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?