POAC Funded Head CT

POAC funding is available for CT Head where required within 24-48 hours to avoid acute hospital referral under the following circumstances:

• TIA, where it is within 7 days of the TIA episode and

  • CT +/-CTA recommended by HNZ neurologist / stroke specialist or physician, OR

  • Patient has no high-risk features *1 and assessed as suitable for being managed in the community AND completion of the BPAC TIA decision support tool indicates CT head +/- carotid imaging is appropriate, OR

  • Patient is unable to access rapid specialist care.

• Focal neurologic signs - consider seeking neurologist advice first (endorsing specialist name and timeframe must be documented)

• Seizure in palliative care setting and result may change management.

• Secondary care clinician or Primary Care Radiology Liaison (PCRL) or radiologist advises referral for same or next day CT scan.

• Non-hospital assessment must be a safe option.

Guidance:

• For clinically suspected anterior circulation events, and if the patient is a potential candidate for carotid endarterectomy, carotid angiography (CTA)or if unavailable, carotid ultrasound, should be added to the CT head exam

• GP may need to discuss further with the specialist if there is uncertainty e.g. lack of clarity around the need for a scan in a POAC timeframe (next 24-48 hours), or if POAC cannot get a scan in the designated timeframe.

• If POAC cannot get a scan within the required timeframe, the referrer will be contacted immediately.

• POAC cannot get same-day scans and cannot get investigations on weekends or public holidays. If a scan can wait until after a weekend or public holiday (ie > 48 hours), it is most likely not a case that falls under the POAC funding criteria.

• POAC does NOT fund injury-related CT heads. POAC has not gained agreement for ACC to fund injury-related CT head outside of the hospital, so ACC patients will have to continue to be assessed in ED

• If CT head is required less acutely (> 48 hours), submit eReferral for urgent CT head, document the name of the endorsing clinician.

CT Head is not funded under POAC for:

• Chronic symptoms

• Head injury (requires ED referral and ACC funded head CT)

• Stroke

• TIA, where the TIA HealthPathway recommends acute assessment (i.e. all TIAs occurring in the last 24 hours, and many TIAs occurring in the last 7 days).  See TIA HealthPathway here

• Cognitive impairment

HOW TO REQUEST:

1. Discuss case with Neurology or Stroke service (as above).  Confirm appropriate for POAC AND the timeframe required (e.g. within 24-48 hours)

2. Email the radiology request form to referral@poac.co.nz (ensure the name of the endorsing specialist is documented)

3. Phone POAC (09) 535 7218 to confirm booking can be facilitated within the required timeframe (if unable to schedule, acute admission may be required).

4. POAC coordinators will schedule appointment and inform the patient or clinic staff member as per the agreed plan.

   Be aware that the referring community clinician is responsible for:

• safety-netting while the patient waits for the CT Head scan appointment, AND

• following up the CT Head report and taking any appropriate clinical actions.