Cardiology

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Kettering General Hospital
NHS Trust

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

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Overview

• Kettering General Hospital
• The reasons why
• The process
• Issues
• Outcomes
• Examples

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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.

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Out Patient sites
Corby
Kettering General Hospital
Rushden
Wellingborough
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Location of departments
AE
Main Out patients
Main Hospital Corridor
Catheter Lab
Cardiac Investigations
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Heartlands CHD Mortality
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Background

• Direct Access Consultant/GPs can refer
  directly for all tests.
• Cardiac Investigation Prolonged waits for all
  tests
• The Echo waiting list was standing at 1292
  (20.8.2005)

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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 ECGs
• Business case for portable ECHO machine
• Unit staff collect patients
• Develop bedside ECHO reduce bed stays
• Validation

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Results
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Outcomes

• 3 week 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

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Kettering General Hospital NHS Trust
Time in days from primary care referral to
Cardiology appointment
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Direct Access Cardiac Investigations
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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

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How are we addressing the changes

• KGH working groups
• LNR working groups
• Cardiac Network lead and involvement within
  groups
• Communication

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One Stop pilot- Who involved

• 2 Consultants
• Technicians
• Cardiac Rehab Nurse
• Outpatient services
• TOMCAT

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COS - flow
Referral onto CB
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
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Clinic Waiting times
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Main Issues

• Pilot undertaken with only 2 consultants
• Cardiologist on Long term sick
• Accessing CB
• Space

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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
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Getting GPs on board

• Practice Learning Event
• Cardiology What we do What do you want
• Approximately 80 GPs attended
• Feedback

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Cardioversion Pathway
Atrial Fibrillation
Referral to Cardiologist
Pre Assessment
Cardioversion
One Stop
2 weeks
16weeks
ECG
ECG
ECHO
ECHO
Warfarin
Warfarin
Rate Control
Rate Control
18 weeks
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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
       
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Pacemaker Implant
Bradycardia
Referred to Cardiologist
Pre assessment
Procedure
One Stop Clinic
2weeks
4weeks
2weeks
ECG
ECG
Referred to Glenfield
24- hour tape
24- hour tape


Referred to Glenfield for TILT test
18weeks
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Angiography
2 weeks
2 weeks
4 weeks
10 weeks
18weeks
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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. Shes also found to
  have raised blood pressure of 190/110. Shes 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.
•  

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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 ?

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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

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• Any
• Questions
• Contact maxine.white_at_kgh.nhs.uk
• 01536 492000 Bleep 610
• 01536 493354