Mid and South West Wales Primary Angioplasty update SE Cardiac Network meeting 02/3/2012 Dr Stephen Dorman, Morriston Cardiac Centre

All comer regional PPCI service 31/10/2011 24/7 PPCI service to ABMU, HD and Powys patients within 90 minute travel time of Morriston” (by air or land ambulance) PPCI workload now doubled ~ 41 PPCI’s per month ( i.e ~ 500 PPCI’s p.a, ~ 500 PPCI p.m.p ) High quality service Benefits realisation Reduced L.O.S at referring hospitals Reduced transfer times for routine ACS transfers

Geographic distribution of PPCI cases by home postcode Oct 2011- Jan 2012 ( Courtesy SM & AR)

Quality standards – Door to Balloon time

Quality standards – Call to balloon

Outcome data 2.5% (3/122) 30 day mortality

~ 50% reduction in total length of stay for STEMI patients Substantial reductions in L.O.S Data from WWG, first 44 days of PPCI, 14 repatriations ~ 50% reduction in total length of stay for STEMI patients 5-6 day mean LOS with local lysis & convalescent transfer vs 3 day mean LOS with PPCI Anedotal data Average (days) Median Morriston 1.3 1 GGH 2.1 2

Local patients – Mean LOS 4.0 days Length of Stay n= 122 patients – between 31/10/2011 and 20/02/2012 (LW informatics) Local patients – Mean LOS 4.0 days Repatriated patients – Mean LOS 3.4 days 73% of patients staying 3 days or less

Ongoing work Accurate 12 lead ECG interpretation Need to identify funding for Telemetry Education sessions Fine tuning operational protocols – WAST/ Secondary/MCC Increasing Air ambulance utilisation for remote areas Repatriation pathways – Bed protection All Wales agreement on pre hospital drug therapy Audit and monitoring of data through MINAP / BCIS Improved discharge information including Cardiac Rehabilitation Communications to patients and public