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NCEPOD Managing the flow SAH Report Launch 22 Nov 2013

Explore the impact of service reorganization on interventional neuroradiology, neurosurgery workforce, and rates of aneurysm coiling in the UK healthcare system.

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NCEPOD Managing the flow SAH Report Launch 22 Nov 2013

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  1. NCEPODManaging the flowSAH Report Launch22 Nov 2013 Interventional Neuroradiology (INR) (Endovascular therapy EVT) Dr John Millar MRCP FRCR UKNG/BSNR Wessex Neurological Centre UHS

  2. Aneurysm Coiling • GDC coil introduced UK 1992

  3. Aneurysm Coiling • GDC coil introduced UK 1992 • ISAT – mcRCT, 1997-Sep 2002

  4. Aneurysm Coiling • GDC coil introduced UK 1992 • ISAT – mcRCT, 1997-Sep 2002 • 2143 pts – NS Clip vs EV Coil

  5. Aneurysm Coiling • GDC coil introduced UK 1992 • ISAT – mcRCT, 1997-Sep 2002 • 2143 pts – NS Clip vs EV Coil • 7.4% (p=0.0001) ARR of death or dependency @1 yr - coiling

  6. Aneurysm Coiling • GDC coil introduced UK 1992 • ISAT – mcRCT, 1997-Sep 2002 • 2143 pts – NS Clip vs EV Coil • 7.4% (p=0.0001) ARR of death or dependency @1 yr - coiling Similar findings RT’s: • Kuopio 1995-97 (109) • BRAT 2003-07 (471)

  7. Audit data UK rates of coiling by centre type September 2001 – April 2002 Based on returns to Royal College of SurgeonsLangham J et al Stroke 2009 Large recruiting ISAT centres(> 50 pts 12) n = 660 Low recruiting ISAT centres (50 pts 9) n = 297 Non ISAT centres with coiling (5) n = 196 N = 1362

  8. Audit data UK rates of coiling by centre type –January 2003 – September 2003Based on returns to RCS Large recruiting ISAT centres n = 431 Low recruiting ISAT centres n = 171 Non ISAT centres with coiling n = 85 N = 775

  9. ? Service Reorganisation • Job planning • Separate directorates of NS and NR • Central work force planning

  10. X Service Reorganisation • Job planning • Separate directorates of NS and NR • Central work force planning

  11. X Service Reorganisation • Job planning • Separate directorates of NS and NR • Central work force planning • Dual role INR/diagnostic NR

  12. 24/7 Diagnostic Neuroradiology Urgent Imaging (CT/MRI) • Head injury/depressed GCS • Stroke & TIA • Cauda equina syndrome • 24/7 MRI • Development of trauma centres

  13. 24/7 Diagnostic Neuroradiology Urgent Imaging (CT/MRI) • Head injury/depressed GCS • Stroke & TIA • Cauda equina syndrome • 24/7 MRI • Development of trauma centres • 7/7 consultant led working in Neuroradiology

  14. Neuroradiology workforce UK WTE 34 Neuroscience Units, UK Source: BSNR, Safe Neuroradiology 2012

  15. Neuroradiology workforce UK • 2013 : 185 Neuroradiologists (BSNR - 34 NSU) • Approx half undertake INR procedures • NSU’s: 3 INR capable

  16. 7/7 Aneurysm Rx? • Neuroradiologist expansion – INR/DNR • Team - Neuroanaesthetist, theatre staff, scrub staff, Radiographic • Vascular Neurosurgery ? • Networks ?

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