DELIVERING PCI THROUGH THE CLINICAL NETWORK DR JIM HALL THE JAMES COOK UNIVERSITY HOSPITAL...
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DELIVERING PCI THROUGH THE CLINICAL NETWORK DR JIM HALL THE JAMES COOK UNIVERSITY HOSPITAL MIDDLESBROUGH
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Transcript of DELIVERING PCI THROUGH THE CLINICAL NETWORK DR JIM HALL THE JAMES COOK UNIVERSITY HOSPITAL...
DELIVERING PCI THROUGH THE CLINICAL NETWORK
DR JIM HALLTHE JAMES COOK UNIVERSITY HOSPITAL
MIDDLESBROUGH
PCIPCI
National Service FrameworkCHD
NHS Plan/Modernisation
Agenda
NICE
EVIDENCE BASED PRACTICEPerformance Management
& Framework
PATIENT CHOICE
Clinical GovernanceCHAI
PCI
National Service FrameworkCHD
NHS Plan/Modernisation
Agenda
NICE
EVIDENCE BASED PRACTICEPerformance Management
& Framework
PATIENT CHOICE
Clinical GovernanceCHAI
CHDNetworks
CHD NSF
• NETWORKS OF CARDIAC CARE
• “The usual model will involve linking tertiary cardiac centres, cardiac units in district hospitals and primary care. Typically the geographical boundaries of a network will match those of the PCTs whose populations are served by the relevant tertiary centre. The network should agree common referral criteria, treatment protocols etc”
WHITEHAVEN
NORTHALLERTON
MIDDLESBROUGH
DARLINGTON
BISHOP AUKLAND
DURHAM
NEWCASTLE
SUNDERLAND
HARTLEPOOL
NORTH TEES
CATCHMENT POPULATION
TEESSIDE 550,000
COUNTY DURHAM 612,000
NORTH YORKSHIRE158,000
CUMBRIA 238,000
TOTAL POPULATION ~ 1.5M
CHD NSF
• PCI CAPACITY
• Revascularisation waiting times– PCI– 3 months maximum
CHD NSF
• PCI CAPACITY
• Revascularisation waiting times– PCI– 3 months maximum
? 750/million
PCI and CABG rates per million in European countries in 2000
0
500
1000
1500
2000
2500
Pol Gre Spa Hun Por Fin UK Ita Bel Cze Nor Lux Fra Ice Swi Aus Ger
PCI
CABG
PCI
0
300
600
900
1200
1500
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
PTCATARGETS
JCUH
PCIRATES PER MILLION
0
200
400
600
800
1000
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
PTCATARGET
JCUH
PCIRATES PER MILLION
0
200
400
600
800
1000
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
PTCATARGETSPCT APCT B
JCUH
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’
the patient’s journey predominates
(the family test)
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’
‘CHD Collaborative embedded within the network’
‘commissioning advisor to the PCO’
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’
PCT Trust AmbulanceLA WDC LITs SHACHDC PCC BHF
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’
sub-groups -commissioning/performanceclinicalCHDC
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
REGIONAL REVASCULARISATION STRATEGY
NETWORK ANGIOGRAPHY STRATEGY
NETWORK ICD STRATEGY
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
• Clinicians sub-group
ACS guidelinesemergency PCI guidelinesICD guidelines
STEP 1 TAKE A HISTORY TIME 0 hrs
ACUTE CARDIAC PAINECG - ST ELEVATIONTHROMBOLYSIS etc(exit guideline)
INTENSIVE MEDICAL THERAPYaspirin nitrates low mol wt heparin clopidogrel beta blockers
STEP 2 RISK STRATIFICATION OF ACUTE CORONARY SYNDROME = 12 hrs
- SIGNIFICANT ECG CHANGES - NORMAL ECGor
- RAISED MARKERS eg TROPONIN T >0.1 - NORMAL ENZYMESor >12 hrs after onset
- Hypotension/heart failure etc- Crescendo history etc
STEP 3 = 24–48 hrs
CONTINUING PAIN ± NO PAINDYNAMIC ST CHANGES EXERCISE TEST
GP IIb/IIIae.g. eptifibatide STRONGLY MILDLY +ve or -ve
+ve
EMERGENCY URGENT ELECTIVEANGIOGRAPHY ANGIOGRAPHY ANGIOGRAPHY <24 hrs <72 hrs
REVASCULARISATION REVASCULARISATION
PCI with GPIIb/IIIa PCI GPIIb/IIIa or e.g.ReoPro or e.g. ReoProCABG CABG
MEDICAL TREATMENT/RISK FACTOR CONTROL/REHABILITATION
ACUTE CARDIAC PAIN
RISK STRATIFICATION OF ACUTE CORONARY SYNDROME
IF NO SIGNIFICANT CO-MORBIDITIES PLAN FURTHER INVESTIGATION
LOW RISKHIGH RISK
HIGH RISK LOW RISK
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
‘commissioning advisor to the PCO’no direct commissioning role not a managed clinical network
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
• NEW DEVELOPMENTS
• Drug eluting stents - approx £1.6m if used in all 1500 projected cases
• GP IIb/IIIa
• ASD closure
• new thrombolytics
• RFA ablation of AF
• biventricular pacing
• others
NORTH OF ENGLAND COAST TO COAST CHD NETWORK
• CHALLENGES better links with PCTs better links with StHA better links with DoH
does this need a more formal structure
cf collaboratives
CAPTAIN JAMES COOK
1728-1779
CHD NETWORKS
• not perfect
• not the finished article
• accountability
• performance management
• clinical governance (?peer review)
• managed clinical networks
PCI
National Service FrameworkCHD
NHS Plan/Modernisation
Agenda
NICE
EVIDENCE BASED PRACTICEPerformance Management
& Framework
PATIENT CHOICE
Clinical GovernanceCHAI
CHDNetworks
