Managed Clinical Networks
Heart & Stroke
Denise W Brown
MCN Manager
8th October 2009 - eScience Centre Edinburgh
Drivers for 2009
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New Action Plan from
Scottish Government
June 2009
SIGN Guidelines
QIS Standards
NHS efficiency savings
Long Term Conditions
Patient Self Management
What are stroke challenges for
2009/10?
QIS Standards
Stroke Thrombolysis services / telemedicine
 Phased implementation of service – with 5 patients
thrombolysed since June 09 at Ayr Hospital. Out of
hours still go to Glasgow.
 Working with clinicians, operational managers, planners,
SAS, West of Scotland Stroke Group and National
telemedicine colleagues
Acute Stroke measures to improve admission
 Working with clinicians, operational managers & QIS
Standards measured by Scottish Stroke Audit
Community involvement in early discharge, exercise for
stroke and promotion of healthy lifestyles
 All requiring working across the pathways and with
partners SAS – Leisure Services and Keep Well
What are challenges for heart in
2009 / 2010?
QIS Standards
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New Heart Attack definition – troponin < 1
(400 plus for c rehab)
Optimal Reperfusion Service for STEMI
(started Jan 2009)
Living and Dying Well - Palliative Care for
Heart Failure (BHF 3 yr post)
Improving Psychology for Heart Disease
(BHF 3 yr post)
18 Referral to treatment (RTT)
ICD follow up service
QIS Draft Standards Pilot Site
18week challenge:
Real-time process mapping
Open access
ETT
GP referrals
In-patient
admission
Consultant
clinic
Investigations
Rapid
access CP
clinic
Post MI
clinic
Other cons
referrals
Angio
Review
Intervention
1st step
Triaging GP Cardiology Referrals
into appropriate pathway:
GP referrals
Consultant
clinic
GPwSi
Rapid Access
Advanced
Specialist Nurse
Palpitation /
Arrthythmia
Pathway
Cardiophysiology
Led investigations
Referred onto Consultant
Clinic if appropriate
Working with patients, clinicians, operational managers,
planners, West of Scotland Tertiary Centres for onward referrals
for surgery
Implantable Cardioverter Defibrillator
(ICD) follow up Service
Patient influence and lobbying of Health Board for
local service rather than travel to Glasgow
 MCN, planners and West of Scotland Group agreed
this shift of care to A&A
 Cardiophysiologists were trained and the service
supported by MCN
 This service is now at Ayr Hospital and we are
delighted with the positive response from patients
 All new patients with ICD fitted in Glasgow will have
their follow up visits at Ayr Hospital
 Currently 75 patients on books with 2 new patients a
month
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Patients at the centre of
Psychology Service planning
Clinical Psychology Project for Stroke –
Dr Luke Williams enabling staff & patients to
recognise distress and agree a plan
Distress Management System to
highlight, monitor & manage distress
Unfortunately no recurring Psychology service after March 2010
♥Ticker
Talk
PPFs
Self support for people
with heart failure, their
families and carers
☼LIFE AFTER STROKE
Self Support Group in the community for people, their families and
carers who have come through a stroke and want to meet socially.
Support by Chest Heart and Stroke Scotland, MCNs and PPFs.
Meeting Monthly in the community setting.
CHALLENGING YOUR CONDITION : A Self Management Generic
Course in Community run by Arthritis paid for by Ayrshire & Arran.
Influences
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Audit Data collection – knowledge
is power
Good Communications – quarterly
reports/ Public Relations / Profile
Patient Power – groups / open
meetings
Multidisciplinary / agency work /
pathways
Self Management philosophy
National, Regional and Local
involvement in planning
Scottish MCN Managers for Heart
Disease Group
Authority & Clout!
Lead Clinicians for MCN are dedicated
 Operational Managers & patients on MCN
 Involvement in A&A Strategy – efficiency
saving/ re-design & planning
 Shifting Balance (Benefits; Burden) of Care
 QIS / SIGN / Action Plan / Patient
Involvement & Influence
We tick all the boxes
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