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NO CONFLICT OF INTEREST TO DECLARE J.M. McLENACHAN, LEEDS.

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Presentation on theme: "NO CONFLICT OF INTEREST TO DECLARE J.M. McLENACHAN, LEEDS."— Presentation transcript:

1 NO CONFLICT OF INTEREST TO DECLARE J.M. McLENACHAN, LEEDS

2 PRIMARY PCI FOR STEMI Is a 24 / 7 service sustainable? Jim McLenachan, Leeds 26 th January, 2006

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4 PRIMARY PCI SERVICE AT LEEDS HOW IT WORKS u Commenced 7/3/05 u 24 / 7 service (after much discussion) u Initial phase covering Leeds only (population 800,000) u Plan to roll out to rest of West Yorks over 2 years (total population 3.1 million) u Interventionist on-call 1 in 6 u 2 full-time PPCI nurses and 1 PPCI support officer u Referrals via cath lab scheduler 8 – 4 Mon to Fri and via SpR out of hours

5 PRIMARY PCI SERVICE AT LEEDS TARGETS u DOOR TO BALLOON TIME < 120 MINUTES u CALL TO BALLOON TIME < 90 MINUTES u DOOR TO REFERRAL TIME < 20 MINUTES u HOSPITAL DISCHARGE AT 3 DAYS (achieved in 75%)

6 TOTAL NUMBERS OF PPCI PATIENTS (data for first 10 months) TOTAL NUMBER OF PATIENTS 203 MEDIAN NUMBER OF PATIENTS PER MONTH 20 MEAN NUMBER OF PATIENTS PER MONTH 18

7 MEDIAN DOOR TO BALLOON TIMES MINUTES

8 HOSPITAL MORTALITY MORTALITY % 7/3/05 – 12/1/067/9/04 – 6/3/0528/4/03 – 28/10/03 6.2% 9.1% 9.9%

9 PPCI AT LEEDS DAY OF THE WEEK AND TIME OF THE DAY (first 137 patients) 63%16%21%

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11 EXPECTED ANNUAL NO. OF PPCI PATIENTS (population of 3.1 million) 8 am – 8 pm pm - midnight 90 midnight – 8 am 190

12 EXTERNAL CHALLENGES u Convincing healthcare commissioners u De-skilling of A and E staff u De-skilling of CCU staff in non-PCI centres u Uncertainty / anxiety among thrombolysis nurses u Ambulance issues : pre-hospital thrombolysis longer transfer times “displaced” ambulances

13 INTERNAL CHALLENGES u WORKING TIME FOR CATH LAB STAFF: finish before midnight - normal hours next day finish after midnight- 11 hours off u WORKING TIME FOR CONSULTANTS: SPA session on morning after on-call

14 ESC GUIDELINES FOR STEMI 2005 PCI STEMITHROMBOLYSIS

15 ESC GUIDELINES FOR STEMI 2005 Consider thrombolysis PCI Contra-indication to thrombolysis or shock ECG resolution thrombolyse No ECG resolution STEMI < 3 hours since onset 3-12 hours since onset salvage PCI within 24 hours

16 IS A 24 / 7 PCI SERVICE SUSTAINABLE? Yes, but………… u Simple guidelines and routes of communication needed u Requires flexibility u ??Easier in a large centre where the frequency of on- call is less but the expectation of being called out-of- hours is higher


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