WORKING TO REDUCE CARDIOLOGY WAITING LISTS

Area(s) of focus: Making services more effective and efficient through collaboration and integration, Develop, grow and invest in our workforce, culture and clinical and professional leadership

The situation

Nationally there are targets in place for the NHS to provide treatment for Acute Coronary Syndrome (ACS) patients 72 hours after admission into hospital.

Working in partnership with University Hospitals Coventry and Warwickshire (UHCW) NHS Trust, we audited all transfers for ACS patients within the hospital between May to October 2023 to identify how long the process takes and any delays in the patient pathway. 

The audit found delays: 

• At the point of patient admission at the referral centre to referral to Percutaneous Coronary Intervention (PCI) (also known as ‘heart attack’) centre.
• To the referral being accepted by the Cardiology team at the PCI centre as well as delays to finding the patient a vacant bed and transferring them to the PCI centre.
• In the ambulance transfer of patients.
• In procedures taking place once a patient had arrived at the PCI centre.

What we did 

Following the audit, UHCW NHS Trust and the ICB worked together to identify how improvements could be made to streamline the process. 

Improvements focused on:

• Making referrals more timely.
• Increasing the capacity for referrals to be reviewed seven days a week (previously they were reviewed Monday to Friday).
• Identifying protected time for Cath Lab slots for ACS patients so that their procedures can be undertaken as soon as possible. T
• Working collaboratively to create a pilot inter-hospital transfer pathway to discharge suitable patients from the PCI centre instead of transferring patients back to the referral centre to be discharged.

Following the pilot which took place between January to March 2024, progress and data was reviewed and showed that: 

• The number of patients that had breached the 72-hour target before the pilot had reduced from 26% to 10% and 43.5% of patients were referred within 24 hours of admission, compared to 26% in 2023.
• 86% of referrals were accepted within 24 hours, seven days a week.
• 45% of patients were transferred within four hours of an ambulance arriving. 
• 76% of patients received their procedure within 24 hours of arriving in hospital, compared to 66% in 2023.
• 83% of patients were discharged from the PCI centre, reducing demand on ambulance transfers.
• 59 beds were freed up across the ICB network which helped to improve bed capacity overall across Coventry and Warwickshire. 

One factor which caused delay during the second audit was bed capacity at the PCI centre. 

To solve this challenge, a new process was introduced to identify patients suitable for the Cath Lab recovery area after treatment (removing the need for a bed). 

Moving forward, further audits will take place so we can continue to refine the process to make positive impacts on patient care and improve the way we work as a system.