ANNUAL CLINICAL SERVICES OVERVIEW

1. ANNUAL CLINICAL SERVICES OVERVIEW Vaughan Pearce Joint Medical Director CoG Meeting 16 January 2008 (Agenda item 8)

2. 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

3. Cooperation with other Trusts • Urology • Gynaecology • Orthodontics/Maxillofacial surgery • Plastic surgery • Chronic kidney disease • Neurology • Haematology • Stroke • Oncology

4. Expansion of Community Work • Operating lists • Endoscopy • Dialysis • Outpatients

5. 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.

6. Kidney Disease • Expansion of dialysis capacity • Probable expansion of community dialysis

7. Respiratory Disease • Home based diagnosis,assessment and treatment of sleep apnoea.

8. Gastroenterology • New endoscopy unit opens February- implications for radiology and colon cancer screening.

9. Haematology • Management of North Devon patients as part of a North and East Devon network.

10. Cancer • Development of brachytherapy for prostate cancer.

11. Emergency Medicine • 3 Acute Physicians • ‘Morning Report’ 7 days Respiratory Elderly Care Gastroenterology Endocrinology Cardiology Neurology(5 days) Evening Ward Round

12. Cardiology • 7 day Primary Angioplasty • Cardiac MRI

13. Myocardial infarction Heart failure Anatomy ‘angina’ during stress Cardiac Magnetic Resonance Imaging at Royal Devon and Exeter NHS Trust Angiography Perfusion Nick Bellenger MD BSc MRCP Valves Coronaries

14. 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 prognosis Another patient showing white area of dead heart muscle

15. Narrow Case 2 70 yr old male Sudden onset troponin positive of chest pain Angiogram: Severe narrowings in all three main vessels Blocked artery 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 Management change after MRI: Only treat one vessel with one stent No narrowing after x1 stent

16. 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

18. Health Care Acquired Infection • Rapid Testing

19. HCAI • Uniforms

20. HCAI • Flooring

21. HCAI • Antibiotic policy and Card • Antibiotic pharmacist • Clean Your Hands Campaign • ‘Saving Lives’ • ‘Hygeine Code’ • Surgical Site Infection Audits