ANNUAL CLINICAL SERVICES OVERVIEW

Vaughan PearceJoint 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

• Strong Research and Development base

• More direct Consultant care

Cooperation with other Trusts

• Urology

• Gynaecology

• Orthodontics/Maxillofacial surgery

• Plastic surgery

• Chronic kidney disease

• Neurology

• Haematology

• Stroke

• Oncology

Expansion of Community Work

• Operating lists

• Endoscopy

• Dialysis

• Outpatients

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

• Expansion of dialysis capacity

• Probable expansion of community dialysis

Respiratory Disease

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

Gastroenterology

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

Haematology

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

Cancer

• Development of brachytherapy for prostate cancer.

Emergency Medicine

• 3 Acute Physicians• ‘Morning Report’ 7 days Respiratory Elderly Care Gastroenterology Endocrinology Cardiology Neurology(5 days)

Evening Ward Round

Cardiology

• 7 day Primary Angioplasty

• Cardiac MRI

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

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

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

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 ?

PPCI & THROMBOLYSIS April 06-October 07

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• Antibiotic policy and Card

• Antibiotic pharmacist

• Clean Your Hands Campaign

• ‘Saving Lives’

• ‘Hygeine Code’

• Surgical Site Infection Audits

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