Starting a Thrombolysis service

Tony KentonConsultant Neurologist, UHCW

Clinical Lead, Coventry and Warwickshire Cardiovascular Network

DON’T DO IT!!

Learn From Cardiology

Models of Acute Stroke Units

• Hyperacute• Hyperacute and acute

Staffing

• Which consultants• Junior cover/EWTD/New deal• On-call• Nurses/training• Therapy staff

Thrombolysis

• Speed, speed, speed

Stroke Onset

• Awareness– Patient/witness– GP/practice– Health care workers

Initial Assessment

• Paramedics• FAST test• Which hospital• Pre-alert• Take a witness/iv line etc• ‘stay and play’ OR ‘scoop and run’

Arrival at Hospital

• Who does initial assessment– ED/medics/stroke nurse/stroke dr

• How are they trained to assess the patient• What if it is not a stroke– Can they recognise stroke mimics– Who do they refer to

• Protocol for BP, bloods, ecg, arranging CT

CT Scan

• Radiographer• Someone to interpret the CT• Are radiographers resident/travel time• When do they get called• Interpreter training?

Post Thrombolysis

• Intense nursing assessments– BP, GCS/NIHSS, other parameters

• Who do they call if something goes wrong• Need a detailed protocol

Follow Up

• Audit– Treated and untreated patients

• Ongoing education• Continual refining of the pathway• ‘Nip things in the bud’• Adopt new guidelines/treatment

Summary

• Set up your hyperacute unit first• Involve all stakeholders• Education: treating acute stroke is good• Make sure most people are happy with the service• Clear guidelines/protocols• Feedback and follow up• Be able to change and adapt

It’s About Change…

• Everyone thinks of changing the world, but no one thinks of changing himself.

Leo Tolstoy

•You must be the change you wish to see in the world.

Mahatma Gandhi.