Cardiology Diagnostic Project

1
Cardiology Diagnostic Project Mary
Currie Innovator lead DH Cardiology Diagnostic
Project Team May 2007
2
Overview

• Background of Project and challenges
• The Project structure, vision and approach
• Cardiology Diagnostic Model
• Progress on reducing waits
• Learning from the DH Innovator sites - key
  ingredients for improvement
• Take home message

3
BackgroundDiagnostic clearance times

• The initial assessment identified long waits for
• Echo
• EP (smaller volumes)

Diagnostic test clearance times
Most significant challenge to reducing diagnostic
waits to below 13 weeks
Demand expected to rise before Dec 2008
Source Pilot site data
Total sample size 100,000 waiters Unvalidated
data, from pilot study of 13 self selected trusts
therefore may not be representative".
4
Challenges contributing to long waits?

• Process issues within department
• Poor waiting list management e.g. many using
  paper diaries for booking appointments
• High DNA rates
• Lack of investment in technology
• High demand for useful tests

• Workforce e.g. recruitment and retention
• Training
• Skill Matching
• Competing interest with the range of cardiac
  diagnostic investigations

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Potential patient pathways flowing into echo
Falls
Trauma crush injuries
Stroke
Cardiac referrals
Renal transplant
Breathless pts (COPD)
Echo
Rheumatology
ITU patients
Requests for right heart pressures
Elderly
Pre-operative screening
General pre, intra and post chemo surveillance
Murmur ? cause (general medicine)
Pregnancy murmur
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Dept of Health Attachment 5
Data from Nov 2005 to Oct 2006
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Assisting delivery of 18 weeks

• Cardiac diagnostic scans are subject to
  diagnostic test milestones (DH Choice of scan)
• 13 weeks by March 2007
• 6 weeks by March 2008

• RTT 18 weeks (whole patient pathway Dec 2008)
• Organisations must use all available levers
• e.g. PBC and tariffs to be in a position to
  deliver the 18 week patient pathway.

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Project structure

• Project steering group jointly chaired by
• Roger Boyle, National Director for Heart Disease,
  DH
• Sue Hill, Chief Scientific Officer and National
  Clinical Lead for Physiological Measurements DH
• Clinical reference group
• Project team Sheelagh Machin, Julie Harries,
  Mary Currie established Autumn 2006
• Reporting into DH Physiological Measurement
  Strategy Group and 18 weeks Taskforce and
  Executive Board

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Vision for cardiac diagnostics

• The vision for people with cardiac disease,
  suspected cardiac disease or where cardiac
  disease needs to be excluded is to ensure cardiac
  diagnostics are performed in an efficient way, in
  an appropriate setting as close to the patients
  home as clinically feasible taking into account
  the needs of the local community.

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Approach- working with Innovator sites

• What are Innovator sites?
• Primary/secondary/tertiary care
• Sites making significant progress in reducing
  waiting times
• How were sites identified?
• Data analysis demonstrating reduced waiting times
  in cardiac diagnostics
• Intelligence- evidence of proven innovation,
  service model that can deliver and sustain
  diagnostic services

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Cardiology Diagnostics Model
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Innovator sites
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Progress with reducing waits
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Echo patients still waiting in England at the end
of each month
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Electrophysiology patients still waiting at end
of each month in England
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So, what's the big question?
?
how have some organisations managed to
reduce waits?
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Learning from Innovator sites- key ingredients

• Systems and Process
• Workforce
• Technology
• .. Coupled with clinical leadership, a
  willingness to change and improve, with
  management support.

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Systems and Process
Systems and Process opportunities

• Understand your service, where referrals come
  from
• Demand and capacity work- release capacity
• Improved waiting list management and
  administrative process
• Removing steps of the patient pathway that add no
  value
• Reducing DNAs (lean thinking) e.g. reminder
  letters, calls, texts
• Maximising capacity/utilisation of equipment
• Reviewing staff rota/working patterns
• Service transformation in some areas e.g.
  introducing new service models e.g. primary care

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Workforce

• Ensure the current workforce is sustainable
• Skill matching, the right people in the right
  place at the right time
• Willingness to adopt new ways of working

• Develop support roles to maximise productivity of
  all staff
• Develop existing physiologist and specialist
  nurse roles
• Use GPwSI and other practitioners in Primary Care
  to provide, where appropriate, diagnostic
  services to patients.

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Technology

• Utilising technology to improve and transform
  services can achieve benefits for patients and
  clinical staff
• e.g.
• BNP testing
• Portable echo machines

• Provision of ECG in Primary Care including
  Tele-monitoring
• Electronic report and image transfer
• IT systems within diagnostic departments
• Use of Tablet-computers in one-stop clinics
• Choose and books systems

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Key outputs

• Information to guide the NHS in the
  development of modernised and sustainable
  cardiology diagnostics services, which support
  delivery of 18 weeks
• Contributing to 3 cardiac commissioning pathways
• Good practice guide (June 2007)
• National stakeholder event 20th June 2007

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Conclusion

• Steady progress is continuing, more work to do
  across the country
• Sharing best practice
• Continue to modernise and improve access for
  patients to cardiac diagnostic testing
• Access to diagnostics must happen early in the
  patient pathway
• Drive forward improvements for patients in order
  to deliver a whole patient pathway from referral
  to treatment in 18 weeks

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Take home message

• Success requires
• A vision for the services we want for patients
• (accessible, timely, high quality)
• Good communication
• A willingness to change
• Radical transformation, in some areas with new
  service models
• Strong clinical leadership, be it a clinician,
  physiologist or nurse, to introduce and sustain
  improvement

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Further information available from

• Mary Currie- mary.currie_at_lewishampct.nhs.uk
• Sheelagh Machin- sheelagh.machin_at_heart.nhs.uk
• Julie Harries- julie.harries_at_heart.nhs.uk
• 18 week website- http//www.18weeks.nhs.uk

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Thank you