Starting a Thrombolysis service

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Starting a Thrombolysis service

• Tony Kenton
• Consultant Neurologist, UHCW
• Clinical Lead, Coventry and Warwickshire
  Cardiovascular Network

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• DONT DO IT!!

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Learn From Cardiology
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Models of Acute Stroke Units

• Hyperacute
• Hyperacute and acute

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Staffing

• Which consultants
• Junior cover/EWTD/New deal
• On-call
• Nurses/training
• Therapy staff

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Thrombolysis

• Speed, speed, speed

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Stroke Onset

• Awareness
• Patient/witness
• GP/practice
• Health care workers

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Initial Assessment

• Paramedics
• FAST test
• Which hospital
• Pre-alert
• Take a witness/iv line etc
• stay and play OR scoop and run

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Arrival at Hospital

• Who does initial assessment
• ED/medics/stroke nurse/stroke dr
• How are they trained to assess the patient
• What if it is not a stroke
• Can they recognise stroke mimics
• Who do they refer to
• Protocol for BP, bloods, ecg, arranging CT

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CT Scan

• Radiographer
• Someone to interpret the CT
• Are radiographers resident/travel time
• When do they get called
• Interpreter training?

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Post Thrombolysis

• Intense nursing assessments
• BP, GCS/NIHSS, other parameters
• Who do they call if something goes wrong
• Need a detailed protocol

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Follow Up

• Audit
• Treated and untreated patients
• Ongoing education
• Continual refining of the pathway
• Nip things in the bud
• Adopt new guidelines/treatment

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Summary

• Set up your hyperacute unit first
• Involve all stakeholders
• Education treating acute stroke is good
• Make sure most people are happy with the service
• Clear guidelines/protocols
• Feedback and follow up
• Be able to change and adapt

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Its About Change

• Everyone thinks of changing the world, but no one
  thinks of changing himself.
• Leo Tolstoy
• You must be the change you wish to see in the
  world.
• Mahatma Gandhi.