Redesign of Cardiology Services in NHS Lothian

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Redesign of Cardiology Servicesin NHS Lothian
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Presentation

• Redesign Drivers
• Current Service Configuration
• Proposed Service Configuration
• Activity Data
• Patient Pathways
• Benefits of the proposed Redesign

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Purpose of Redesign

• Sustainability of Cardiology and General Medicine
  in Lothian
• Equity of access to all levels of cardiology
  services across Lothian
• Consistent cardiology support for unselected
  medical takes and in-patient aspects of specialty
  service delivery at WGH, SJH RIE
• Uniform management of STEMI across Lothian
• Support for capacity planning and modelling in
  terms of elective activity and achieving national
  waiting times targets
• Creation of a single interventional site for
  cardiology services in Lothian
• Places cardiology services in a position to
  deliver new developments eg primary PCI and
  electrophysiology

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Current Service Model
Primary Care
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Redesigned Service Model
3o
Single standards, protocols, pathways
Primary Care
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Current Cardiology Activity in Lothian
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2004/5 Activity 10,437 episodes
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2004/5 Activity 10,437 episodes
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2004/5 Activity 10,437 episodes
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2004/5 Activity 10,437 episodes
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Service Model

• Consultant delivered cardiology service on all
  three sites
• Consistent support for unselected medical takes
  scheduled consultant time
• CCU / Medical HDU facilities on all three sites
• Standardised STEMI pathway
• Impact of emergency activity on elective
  procedures minimised
• Equity of access and treatment
• Kerr compatible local delivery of all but the
  more specialised aspects of care

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Current Configuration of Services
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Future Configuration of Services
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Future Configuration of Services
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Emergency Patient Pathway - WGH / SJH
Thrombo lysis
CCU RIE
Angioplasty
Yes
SAS Triage
Rehab
Chest Pain
Local Rehab
STEMI
Home
No
CCU/HDU WGH or SJH
Medical Ward
ARU-WGH MAU-SJH
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Elective Patient Pathway
Angiography
Angioplasty
Investigation / Intervention Catheter Unit RIE
Yes
Investigations ECG Echo ETT
Angiography required
DISCHARGE Management Plan
GP Referral
Local OPD
No
Follow up
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Emergency Patient Pathway Heart Failure
Manage at Home
Local Follow-up (Long Term Condition)
No
Input from Heart Failure Clinical Nurse Specialist
Community Triage
Heart Failure
Refer to Hospital
Home
Post Acute Care
Yes
CCU/HDU WGH or SJH
Assessment
Medical Ward
ARU-WGH MAU-SJH
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3 Acute Hospitals - Benefits

• One cardiology service delivered across three
  sites
• Consultant-delivered cardiology service on all
  three sites
• Full range of non-invasive investigations and
  support staff on 3 sites
• Support for three hospitals providing unselected
  medical takes
• General medicine
• STEMI
• CCU (critical care)
• Support for co-located specialties on all three
  sites
• Support for primary care on all three sites
• Locally delivered out-patient clinics

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1 Suite of Cardiac Laboratories - Benefits

• 3 co-located laboratories (RIE)
• Supported by one team of medical, nursing and
  technical staff matched to activity
• Minimal impact of emergency on elective activity
  (12 labs)
• Single waiting list
• Consistent list management
• Numbers per list
• Angioplasty becomes a follow-on rather than a
  return procedure
• One location for non-Lothian activity

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Benefits

• Quality
• Equity
• Single waiting list
• Single rotas
• consultants
• middle grade doctors
• cath lab staff
• Consistent practice
• Economies of scale release of costs
• Sustainability