annual clinical services overview
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ANNUAL CLINICAL SERVICES OVERVIEW. Vaughan Pearce Joint Medical Director CoG Meeting 16 January 2008 (Agenda item 8). THEMES. Cooperation with neighbouring Trusts Expansion of work in the Community Improving the Clinical Environment 7 day week / longer day - PowerPoint PPT PresentationTRANSCRIPT
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ANNUAL CLINICAL SERVICES OVERVIEWVaughan Pearce
Joint 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 infarctionHeart failure
‘angina’ during stressAnatomy
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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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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Actual monthly figureTarget figureLOWER ACTION LIMITSUPPER ACTION LIMITSLOWER WARNING LIMITSUPPER WARNING LIMITS