3 hours of the onset of stroke symptoms 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 24/7 availability of emergency CT scanning, emergency access to a stroke specialist and the administration of t-PA when

appropriate.

Radiology specific requirements

“Instant” scanning 24/7 immediate imaging on site to plain brain

scan 8am ->8pm provision of specialist

radiographer Resident radiology SpR between 8am and 9pm

Good communications with GMAS Call to be made by GMAS to radiology

Increased resources in staffing Recruitment ongoing

Teleradiology Consultant Neuro Radiology opinion

Why? 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?

Process mapping of SEP Discussion taking place Change to referral pattern for GP’s for

stroke Minimum dataset required:-

Time of onset of symptoms Warfarin? GCS Observations

Summary

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

Exciting time for stroke services Responsive Manage change effectively

Any Questions?