Transcript WHAT IS IMPORTANT IN DYSTONIA FOR THE PATIENT?

ANNUAL CLINICAL
SERVICES OVERVIEW
Vaughan Pearce
Joint Medical Director
CoG Meeting 16 January 2008
(Agenda item 8)
THEMES
• Cooperation with neighbouring Trusts
• Expansion of work in the Community
• Improving the Clinical Environment
• 7 day week / longer day
• Strong Research and Development
base
• More direct Consultant care
Cooperation with other Trusts
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Urology
Gynaecology
Orthodontics/Maxillofacial surgery
Plastic surgery
Chronic kidney disease
Neurology
Haematology
Stroke
Oncology
Expansion of Community Work
• Operating lists
• Endoscopy
• Dialysis
• Outpatients
Surgery
• New Urologist:-to support
urological cancer service in N&S
Devon.
• Maxillofacial surgeon/Orthodontist
to support Head and Neck cancer
service in East Peninsula.
• MIO:-Largest Centre in Europe
Largest series outside U.S.
Kidney Disease
• Expansion of dialysis capacity
• Probable expansion of community
dialysis
Respiratory Disease
• Home based
diagnosis,assessment and
treatment of sleep apnoea.
Gastroenterology
• New endoscopy unit opens
February- implications for
radiology and colon cancer
screening.
Haematology
• Management of North Devon
patients as part of a North and
East Devon network.
Cancer
• Development of brachytherapy for
prostate cancer.
Emergency Medicine
• 3 Acute Physicians
• ‘Morning Report’ 7 days
Respiratory
Elderly Care
Gastroenterology
Endocrinology
Cardiology
Neurology(5 days)
Evening Ward Round
Cardiology
• 7 day Primary Angioplasty
• Cardiac MRI
Anatomy
Heart failure
Myocardial
infarction
‘angina’ during stress
Cardiac Magnetic Resonance Imaging
at Royal Devon and Exeter NHS Trust
Angiography
Perfusion
Nick Bellenger MD BSc MRCP
Valves
Coronaries
Case 1
65 yr male
3 weeks of SOB and chest pain
Admitted with trop positive acute coronary syndrome
Angiogram: severe three vessel disease
very poor left ventricular function
Usual management:
Too high risk for surgery with damaged heart so medical
treatment with poor prognosis
Management at
Cardiac MRI:
Showed poor function but myocardium is still alive and highly
likely to recover
Change in management following MRI:
Accepted for bypass surgery with good prognosisAnother patient
showing white area
of dead heart
muscle
Case 2
70 yr old male
Sudden onset troponin positive of chest pain
Narrow
Blocked artery
Angiogram:
Severe narrowings in all three main vessels
Usual treatment:
Try to stent all three vessels [putting patient at risk of
prolonged procedure plus requiring at least 2 guides,
2 wires, several balloons, 6 stents (£800 each)]
Management at
Narrowing before
Cardiac MRI:
Left coronary territory dead so no need to
treat
Right coronary territory gets blood from
circumflex so no need to treat
Circumflex territory alive and important so
treat
No narrowing after x1 stent
Management change after MRI:
Cardiac Magnetic Resonance Imaging
at Royal Devon and Exeter NHS Trust
Do you need cardiac MRI ?
Patient benefits:
• Better care
• Best information
• Massive impact
on management
• Safe
• Non-invasive
• No radiation
Trust benefits:
• Better care
• Comply with NICE
• Reduce nuclear wait
• Regional referral income
• Regional Research centre
• Regional Training centre
Financial benefits:
• Save unnecessary revascularization
• Save diagnostic duplication
• Save unnecessary wait for + cost of
CABG
• Income generator
Month
Oct-07
Sep-07
PPCI
Aug-07
20
Jul-07
Jun-07
May-07
Apr-07
Mar-07
Feb-07
Jan-07
Dec-06
Nov-06
Oct-06
Sep-06
Aug-06
Jul-06
Jun-06
May-06
Apr-06
Numbers of Patients
PPCI & THROMBOLYSIS
April 06-October 07
Thrombolysis
25
24/7
PPCI
15
10
5
0
Health Care Acquired Infection
• Rapid Testing
HCAI
• Uniforms
HCAI
• Flooring
HCAI
• Antibiotic policy and Card
• Antibiotic pharmacist
• Clean Your Hands Campaign
• ‘Saving Lives’
• ‘Hygeine Code’
• Surgical Site Infection Audits
05/06
06/07
07/08
March
February
January
December
November
12
October
14
September
August
July
June
May
April
March
February
January
December
November
October
September
August
July
June
May
April
March
February
January
December
November
October
September
August
July
June
May
April
Monthly MRSA bacteraemia
Monthly Statistical process chart for end point MRSA bacteraemia target
16
Actual monthly figure
Target figure
LOWER ACTION LIMITS
UPPER ACTION LIMITS
LOWER WARNING LIMITS
UPPER WARNING LIMITS
10
8
6
4
2
0