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How a Stroke Physician can find potentially eligible patients for ACST-2

How a Stroke Physician can find potentially eligible patients for ACST-2. 18 th September 2014. David Hargroves, Consultant Physician, Clinical Lead for Stroke Medicine, East Kent Hospitals University NHS Foundation Trust. david.hargroves@nhs.net.

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How a Stroke Physician can find potentially eligible patients for ACST-2

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  1. How a Stroke Physician can find potentially eligible patients for ACST-2 18th September 2014 David Hargroves, Consultant Physician, Clinical Lead for Stroke Medicine, East Kent Hospitals University NHS Foundation Trust. david.hargroves@nhs.net

  2. How a Stroke Physician can find potentially eligible patients for ACST-2….offer cross sectional imaging to everyone 18th September 2014 David Hargroves, Consultant Physician, Clinical Lead for Stroke Medicine, East Kent Hospitals University NHS Foundation Trust. david.hargroves@nhs.net

  3. Who we are:East Kent Hospitals University NHS Foundation Trust is one of the largest hospital trusts in England, with three acute hospitals and several outpatient facilities across East Kent and Medway (1,118 beds)Who we serve: A population of ~750,000 covering approximately 50% of the county of Kent The challenges we faced A large geographical area ( takes an hour to travel from Margate to Ashford), ageing populations in coastal resorts, three distinct combined stroke units

  4. 24hr. Access to Hyper acute stroke care across East Kent Nurse calls consultant for remote assessment Home Office Doctor on call uses laptop connected to the internet to see live video of patient with two-way audio Patient presented in A&E with symptoms of stroke Canterbury (Vascular Hub) Margate Ashford Any “high speed” internet connection e.g. Broadband, 3G N3(NHSnet) The Internet Solution available from PC’s within Trust

  5. Research and Education Hyper acute Care ESD / ICT TIA clinics TIA clinics Neuroradiology Luminal intervention RACE / stenting Luminal intervention Social service Social service Early supportive discharge Primary Care Acute Treatment Reviews Early Diagnosis Prolonged Neurorehabilitation Rehabilitation 1° Prevention Neuro psychology Palliative Care Neurosurgery Palliative Care Neurosurgery 2° Prevention Organised Stroke care

  6. TIA Clinics: Daily clinics upon all sites – 1 at weekends MRI head with DWI and CEMRA neck available for all patients; 8/day CTA and Doppler second line modality Monthly MDM to discuss all asymptomatic patients

  7. R ICA stenosis 90%

  8. MDM: ‘ no patient to be offerred intervention without consideration for ACST-2’ Clinical diagnosis confirmed Imaging reviewed Agreement as to asymptomatic nature (>6/12 post symptoms) and life expectancy Compatibility for stenting and surgery ascertained Physician and surgeon assessed Approached in clinic setting ref inclusion in ACST-2

  9. Summary: Research focused ‘A commitment to answering the question’ Collaboration: physicians / surgeons / IR Systems based approach: All significant stenosis identified sent for review Monthly governance MDM to discuss all cases before asymptomatic intervention via ACST-2

  10. Thank you David Hargroves, Consultant Physician, Clinical Lead for Stroke Medicine, East Kent Hospitals University NHS Foundation Trust. david.hargroves@nhs.net

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