Cardiology Out patients 18 Week Pathway Maxine White - Cardio Respiratory Service Manager

1. Kettering General Hospital NHS Trust Cardiology Out patients 18 Week Pathway Maxine White - Cardio Respiratory Service Manager

2. Overview • Kettering General Hospital • The reasons why • The process • Issues • Outcomes • Examples

3. Kettering General Hospital • Kettering General Hospital is a medium-sized district general hospital which provides a wide range of services to about 300,000 people in North Northamptonshire.   • 600 inpatient and day case beds • 4 bed CCU, 6 bed CCCU. • 44 Cardiology Ward beds • Catheter Lab opened July 07 • High incident of Coronary Heart Disease – Corby.

4. Out Patient sites Corby Kettering General Hospital Rushden Wellingborough

5. Location of departments A&E Main Out patients Main Hospital Corridor Catheter Lab Cardiac Investigations

6. Heartlands CHD Mortality

7. Background • Direct Access – Consultant/GP’s can refer directly for all tests. • Cardiac Investigation –Prolonged waits for all tests • The Echo waiting list was standing at 1292 (20.8.2005)

8. Problems and Solutions • Referrals not screened • Referrals not on system • No idea of inpatient or out patient demand • No idea of true capacity • Reviewed working hours. Technician adopting 12 hour day • Develop and adhere to a strict referral policy (BCE) given out to all Jnr Docs • Support of Consultants • Ward based ECG’s • Business case for portable ECHO machine • Unit staff collect patients • Develop bedside ECHO reduce bed stays • Validation

9. Results

10. Outcomes • 3week wait for ECHO • Less than 24 hour wait for inpatient echo • 40 minute slot for technician • Portable Echo machine • Education of all staff reduces inappropriate requests • Weekly reports

11. Kettering General Hospital NHS Trust Time in days from primary care referral to Cardiology appointment

12. Direct Access Cardiac Investigations

13. What next Reduction in waiting times meant that we could think about implementing different solutions to help meet the 18week target so started piloting a One Stop approach

14. How are we addressing the changes • KGH – working groups • LNR – working groups • Cardiac Network lead and involvement within groups • Communication

15. One Stop pilot- Who involved • 2 Consultants • Technicians • Cardiac Rehab Nurse • Outpatient services • TOMCAT

16. COS - flow Referral onto C&B Redirected onto COS with appropriate Test flagged Booking transferred to TOMCAT and invite letter generated Patient attends – Outpatient reception Consultation/ECHO or Stress test/Health Advisor Outcome letter sent to GP within 24hours Patient evaluation

17. Clinic Waiting times

18. Main Issues • Pilot undertaken with only 2 consultants • Cardiologist on Long term sick • Accessing C&B • Space

19. Patient Evaluation All tests same appointment and information specialist available so diagnosis known on same day Diagnosis and treatment without waiting follow up All questions answered, friendly and helpful Superb to have tests and consultant together Staff from receptionist, nurse to consultant all very helpful

20. Getting GP’s on board • Practice Learning Event • Cardiology ‘What we do’ ‘What do you want’ • Approximately 80 GP’s attended • Feedback

21. Cardioversion Pathway Atrial Fibrillation Referral to Cardiologist Pre Assessment One Stop Cardioversion 2 weeks 16weeks ECG ECG ECHO ECHO Warfarin Warfarin Rate Control Rate Control 18 weeks

22. Heart Murmur / Valve Pathway Breathlessness Clinic GP Referral TOE Angio Surgery One Stop Clinic 4 weeks ECHO ECHO 14 weeks 2 weeks 2 weeks 18 weeks

23. Pacemaker Implant Bradycardia Referred to Cardiologist One Stop Clinic Pre assessment Procedure 2weeks 4weeks 2weeks ECG ECG Referred to Glenfield 24- hour tape 24- hour tape Referred to Glenfield for TILT test 18weeks

24. Angiography 2 weeks 2 weeks 4 weeks 10 weeks 18weeks

25. Choose & Book Thank you for seeing this 82 year old hypothyroid lady who has fast AF made worse by thyrotoxicosis. I would appreciate your assessment. Thank you for seeing Mrs.. She presented complaining of feeling hot and was found to be in AF with a rate of about 100. She’s also found to have raised blood pressure of 190/110. She’s on Perindopril, Bendrofluazide and Atenolol. Her TSH returned at 3.04. She has normal heart sounds. I have arranged an ECHO and referred to the warfarin clinic. Her cholesterol on 14th December was 4.4.

26. What next • Increase sessions • All New referrals to be seen at Kettering? • Kettering clinics to be satellite service • Discussions in progress re dates for Procedures • Pre assessment at same appointment ?

27. Key Elements to achieve Cardiac 18weeks • Work up prior to referral • Results thus available at consultation • Patients ‘willing and able’ prior to referral • Advice and Guidance – joint pre hospital planning • Shared pathways enabling achievement

28. Any Questions Contact: maxine.white@kgh.nhs.uk 01536 492000 Bleep 610 01536 493354