Скачать презентацию Slide 1 INR outcomes services in the Скачать презентацию Slide 1 INR outcomes services in the

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Slide 1 INR outcomes & services in the UK Phil White Professor of Interventional Slide 1 INR outcomes & services in the UK Phil White Professor of Interventional & Diagnostic Neuroradiology - Secretary UKNG - Chair BSNR Standards Committee

Slide 2 Disclosures § RCR &/or Br Soc Neuroradiologists representative: – on National Stroke Slide 2 Disclosures § RCR &/or Br Soc Neuroradiologists representative: – on National Stroke Strategy [Emergency Response] – Intercollegiate Stroke Working Party § Radiology lead RCP Stroke peer review panel § Occasional educational consultancy work for 3 companies making devices for stroke/aneurysm Rx § Some research co-funded from commercial sources

Slide 3 1. INR patient benefits in a. SAH 2. UKNG survey of INR Slide 3 1. INR patient benefits in a. SAH 2. UKNG survey of INR services

Slide 4 Interventional Neuroradiology delivered therapy is good news ISAT stopped Courtesy of AJ Slide 4 Interventional Neuroradiology delivered therapy is good news ISAT stopped Courtesy of AJ Molyneux, T Mukta, M Goldacre and colleagues ONNRU/OU Dept. Public Health – in press NOT FOR REPRODUCTION

Slide 5 § SAH mortality declined 41% 1995 -2010 – SAH admission rates reduced Slide 5 § SAH mortality declined 41% 1995 -2010 – SAH admission rates reduced from 100 to 82 pm pa (18%) § Earlier US data on INR services in agreement – RR 0. 91 (California) & 0. 68 (NY State) for every 10% coiled – RR 0. 84 mortality in hospitals with INR available for vasospasm angioplasty (indicator of MDT approach &/or extended hours service? ) • Johnston SC et al Stroke 2000 & 2003 § The pattern of decline in population mortality is very similar to that observed for decline in clipping rates – Likely to reflect more widespread multidicplinary team care as much as impact of coiling per se? BUT………. .

Slide 6 Coiling results continue to improve § IPR meta-analysis of 2 UK led Slide 6 Coiling results continue to improve § IPR meta-analysis of 2 UK led current coiling technology trials vs ISAT AD = 13%; NNT = <8

Slide 7 Technology getting patients out of danger Slide 7 Technology getting patients out of danger

Slide 8 But need to get to the technology in time… Slide 8 But need to get to the technology in time…

Slide 9 INR Services – June 2013 UKNG Survey § Representative sample – 40% Slide 9 INR Services – June 2013 UKNG Survey § Representative sample – 40% of all UK INR’s – Good geographical spread – Experience spread

Slide 10 Currently…………. . § Just under 1/3 offer 7 day service now – Slide 10 Currently…………. . § Just under 1/3 offer 7 day service now – Many more could with additional resource & some reorganisation or resourced networking – Only formal & resourced network is in Scotland

Slide 11 Ability to deliver 7 day service § 18% could deliver 7 -day Slide 11 Ability to deliver 7 day service § 18% could deliver 7 -day [daytime] coiling service by end of 2014 + a further 59% could deliver 6 -day coiling service § So, 48 h+ delay from a. SAH diagnosis to aneurysm treatment could be largely eliminated by end 2014 • ~50% offering 7 -day service, remainder 6 -day § Larger NS units could offer 6 -7 day coiling service standalone “in house” if resourced • 15/24 English units • 9/24 smaller catchment population units could struggle – 8/9 are <55 miles by road from a neighbouring larger unit

Slide 12 Resources to deliver extended number of days service § MODEST increase in Slide 12 Resources to deliver extended number of days service § MODEST increase in INR & diagnostic neuroradiology consultant staffing (68 INRs in post in England, 4 advertised/planned) – Median increase in INR complement from 3 to 4 – Median increase in DNR complement from 4 to 5 § Additional support staff more expensive ! – Anaesthetist, ODP, radiographer, angio nurses, ITU & HDU drs/nurses § Networking superficially may be cheaper alternative – Fixed staffed lists & ITU/HDU availability very expensive • <40 pm pa for early coiling = <0. 25 cases per weekend pm pop § Major issue round maintaining skills if big ↑ INR staff – 2003 SBNS/BSNR consensus document: minimum activity level to maintain skills = 40 pa coiling, 15 pa clipping • a. SAH patients with 80% coiling: workload in England for 70 INRs – May be feasible if resourced for some units

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