Stroke in Stoke 15 th March 2016 The Stroke Team

The average number of neurons in the human forebrain is 22 billion. In patients experiencing a typical large vessel acute ischemic stroke 120 million neurons 830 billion synapses 714 km (447 miles) of myelinated fibers are lost each hour Compared with the normal rate of neuron loss in brain aging, the ischemic brain ages 3.6 years each hour without treatment. Time is brain--quantified. Saver JL. Stroke Jan;37(1): Epub 2005 Dec 8

Those who survive Stroke

UHNS Acute Stroke Unit (ASU) 2001 to 2012 Outcome/Results 39 beds 32 beds26 beds

Pathway for patients with suspected STROKE in 2008 Triaged in A and E Acute Stroke Unit CT scan if lucky within 24 hours

Looking for An Ideal Pathway !!!

Re-organisation of stroke services 2010 Moved to Single site in 2010 In-reaching to ED Pull model rather than Push model proposed Revolt in our camp ( one left one decided to retire) Interdisciplinary model of working with the therapists and nurses 24/7 thrombolysis rota (Another revolt) 7 Day working (Major Revolt)

Pathway for patients with suspected STROKE Triaged in A and E Within 4 hours Within 1 hour

Pre-Alert 999 Stroke Team

Our Current Service 26 dedicated beds within the 52 bedded Neurosciences Unit, allowing flexibility for peaks in demand, offering an acute stroke service and first stage rehabilitation. Tertiary Stroke Centre within the Neurosciences Umbrella Serving a population of approximately 1.5 million Caring for 1,200 stroke patients each year 60 plus multidisciplinary team with integrated therapists Average LOS 5 days National leading centre, performing well against Acute Stroke Indicators (86.3 points, top quartile) Lower than the national average 30 day mortality (10%)

Regional Thrombolysis led by UHNS

Regional Thrombolysis rota for 24/ 7 cover across the region ( Feb 2011)

Further Developments Final Move to CGH with Neurosciences Unit Early Support Discharge team developed Endovascular pathway for large strokes 7 Day TIA Services Developed our Neurosciences rota Tertiary Stroke Centre

Services we offer 24/7 Hyper-acute Stroke/ TIA service, for Stoke on Trent, Stafford, Leighton and more recently Macclesfield. 24/7 Thrombolysis, service - from a regional rota across Shropshire and Staffordshire A nationally renowned multidisciplinary team/ ESD 7 day service. In reach SEAT team to Emergency Department Neuro-intervention EndoVascular Treatment– clot retrieval ( One of the active hyper-acute Centres treated around 200 patients with complex strokes.

National Leaders New Treatments and Research Endovascular Clot Removal treatments First in the country Started in 2009 Over 275 patients treated Leaders in the United Kingdom

Sentinal Stroke National Audit Programme (SSNAP) Team Centred Quarterly Scores for 2015

Future Challenges….. Integrating with Stroke Services across the whole pathway Working on Pre alert Re-patriation (Workable Model) Sustaining Hi gh Quality Stroke Care

Prevention

ESD / CST Patient Cohort Stroke Prevention Stage Hyper-Acute Stage Acute StageRehab Stage Provided by UHNSProvided by SSOTP Days in Patient Pathway A percentage of patients are being stepped down to SSOTP for the remainder of their Acute stage Patients are referred to ESD / CST from all parts of the pathway, including a small percentage referred directly from A&E in the Hyper-Acute stage UHNS lead on promoting Stroke prevention in the community

Thank you