Improving care after stroke Dr Nick Losseff Consultant Neurologist
What is a stroke ?
Recognising a stroke
What is the treatment ?
Time is brain
Preventing brain damage Accurate diagnosis Respiratory care Hydration Hypertension Hyperglycaemia Pyrexia TPA Drugs (ASA)
Outcome after stroke • Casemix adjusted outcome in Europe – 4534 patients (Wolfe et al – Stroke 1999) • 42% dead at 3 months - U.K. • 19% dead - France
Recent UCLH developments • 2007: Started the first 24 /7 “clot busting treatment” service for stroke in North London – Accessible to anyone coming to UCH A+E – Delivered excellent results (numbers treated / survival)
London Stroke Strategy
Critical Mass • Clinical expertise • Volume facilitate multidisciplinary teams • Research facilitated • Junior Staffing optimised • Efficiency
Decision to change
Hyperacute Stroke Units
SU and TIA services
UCLH Hyperacute Stroke Unit • Far greater number of people being treated • High thrombolysis rates - 18% - extended to sector (i.e. thrombolysis rate doubled in sector by centralisation) • All in license thrombolysis achieved in target < 1 hr • Survey of mortality shows UCLH low mortality extending to all HASU treated pts (6% - follow up in local unit)
Success !
Partnership
Exemplar of change • Clear demonstration where concentration of expertise and partnerships between health service providers delivers real benefits for people
Conclusion • Radical and bold • Should strive to improve our services • Nihilism • Population based – organisational and local altruism
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