Emergency care for people who suffer strokes - the UK's third most common killer - has been centralised on one site for the region in a bid to reduce death rates and long-term disability. Chief reporter IAN PROCTOR went to see how well it works
STROKE victims from north-west London will end up at a new 'hyper acute' unit in Harrow, where specialist staff and equipment will greatly improve their chances of recovery.
People arriving at hospitals in Hillingdon, Brent and Ealing will be assessed and, if necessary, transferred by ambulance to the unit or else taken straight there by paramedics.
The unit, on the eighth floor of the hospital in Watford Road, is geared to give emergency treatment called thrombolytic therapy.
Consultant physician Dr David Cohen explained: "In about seven out of 10 who have a stroke, it will be caused by a blood clot blocking an artery to the brain and that clot is best treated by unblocking that artery with thrombolysis.
"It is given by an intravenous injection and the earlier you give it, the more effective it is. We want to try to give it as soon as possible after the stroke. If you delay more than four-anda-half hours, it's probably not worth using that treatment because the side effects are worse than the benefits."
However, Northwick Park is trialling an extension of that deadline, to six hours.
The man in charge of nursing, clinical team leader Samson Olenloa, said when an ambulance is bringing in a stroke patient, the paramedics call ahead to the accident and emergency (A&E) department, who in turn alert their colleagues on the hyper acute unit via a pocket radio, so the correct staff can be dispatched to meet the patient at A&E. Within 30 minutes a brain scan is conducted in the radiography department -
located next to A&E for these very circumstances - and as long as the results show the stroke is caused by a blood clot and not internal bleeding, the clot-busting drugs are administered immediately.
Stroke victims remain in the hyper acute unit for up to 72 hours, the first 24 of them wired up to a cardiac monitor, so doctors can check their blood pressure and make neurological observations.
Afterwards, they are transferred to the recovery ward next door or the equivalent stroke recuperation ward at their local hospital, where they will see occupational and physiotherapists as part of their rehabilitation.
There are eight hyper acute units across the capital and Northwick Park is one of two serving north-west London, alongside Charing Cross Hospital in central London. The creation of these hyper acute units, under the guidance of NHS London, is intended to centralise specialist care.
The difference between the network of hyper acute units and the way individual hospital's stroke units used to work is that the former can provide consultants, specialist nurses and radiographers on call 24 hours a day, whereas the cost and shortage of trained medical staff made it difficult for every hospital to provide this level of coverage in the past.
Dr Cohen said: "The system was OK but it could be done better. We were finding that not enough patients were getting to a proper stroke unit earlier enough to be treated.
"We're having to train specialist consultants and nurses and there is a significant amount of investment being put into stroke services.
"The trust has completely upgraded this ward. All the beds are new, the equipment is new and the nursing staff are new, and we have new therapists. It's all extra.
"The standards required of us are higher than they were six months ago."
By the end of April, the hyper acute unit will have its full complement of 10 beds, in separate male and female bays, and more than 90 nurses. It will treat more than 1,550 stroke victims each year.
Staff update the London Ambulance Service twice a day on the unit's occupancy rate, so ambulances can be diverted to Charing Cross Hospital, if necessary, and vice versa.
Patient Brian West, 73, was able to walk out of the unit just a day-and-a-half after he was admitted, having suffered a stroke during the night at home in Hill Road, Pinner, in February.
"I found out it had been open for just two weeks so, yes, I was impressed," he said.
"Everyone who sees me and knows I had a stroke says: 'You were back on your feet in two days - that's incredible'. It was miraculous."
Mr West was among the estimated 150,000 people annually to suffer a stroke in the UK, showing the importance of the NHS providing high quality care.
"In general, if you take the whole spectrum of stroke, about a third will die, a third will survive without any problems, and a third will suffer some sort of disability, but it might be quite mild," Dr Cohen said.
"The important message is - if you think you or a friend or relative is having a stroke, dial 999."