How to set up an Acute Stroke Service

221 Pages·2012·4.73 MB·English

by  Iris Q. Grunwald

How to set up an Acute Stroke Service

Iris Q. Grunwald (cid:129) Klaus Fassbender
Ajay K. Wakhloo
How to set up an Acute
Stroke Service
Prof. Iris Q. Grunwald Prof. Dr. Klaus Fassbender
Acute Vascular Imaging Centre Department of Neurology
Oxford University Hospitals NHS Trust Saarland University
and NIHR Biomedical Research Centre Kirrberger Strasse
Headley Way 66421 Homburg
Oxford OX3 9DU Germany
UK
Prof. Ajay K. Wakhloo
Department of Radiology
Division of Neuroimaging & Intervention NII
University of Massachusetts
Lake Avenue N. 55
Worcester, MA 01655
USA
Illustrations: Jean-Philippe Legrand “Aster”
www.dessindepresse.com and www.cartoonevent.com
Medical graphic design: Eloise White
www.eloisewhite-illustrator.com
ISBN 978-3-642-21404-2 e-ISBN 978-3-642-21405-9
DOI 10.1007/978-3-642-21405-9
Springer Heidelberg Dordrecht London New York
Library of Congress Control Number: 2011942220
© Springer-Verlag Berlin Heidelberg 2012
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consulting the relevant literature.
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Springer is part of Springer Science+Business Media (www.springer.com)
Foreword
Setting up something new is often challenging, particularly if it involves changing
the existing routine that people have become used to. The challenges can be particu-
larly daunting when it comes to developing a new clinical service in a modern health
care system. This is rarely more so than in setting up an acute stroke service.
However, this book provides clinicians and managers with all of the information
they need to plan for and overcome the foreseeable obstacles to setting up a new
service as well as providing a blueprint for a highly effective service.
The book assumes little prior knowledge about acute stroke and provides all of
the relevant background information necessary to understand the most important
issues, including summaries of the evidence supporting each of the main clinical
interventions that currently make up an acute stroke service. The “how-to-do-it”
style of the book is testimony to the fact that the authors have themselves set up ser-
vices and are all highly experienced in the practical delivery of acute stroke care.
The coverage of the important issues relating to each stage of the patient pathway
is particularly valuable, as is the emphasis on the practical problems to be overcome
in areas such as pre-hospital care and the imaging pathway. Coverage of other key
considerations in setting up a new service, including space, staffi ng, teams, budget
and management, is also extremely useful. There are, in fact, no major issues that
are not covered.
I am certain this manual will prove invaluable to anybody who wishes to either
improve an existing stroke service or to set up a new service from scratch.
Professor of Clinical Neurology Peter M. Rothwell
University of Oxford
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Preface
T he authors have made every effort in preparing this book to provide accurate and
up-to-date information, which is in accordance with accepted clinical practice at the
time of publication. However, the authors, editors and publishers can make no guar-
antees that the information contained in this book is totally free from error, not least
because clinical standards vary in different countries and are subject to constant
change through research and regulation. The authors, editors and publishers there-
fore disclaim all liability for direct or consequential damages resulting from the use
of material contained in this publication. We strongly advised readers to pay careful
attention to information provided by their regulatory department and manufacturer
of drugs or equipment they plan to use .
E very dosage schedule or every form of application described is entirely at the
user’s own risk and responsibility. Some drugs and medial devices presented in the
book do not have or have only limited Food and Drug Administration (FDA) clear-
ance for use in restricted research settings. It is the responsibility of the user to
ascertain the regulatory status of each drug and advice planned for use. The authors,
editors and publishers have taken care to confi rm the accuracy of the information
presented but are not responsible for errors or omissions or for any consequences
from application of the information provided in this book. They take no warranty,
expressed or implied, with respect to the information provided and the application
of the information remains the responsibility of the practitioner. In view of ongoing
research, changes in Government regulations, and the constant fl ow of information,
the reader is urged to double check applicability of the content .
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About This Book
B ecause you are reading this book, I presume that you have been asked or are
involved in the challenging task of setting up or optimizing an acute stroke service.
For this you are going to need a basic insight into the current treatment of stroke.
Y ou might ask yourself, why is the topic of acute ischemic stroke of such great
interest today? The answer is simple:
(cid:129) Stroke represents a major economic health burden , and nowadays is treatable .
H istorically, stroke treatment consisted of prevention and rehabilitation – but
successful options in acute stroke treatment have dramatically increased.
Administration of i.v.-lytics as well as endovascular stroke treatment has been shown
highly benefi cial in clinical trials and effective in net cost savings. Also, develop-
ments in CT and MR imaging and the availability of effective mechanical stroke
devices offer the prospect of improvements in diagnosis, treatment, and outcome.
H owever, time is of the essence in the management of stroke, and we are called upon
to take measures to ensure that the response to acute stroke is both rapid and effective.
T his book aims to give an insight into the recent changes regarding acute ischemic
stroke management where treatment of acute stroke can now begin during the pre-
hospital phase, before a stroke physician is even involved. No matter if you are the one
that has taken on the challenge of setting up an acute stroke service or whether you just
want to familiarize yourself with current management options, this book offers a con-
cise and practical guide on how to set up and effi ciently run an acute stroke service. It
provides the essential knowledge on current imaging and treatment options and helps
organize a site-specifi c stroke pathway to treat patients as quickly as possible in order
to optimize the benefi t to the patient as well as to maximize the cost-effectiveness.
This book uses modern project management techniques to provide guidance in
setting up a stroke service, but more importantly gives you the essential knowledge
to make such a concept work. It also aims to provide tools to conquer the multiple
technical and administrative challenges you will face.
We include a short overview of relevant, clinical trials carried out to date and describe
different treatment options for acute stroke. The challenging, multidisciplinary nature
of care and the importance of pre- and post-hospital management are emphasized.
Each chapter is self-contained, so you can read the chapters that are most rele-
vant to you fi rst. However, if you do not have any previous knowledge of the
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