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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

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Annual clinical services overview

ANNUAL CLINICAL SERVICES OVERVIEW

Vaughan Pearce

Joint Medical Director

CoG Meeting 16 January 2008 (Agenda item 8)


Themes
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


Cooperation with other trusts
Cooperation with other Trusts

  • Urology

  • Gynaecology

  • Orthodontics/Maxillofacial surgery

  • Plastic surgery

  • Chronic kidney disease

  • Neurology

  • Haematology

  • Stroke

  • Oncology


Expansion of community work
Expansion of Community Work

  • Operating lists

  • Endoscopy

  • Dialysis

  • Outpatients


Surgery
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.


Kidney disease
Kidney Disease

  • Expansion of dialysis capacity

  • Probable expansion of community dialysis


Respiratory disease
Respiratory Disease

  • Home based diagnosis,assessment and treatment of sleep apnoea.


Gastroenterology
Gastroenterology

  • New endoscopy unit opens February- implications for radiology and colon cancer screening.


Haematology
Haematology

  • Management of North Devon patients as part of a North and East Devon network.


Cancer
Cancer

  • Development of brachytherapy for prostate cancer.


Emergency medicine
Emergency Medicine

  • 3 Acute Physicians

  • ‘Morning Report’ 7 days

    Respiratory

    Elderly Care

    Gastroenterology

    Endocrinology

    Cardiology

    Neurology(5 days)

    Evening Ward Round


Cardiology
Cardiology

  • 7 day Primary Angioplasty

  • Cardiac MRI


Myocardial

infarction

Heart failure

Anatomy

‘angina’ during stress

Cardiac Magnetic Resonance Imaging

at Royal Devon and Exeter NHS Trust

Angiography

Perfusion

Nick Bellenger MD BSc MRCP

Valves

Coronaries


Case 1

65 yr male

3 weeks of SOB and chest pain

Admitted 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 prognosis

Another patient showing white area of dead heart muscle


Narrow

Case 2

70 yr old male

Sudden onset troponin positive of chest pain

Angiogram:

Severe narrowings in all three main vessels

Blocked artery

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)]

Management at

Narrowing before

Cardiac MRI:

Left coronary territory dead so no need to treat

Right coronary territory gets blood from circumflex so no need to treat

Circumflex territory alive and important so treat

Management change after MRI:

Only treat one vessel with one stent

No narrowing after x1 stent


Cardiac Magnetic Resonance Imaging

at Royal Devon and Exeter NHS Trust

Do you need cardiac MRI ?

  • 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



HCAI

  • Uniforms


HCAI

  • Flooring


HCAI

  • Antibiotic policy and Card

  • Antibiotic pharmacist

  • Clean Your Hands Campaign

  • ‘Saving Lives’

  • ‘Hygeine Code’

  • Surgical Site Infection Audits


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