Stroke care seven days a week – improving outcomes for patients, co-ordinating the Stroke imaging pathway
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Stroke care seven days a week – improving outcomes for patients, co-ordinating the Stroke imaging pathway

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Stroke care seven days a week – improving ...

Stroke care seven days a week – improving
outcomes for patients, co-ordinating the Stroke
imaging pathway - 365 day rapid-access one-stop TIA clinic - Dr David Eveson - presentation from the seven day services in diagnostics event held on 4 March 2013 #7dayDiagnostics

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Stroke care seven days a week – improving outcomes for patients, co-ordinating the Stroke imaging pathway Stroke care seven days a week – improving outcomes for patients, co-ordinating the Stroke imaging pathway Presentation Transcript

  • Stroke care seven days a week – improvingoutcomes for patients, co-ordinating the Stroke imaging pathway 365 day rapid-access one-stop TIA clinic “NHS Improvement - Equality for all. Delivering safe care -seven days a week” - Sept 2011 Dr David Eveson Consultant in Stroke Medicine University Hospitals Leicester
  • What is a TIA and why is it important to manage rapidly? • ‘Heralding’ event • Half of TIA patients have a 2-day stroke risk 6-10% • Immediate versus late treatment, reduction of stroke recurrence by 80% (EXPRESS Study) Rothwell PM et al. Lancet 2007. 370, 1432-42
  • What is a TIA and why is it important to manage rapidly? • Specialist services: – Confirm diagnosis – Conduct full assessment of stroke risk • Carotid imaging (duplex US) • Brain imaging (MRI) – Initiate tailored treatment • Antiplatelet / Anticoagulant • Antihypertensive • Lipid lowering • Lifestyle intervention • Carotid endarterectomy
  • Incentives for 7 day service provision• Quality of care – Improved patient outcomes – What service would you or a relative wish to access? – Two-tier services no longer acceptable (7-day society)• Financial – Best practice tariff • Core – access to a 7-day service - £477 (versus £133) • Supplementary – Investigate and treat higher-risk patients within 24 hours £97 – MRI for brain imaging - £72 – Every stroke prevented saves £23,315 (NAO 1st year costs)
  • The Leicester model• <2007 – No system – Imaging took several weeks• >2007 – Combined business case for Acute Stroke and TIA services – Capital – PCT (revenue funding support) and acute trust – Local tariff negotiated (now superseded) TIA Vital Sign (Integrated Performance Measure) Percentage of Transient Ischaemic Attack (TIA) cases with a higher risk of stroke who are treated within 24 hours Q3 2008/9 Q4 2010/11 Leicester City 33% 70% Leicester County 13% 70%
  • The Leicester model• Imaging – Brain • Costing prepared by radiology department in accordance with National Stroke Strategy – an imaging guide (2008) • 3.5 wte Band 6 Radiographers • 3.0 wte Band 3 RDA • 1.0 wte Band 2 Porters – 5-day MRI, 2-day CT initially, now 7-day MRI – Carotid • Vascular scientists attached to vascular surgery department • Permanent weekend staffing (management of change, not overtime) • Weekend pay enhancement plus time back during week • Locate scanner in TIA clinic and use it for in-patient scans
  • Ongoing challenges200180160140120100 Number of patients High-risk percentage 80 60 40 20 0 An ever increasing number of referrals to the TIA clinic?
  • Ongoing challenges and solutions• Appointment saturation (Parkinson’s law?) – Increase the number of appointments – Utilise taxis instead of NHS transport – Electronic referral system including ‘intelligent booking’ and user feedback• 7-day TIA services elsewhere – Not a one size fits all solution – TIA incidence 0.5/1000 per annum – Combine populations – Weekend ward rounds – Tele-medicine/radiology