T JosephConsultant Vascular surgeon
Cumberland Infirmary, Carlisle.
North Cumbria University HospitalsCumberland Infirmary
187,000
Estimated TIAs ‐74* ‐155#
Dumfries – 120,000
West Cumberland Hospital136,000
Estd. TIAs – 54* ‐ 113#
*Crude annual incidence 0.35-0.42/1000 – Dennis MS et al. Incidence of TIA in Oxfordshire; Storke1989;20: 333-339
#Race, age, gender adjusted incidence 83/100,000 –Kleindorfer D et al. Incidence & short-term prognosis of TIA….Stroke 2005;36:720-23
Solway Basin Vascular Network‐Carotid endarterectomy
Hospital Actual Numbers ?Expected Maximum
CI Carlisle 15‐25 90
WCH Whitehaven 10‐15 65
D & G 10 58
Problemsthere are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns ‐‐ the ones we don't know we don't know."
"I am not going to give you a number for it because it's not my business to do intelligent work."
ProblemsAwarenessPeopleGPSecondary care
Junior doctorsAccident & EmergencyOpthalmologists
AccessGPSecondary careInvestigations
CT/MRIU/SEcho
SurgeryTheatreVascular anaesthetistVascular surgeon
Strategy
Organise the secondary care
Spread awareness
ProblemsAwarenessPeopleGPSecondary care
Junior doctorsAccident & EmergencyOpthalmologists
AccessGPSecondary careInvestigations
CT/MRIU/SEcho
SurgeryTheatreVascular anaesthetistVascular surgeon
Carlisle solutionsStarted with improved clinic access
Improved access to surgery
Disseminate awareness
Clinic accessTwo stroke physicians3 clinics in Carlisle – 5 by Nov.
Neurovascular clinicsAppointment systemStroke hot‐lineSeen within 3 days
Access to ultrasound, CT.
Surgical accessMeeting with stake holders
Radiologists, Managers, Vascular anaesthetists, vascular surgeons and physicians.
Impact assessment with historical data~100 investigations expected~50 cases expectedDedicated list on alternate weeks/extra sessions
AwarenessGuidelines for GPs
Emergency hot‐line for advice
Meetings – e.g. Ophthalmology
Public awareness programmes
Case studyAG/67/mLt. sided symptoms 21/09/09GP ref: 22/09/09 1 dayNV Outpatients & u/s 24/09/09 3 daysweekendSurg r/v 28/09/09 7 daysCT 30/09/09 9 daysRt. CEA 2/10/09 11 days
Carlisle solutionsProblems Solutions
Access – for opinion 3 urgent referral clinics Further plan to make daily clinics?Walk in facility
Access for investigations 2 ultrasound slots for TIA clinic2 CT slotsMRI – informalCTA – within 3 daysEcho – within 48 hours – informal
Access to surgery Offered within 3‐7 days.(theatres, anaesth. Services, recovery, surgeons)
Awareness A/E, Ophthalmology, GPs.
Questions
Thank you