bcis annual meeting london january 2006 dr bernard prendergast dm frcp wythenshawe hospital...
TRANSCRIPT
![Page 1: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/1.jpg)
BCIS Annual MeetingLondon January 2006
Dr Bernard Prendergast DM FRCP
Wythenshawe Hospital Manchester UK
Primary Angioplasty for Acute MIWho are the Stakeholders?
NO CONFLICT OF INTEREST TO DECLARE
![Page 2: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/2.jpg)
Manchester Cardiac Services 2001
![Page 3: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/3.jpg)
![Page 4: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/4.jpg)
PCI projections Greater Manchester 2005-6
Population 3.8 millionPCI @ 1050/million:
4000/annumWythenshawe 1500MRI 1750DGH (250x3) 750
![Page 5: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/5.jpg)
● FebruaryFebruary: MRI commences 8am – 4pm primary PCI service for A&E patients.
● June:June: Greater Manchester Cardiac Board allows PCI Group to consider provision of a city wide service.
● SeptemberSeptember: Multidisciplinary process mapping meeting.
● OctoberOctober: Two day Network meeting attended by DOH representatives to establish a network PCI programme.
● NovemberNovember: “Primary PCI: The Challenge” – national UK conference (193 delegates).
● DecemberDecember: Invitation to submit a NIAP proposal. 2 year phased proposal signed by chief Executives of the two PCI centres, the Ambulance Trust and the Cardiac Network.
● February:February: Successful NIAP bid with six other UK centres.
● March / April:March / April: Meetings to discuss implementation of primary PCI proposals.
● April:April: Wythenshawe commences 8am – 4pm primary PCI service for A&E patients.
● June:June: A&E Consultants meeting.● July:July: NMGH & Hope meeting.● August:August: Stepping Hill Hospital meeting.● September:September: Greater Manchester
Ambulance Service commissioning meeting. ● October:October: Appointment of PCI Project
Manager and Clinical Audit/Information Officer.
● November: 3 initial pilot sites confirmed
2004
2005
![Page 6: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/6.jpg)
Primary PCI StakeholdersThe Patient
● Local vs. specialist care
● Inequity of access to PPCI
● When for my DGH?
● Informed consent
● Relatives
● Confusion/bewilderment
![Page 7: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/7.jpg)
Primary PCI StakeholdersThe Ambulance Service
Thrombolysis in Greater Manchester 2005
● CTS < 8 min 75%
● CTD < 30 min 55% < 40 min 89%
● CCG 86%
● DTN < 20 min 64% < 30 min 88%
● CTN < 60 min 82%
Outstanding IssuesSkills in ECG interpretationImpact on other emergency servicesGeographical imbalance of ambulance poolAlternative strategies for urban and rural populations
![Page 8: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/8.jpg)
Primary PCI StakeholdersThe Referring DGH A&E Department
● “Why should we replace optimal thrombolysis with an experimental PPCI service”
● “What about our stars – we’re about to bid for foundation status, you know!”
● “We’re not going back to the dark ages of assessment in the back of ambulances”
● “Who’s responsible if the patient dies in transit?”● “We will need informed consent for transfer”● “This clinical trial – what about ethical approval?”
![Page 9: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/9.jpg)
Primary PCI StakeholdersThe Catheter Lab Team
Nurses, Radiographers, Technicians, Audit Team, Activity Managers
![Page 10: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/10.jpg)
Primary PCI StakeholdersThe DGH Cardiac Team
• The backlog of ACS transfers is a greater day-to-day headache
• Guaranteed repatriation at 24 hrs (and perhaps sooner) and need for altered nursing skill mix
• Abbreviated IP stay diminishes time for Phase 1 rehabilitation and education
• GPs may be unprepared or unwilling to cope• Limited exposure to AMI for doctors in training
![Page 11: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/11.jpg)
Primary PCI StakeholdersThe Bed Manager
Time spent in A&E
Locker, T. E et al. BMJ 2005;330:1188-9.
![Page 12: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/12.jpg)
Primary PCI StakeholdersTertiary Centre NHS Trusts
The clinical/political conflict
● 3/12 waiting list target met as a priority
● Current mean wait 7-10 days (range 2-21 days)
● Constant pool of 40-50 patients awaiting transfer to tertiary care
Elective Non-elective (ACS)
![Page 13: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/13.jpg)
Primary PCI StakeholdersHealthcare commissioners/Cardiac Network● Current activity projections are conservative and
account only for elective and ACS work● In 2005-2006, a 40% reduced rate non-elective short
stay tariff will apply for in-patient stays <48hrs*● Only in the NHS could attempts at increased efficiency
be rewarded by diminished reimbursement!!● Who pays for:
– Ambulance activity– Clopidogrel– Abciximab– etc, etc *Currently being addressed by DOH/BCS
![Page 14: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/14.jpg)
Primary PCI StakeholdersThe Government/Department of Health
To address:● Logistic difficulties of
providing a PPCI service● Challenges in different
geographical settings● Robust data collection and
audit● Costs of service provision● Patient’s experience of such a
service
● Detailed outcome analysis● Patient and carer experience● Workforce implications● Outcome using different models
of service delivery● Implementation and feasibility
issues● Economic evaluation
THE NATIONAL INFARCT ANGIOPLASTY PROJECTBritish Cardiac Society and Department of Health - a joint project.
AIMS OUTCOMES
“Ultimately, a hybrid model of PPCI and pre-hospital thrombolysisseems likely.” Sue Dodd, DOH, Manchester November 2005.
![Page 15: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/15.jpg)
Primary angioplasty is arriving!
![Page 16: BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the](https://reader035.vdocument.in/reader035/viewer/2022062517/56649edb5503460f94beb8ee/html5/thumbnails/16.jpg)
Primary PCI in the UKEvolution not REvolution