annual clinical services overview vaughan pearce joint medical director cog meeting 16 january 2008...
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ANNUAL CLINICAL SERVICES OVERVIEW
Vaughan PearceJoint Medical Director
CoG Meeting 16 January 2008 (Agenda item 8)
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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
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Cooperation with other Trusts
• Urology
• Gynaecology
• Orthodontics/Maxillofacial surgery
• Plastic surgery
• Chronic kidney disease
• Neurology
• Haematology
• Stroke
• Oncology
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Expansion of Community Work
• Operating lists
• Endoscopy
• Dialysis
• Outpatients
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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.
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Kidney Disease
• Expansion of dialysis capacity
• Probable expansion of community dialysis
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Respiratory Disease
• Home based diagnosis,assessment and treatment of sleep apnoea.
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Gastroenterology
• New endoscopy unit opens February- implications for radiology and colon cancer screening.
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Haematology
• Management of North Devon patients as part of a North and East Devon network.
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Cancer
• Development of brachytherapy for prostate cancer.
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Emergency Medicine
• 3 Acute Physicians• ‘Morning Report’ 7 days Respiratory Elderly Care Gastroenterology Endocrinology Cardiology Neurology(5 days)
Evening Ward Round
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Cardiology
• 7 day Primary Angioplasty
• Cardiac MRI
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Perfusion
Coronaries
Myocardial infarction
Heart failure‘angina’ during stress
Anatomy
Valves
Angiography
Cardiac Magnetic Resonance Imagingat Royal Devon and Exeter NHS Trust
Nick Bellenger MD BSc MRCP
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Case 1
65 yr male3 weeks of SOB and chest painAdmitted 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 prognosisAnother patient
showing white area of dead heart muscle
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Case 270 yr old maleSudden onset troponin positive of chest pain
Angiogram:Severe narrowings in all three main vessels
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)]
Cardiac MRI:Left coronary territory dead so no need to treatRight coronary territory gets blood from circumflex so no need to treatCircumflex territory alive and important so treat
Management change after MRI:Only treat one vessel with one stent
Narrowing before
No narrowing after x1 stent
Blocked arteryNarrow
Management at
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Cardiac Magnetic Resonance Imagingat Royal Devon and Exeter NHS Trust
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
Do you need cardiac MRI ?
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PPCI & THROMBOLYSIS April 06-October 07
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PPCI Thrombolysis
24/7 PPCI
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Health Care Acquired Infection
• Rapid Testing
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HCAI
• Uniforms
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HCAI
• Flooring
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HCAI
• Antibiotic policy and Card
• Antibiotic pharmacist
• Clean Your Hands Campaign
• ‘Saving Lives’
• ‘Hygeine Code’
• Surgical Site Infection Audits
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Monthly Statistical process chart for end point MRSA bacteraemia target
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LOWER ACTION LIMITS
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