Changes in Radiology in preparation for the CSC

1. Changes in Radiology in preparation for the CSC Jonathon Priestley Acting Directorate Superintendent

2. Aims • Discuss the CSC • Discuss the requirements of the CSC • Discuss the radiology service changes

3. 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.

4. Why a CSC? • Improvement of acute stroke services in the Greater Manchester will allow • Patient centred • Effective • Safe • Timely • Efficient • Equitable

5. 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

7. 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

8. 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.

9. 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

10. 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

11. Current position? Pts receiving brain scan within 24 hours?

12. FAST test

13. 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

14. 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.

15. Conclusion • Exciting time for stroke services • Responsive • Manage change effectively

16. Any Questions?