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Kettering General Hospital NHS Trust Cardiology Out patients 18 Week Pathway Maxine White - Cardio Respiratory Service Manager Overview Kettering General Hospital The reasons why The process Issues Outcomes Examples Kettering General Hospital

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cardiology out patients 18 week pathway maxine white cardio respiratory service manager

Kettering General Hospital

NHS Trust

Cardiology

Out patients

18 Week Pathway

Maxine White - Cardio Respiratory Service Manager

overview
Overview
  • Kettering General Hospital
  • The reasons why
  • The process
  • Issues
  • Outcomes
  • Examples
kettering general hospital
Kettering General Hospital
  • Kettering General Hospital is a medium-sized district general hospital which provides a wide range of services to about 300,000 people in North Northamptonshire.  
  • 600 inpatient and day case beds
  • 4 bed CCU, 6 bed CCCU.
  • 44 Cardiology Ward beds
  • Catheter Lab opened July 07
  • High incident of Coronary Heart Disease – Corby.
out patient sites
Out Patient sites

Corby

Kettering

General Hospital

Rushden

Wellingborough

location of departments
Location of departments

A&E

Main

Out patients

Main Hospital Corridor

Catheter

Lab

Cardiac

Investigations

background
Background
  • Direct Access – Consultant/GP’s can refer directly for all tests.
  • Cardiac Investigation –Prolonged waits for all tests
  • The Echo waiting list was standing at 1292 (20.8.2005)
problems and solutions
Problems and Solutions
  • Referrals not screened
  • Referrals not on system
  • No idea of inpatient or out patient demand
  • No idea of true capacity
  • Reviewed working hours. Technician adopting 12 hour day
  • Develop and adhere to a strict referral policy (BCE) given out to all Jnr Docs
  • Support of Consultants
  • Ward based ECG’s
  • Business case for portable ECHO machine
  • Unit staff collect patients
  • Develop bedside ECHO reduce bed stays
  • Validation
outcomes
Outcomes
  • 3week wait for ECHO
  • Less than 24 hour wait for inpatient echo
  • 40 minute slot for technician
  • Portable Echo machine
  • Education of all staff reduces inappropriate requests
  • Weekly reports
slide11

Kettering General Hospital

NHS Trust

Time in days from primary care referral to Cardiology appointment

slide13

What next

Reduction in waiting times meant

that we could think about implementing

different solutions to help meet the

18week target so started piloting a One

Stop approach

how are we addressing the changes
How are we addressing the changes
  • KGH – working groups
  • LNR – working groups
  • Cardiac Network lead and involvement within groups
  • Communication
one stop pilot who involved
One Stop pilot- Who involved
  • 2 Consultants
  • Technicians
  • Cardiac Rehab Nurse
  • Outpatient services
  • TOMCAT
cos flow
COS - flow

Referral onto C&B

Redirected onto COS with appropriate Test flagged

Booking transferred to TOMCAT and invite letter generated

Patient attends – Outpatient reception

Consultation/ECHO or Stress test/Health Advisor

Outcome letter sent to GP within 24hours

Patient evaluation

main issues
Main Issues
  • Pilot undertaken with only 2 consultants
  • Cardiologist on Long term sick
  • Accessing C&B
  • Space
patient evaluation
Patient Evaluation

All tests same appointment

and information specialist

available so diagnosis

known on same day

Diagnosis and treatment

without waiting

follow up

All questions answered,

friendly and helpful

Superb to have tests and

consultant together

Staff from receptionist, nurse

to consultant all very helpful

getting gp s on board
Getting GP’s on board
  • Practice Learning Event
  • Cardiology ‘What we do’ ‘What do you want’
  • Approximately 80 GP’s attended
  • Feedback
cardioversion pathway
Cardioversion Pathway

Atrial

Fibrillation

Referral to

Cardiologist

Pre

Assessment

One Stop

Cardioversion

2 weeks

16weeks

ECG

ECG

ECHO

ECHO

Warfarin

Warfarin

Rate Control

Rate Control

18 weeks

slide22

Heart Murmur / Valve Pathway

Breathlessness Clinic

GP

Referral

TOE

Angio

Surgery

One Stop

Clinic

4 weeks

ECHO

ECHO

14 weeks

2 weeks

2 weeks

18 weeks

slide23

Pacemaker Implant

Bradycardia

Referred to Cardiologist

One Stop Clinic

Pre assessment

Procedure

2weeks

4weeks

2weeks

ECG

ECG

Referred to Glenfield

24- hour tape

24- hour tape

Referred to Glenfield for TILT test

18weeks

slide24

Angiography

2 weeks

2 weeks

4 weeks

10 weeks

18weeks

choose book
Choose & Book

Thank you for seeing this 82 year old hypothyroid lady who has fast

AF made worse by thyrotoxicosis.

I would appreciate your assessment.

Thank you for seeing Mrs.. She presented complaining of feeling hot and was found to be in AF with a rate of about 100. She’s also found to have raised blood pressure of 190/110. She’s on Perindopril, Bendrofluazide and Atenolol. Her TSH returned at 3.04. She has normal heart sounds. I have arranged an ECHO and referred to the warfarin clinic. Her cholesterol on 14th December was 4.4.

what next
What next
  • Increase sessions
  • All New referrals to be seen at Kettering?
  • Kettering clinics to be satellite service
  • Discussions in progress re dates for Procedures
  • Pre assessment at same appointment ?
key elements to achieve cardiac 18weeks
Key Elements to achieve Cardiac 18weeks
  • Work up prior to referral
  • Results thus available at consultation
  • Patients ‘willing and able’ prior to referral
  • Advice and Guidance – joint pre hospital planning
  • Shared pathways enabling achievement
slide28
Any

Questions

Contact: maxine.white@kgh.nhs.uk

01536 492000 Bleep 610

01536 493354