T JosephConsultant Vascular surgeon

Cumberland Infirmary, Carlisle.

North Cumbria University HospitalsCumberland Infirmary

187,000

Estimated TIAs ‐74* ‐155#

Dumfries – 120,000

West Cumberland Hospital136,000

Estd. TIAs – 54* ‐ 113#

*Crude annual incidence 0.35-0.42/1000 – Dennis MS et al. Incidence of TIA in Oxfordshire; Storke1989;20: 333-339

#Race, age, gender adjusted incidence 83/100,000 –Kleindorfer D et al. Incidence & short-term prognosis of TIA….Stroke 2005;36:720-23

Solway Basin Vascular Network‐Carotid endarterectomy

Hospital Actual Numbers ?Expected Maximum

CI Carlisle 15‐25 90

WCH Whitehaven 10‐15 65

D & G 10 58

Problemsthere are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns ‐‐ the ones we don't know we don't know."

"I am not going to give you a number for it because it's not my business to do intelligent work." 

ProblemsAwarenessPeopleGPSecondary care

Junior doctorsAccident & EmergencyOpthalmologists

AccessGPSecondary careInvestigations

CT/MRIU/SEcho

SurgeryTheatreVascular anaesthetistVascular surgeon

Strategy

Organise the secondary care

Spread awareness 

ProblemsAwarenessPeopleGPSecondary care

Junior doctorsAccident & EmergencyOpthalmologists

AccessGPSecondary careInvestigations

CT/MRIU/SEcho

SurgeryTheatreVascular anaesthetistVascular surgeon

Carlisle solutionsStarted with improved clinic access

Improved access to surgery

Disseminate awareness

Clinic accessTwo stroke physicians3 clinics in Carlisle – 5 by Nov.

Neurovascular clinicsAppointment systemStroke hot‐lineSeen within 3 days

Access to ultrasound, CT.

Surgical accessMeeting with stake holders

Radiologists, Managers, Vascular anaesthetists, vascular surgeons and physicians.

Impact assessment with historical data~100 investigations expected~50 cases expectedDedicated list on alternate weeks/extra sessions

AwarenessGuidelines for GPs

Emergency hot‐line for advice

Meetings – e.g. Ophthalmology

Public awareness programmes

Case studyAG/67/mLt. sided symptoms 21/09/09GP ref: 22/09/09 1 dayNV Outpatients & u/s 24/09/09 3 daysweekendSurg r/v 28/09/09 7 daysCT 30/09/09 9 daysRt. CEA 2/10/09 11 days

Carlisle solutionsProblems Solutions

Access – for opinion 3 urgent referral clinics Further plan to make daily clinics?Walk in facility

Access for investigations 2 ultrasound slots for TIA clinic2 CT slotsMRI – informalCTA – within 3 daysEcho – within 48 hours – informal

Access to surgery Offered within 3‐7 days.(theatres, anaesth. Services, recovery, surgeons)

Awareness A/E, Ophthalmology, GPs.

Questions

Thank you