Results and Lessons from a National Audit

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Results and Lessons from a National Audit
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Interhospital transfer for revascularisation

• At a CHD Collaborative Angina Workshop in
  September 2003 this was identified as national
  problem 1
• Organise a national survey and audit of
  current practice in patients with ACS

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CHD-C Survey and Audit

• National survey to scope the problem of
  interhospital transfer for the treatment of ACS
• Review of Central Returns (RoCR) insisted on
  voluntary contribution
• Collect baseline data about referring DGHs,
  transfer process and interventional/surgical
  centres across England
• Identify process redesign work already introduced
  and share best practice

4
CHD-C Survey and Audit

• Collect data about waiting times for transfer
  from DGH to referral centre for angiography and
  revascularisation in England over 4 weeks in
  March 2004
• These data provide a snapshot of our capacity to
  provide non-elective revascularisation
• Expose any limitations in the system

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ACS transfer

• Data suggest that at-risk patients with ACS
  benefit from early invasive assessment within
  72hrs and this is recommended in local, national
  and international guidelines

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Submitted Forms

• We tried to reach all the trusts in England
• 141/148 Trusts submitted forms

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Interhospital Transfers Audit Topline Average
Waits (Angio at DGH)
Admitted To DGH
Angiogram
Referred
Transferred
Procedure
5.9 Days
1.6 Days
7.1 Days
1.9 Days
14.6 Days
16.5 Days
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Interhospital Transfers Audit Topline Average
Waits (Where no angio date was given)
Admitted To DGH
Referred
Transferred
Procedure
1.3 Days
4.4 Days
7.5 Days
11.9 Days
13.2 Days
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Difference between PCI and Cardiac
Surgery (Angio at DGH)
PCI
13.9 Days
12.6 Days
1.3 Days
5.9 Days
1.3 Days
5.4 Days
Admitted To DGH
Referred
Procedure
Angiogram
Transferred
5.2 Days
2.4 Days
12.5 Days
3.8 Days
20.1 Days
23.9 Days
CARDIAC SURGERY
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Difference between PCI and Cardiac Surgery
(Where no angio date was given)
PCI
12.7 Days
11.5 Days
3.8 Days
7.7 Days
1.2 Days
Admitted To DGH
Referred
Transferred
Procedure
6.0 Days
9.8 Days
3.1 Days
15.8 Days
18.9 Days
CARDIAC SURGERY
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Wait after transfer to procedure
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Geographical Differences In Average Waits (Days)
The North Average wait from admission to PCI
9.4 Average wait
from admission to cardiac surgery 15.3 Average
wait from admission to procedure
(all transfers) 10.3
The Midlands And Anglia Average wait from
admission to PCI 11.0
Average wait from admission to cardiac
surgery 23.2 Average wait from admission to
procedure
(all transfers) 12.8
The South East And London Average wait from
admission to PCI 12.6
Average wait from admission to cardiac
surgery 19.3 Average wait from admission to
procedure
(all transfers) 13.7
The South And West Average wait from admission
to PCI 16.9
Average wait from admission to cardiac surgery
25.4 Average wait from admission to procedure

(all transfers) 17.5

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Summary
Patients admitted to a DGH during 4 week audit
period 2196 Average Wait (all
transfers) 13.6 Bed Days over 28 Day Period
29,866
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Summary

• This audit has identified a major opportunity to
  improve the quality of care for patients with
  acute coronary syndromes
• Service improvement has the potential to reduce
  waste
• Additional resources are being made available
• As part of the new local performance regime, an
  indicator will be developed for interhospital
  transfer patients
• Repeat audit in one year

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Thank you for all your hard work