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.
