NO CONFLICT OF INTEREST TO DECLARE J.M. McLENACHAN, LEEDS.
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Transcript of NO CONFLICT OF INTEREST TO DECLARE J.M. McLENACHAN, LEEDS.
NO CONFLICT OF INTEREST TO DECLARE
J.M. McLENACHAN, LEEDS
PRIMARY PCI FOR STEMI
Is a 24 / 7 service sustainable?
Jim McLenachan, Leeds
26th January, 2006
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PRIMARY PCI SERVICE AT LEEDSHOW IT WORKS
Commenced 7/3/05 24 / 7 service (after much discussion) Initial phase covering Leeds only (population 800,000) Plan to roll out to rest of West Yorks over 2 years
(total population 3.1 million) Interventionist on-call 1 in 6 2 full-time PPCI nurses and 1 PPCI support officer Referrals via cath lab scheduler 8 – 4 Mon to Fri and via
SpR out of hours
PRIMARY PCI SERVICE AT LEEDSTARGETS
DOOR TO BALLOON TIME < 120 MINUTES
CALL TO BALLOON TIME < 90 MINUTES
DOOR TO REFERRAL TIME < 20 MINUTES
HOSPITAL DISCHARGE AT 3 DAYS (achieved in 75%)
TOTAL NUMBERS OF PPCI PATIENTS(data for first 10 months)
TOTAL NUMBER OF PATIENTS 203
MEDIAN NUMBER OF PATIENTS PER MONTH 20
MEAN NUMBER OF PATIENTS PER MONTH 18
MEDIAN DOOR TO BALLOON TIMES
0
20
40
60
80
100
120
APR MAY JUN JUL AUG SEPT OCT NOV
MINUTES
HOSPITAL MORTALITY
0123456789
10
PRIMARY PCI THROMBOLYSIS THROMBOLYSIS
MO
RT
AL
ITY
%
7/3/05 – 12/1/06 7/9/04 – 6/3/05 28/4/03 – 28/10/03
6.2%
9.1% 9.9%
PPCI AT LEEDSDAY OF THE WEEK AND TIME OF THE DAY
(first 137 patients)
0
5
10
15
20
25
M T W T F S S
01020
304050
607080
90
8am -8pm
8pm-12mn
12mn-8am
63% 16% 21%
West Yorkshire Cardiac Network
Harrogate
York
PontefractDewsbury
Halifax
Huddersfield
Airedale
BradfordLeeds
Pinderfields
EXPECTED ANNUAL NO. OF PPCI PATIENTS(population of 3.1 million)
8 am – 8 pm 570
8 pm - midnight 90
midnight – 8 am 190
EXTERNAL CHALLENGES
Convincing healthcare commissioners De-skilling of A and E staff De-skilling of CCU staff in non-PCI centres Uncertainty / anxiety among thrombolysis nurses Ambulance issues :
pre-hospital thrombolysis
longer transfer times
“displaced” ambulances
INTERNAL CHALLENGES
WORKING TIME FOR CATH LAB STAFF:
finish before midnight - normal hours next day finish after midnight - 11 hours off
WORKING TIME FOR CONSULTANTS:
SPA session on morning after on-call
ESC GUIDELINES FOR STEMI2005
PCI
STEMI THROMBOLYSIS
ESC GUIDELINES FOR STEMI2005
Considerthrombolysis
PCI
Contra-indicationto thrombolysis
or shock
ECG resolution
thrombolyse
No ECGresolution
STEMI
< 3 hours since onset
3-12 hours since onset
salvagePCI PCI
within24 hours
IS A 24 / 7 PCI SERVICE SUSTAINABLE?Yes, but…………
Simple guidelines and routes of communication needed
Requires flexibility
??Easier in a large centre where the frequency of on-call is less but the expectation of being called out-of-hours is higher