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The Cardiothoracic Centre Liverpool. Dr Raphael Perry Clinical Director. Advanced Angioplasty 2007. No conflict of Interest to Declare. Liverpool/Merseyside. Capital of Kulcha 2008 Two Liver Birds Two Cathedrals Two great football teams Everton Everton reserves

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the cardiothoracic centre liverpool

The Cardiothoracic Centre Liverpool

Dr Raphael Perry

Clinical Director

advanced angioplasty 2007
Advanced Angioplasty 2007
  • No conflict of Interest to Declare
liverpool merseyside
Liverpool/Merseyside
  • Capital of Kulcha 2008
  • Two Liver Birds
  • Two Cathedrals
  • Two great football teams
    • Everton
    • Everton reserves
  • One Tertiary Cardiac Centre
models of pci service delivery
Models of PCI Service Delivery
  • Trend is for devolution
  • Plan for lots of smaller local centres
  • People think it’s better to have local services
  • May have to defend central model
  • You cannot be serious!
centralism rules ok
Centralism Rules OK
  • Most services are determined by local history and geography
  • What is good about it
  • What is bad about it
cheshire mersey cardiac network
Cheshire & Mersey Cardiac Network
  • Catchment population of around 2.8 million
  • High SMR
  • Traditionally underprovided
  • Includes The Welsh

CTC

traditional cardiac unit gradual erosion of capability
Traditional Cardiac Unit-Gradual Erosion of Capability

Local secondary care demand

Service reduction due to local pressures

Managers being stupid

Bed loss due to emergency GIM

plus points
Plus Points
  • 100% regional resource dedicated to meeting the needs of the network
    • Network Lead is secondary care cardiologist
    • Local Cardiology Advisory Board
  • Flexibility of Response
    • Potential for expansion
    • Changing Clinical Indications
  • Economies of Scale
  • Needs include
    • Waiting Times
    • Transfer Times
quality quality quality
Quality, Quality, Quality
  • High Volume Operators in High Volume Centre
    • Interactive learning/discussion
  • Seven operators performing 2,400 PCIs (c.350/operator)
    • National Average 145
    • 24/7 multi operator presence
  • Named risk adjusted MACE in public domain
    • Robust Data
    • Rapid regular feedback
risk adjusted mace 2003 2005
Risk Adjusted MACE*2003-2005

CTC

0.9%

* MACE includes in-hospital mortality,

Q-wave MI, emergency CABG, and CVA

more plus points
More Plus Points
  • ACS Transfer times
    • Median < one day
  • Waiting Times Elective PCI
    • 4-6 weeks
  • All technology available
    • Rapid integration of new technology
  • Research Coordination
    • North West QIP

Transoesophageal rotablator?

minus points
Minus Points
  • No onsite interaction with GIM
    • No general ITU
  • No A & E
    • Different model for primary PCI
  • Can be seen as Elitist
      • (I actually think this is a plus point)
past and future
Past and Future
  • 1988
    • One cath lab CTC – four cardiologists
    • One DGH Cardiologist
  • 2007
    • Six cath labs CTC – 11 cardiologists
    • Six labs in DGHs – 35 cardiologists
  • Local PCI service
    • Developing with North Wales

“I’m just glad I’m not a Turkey”

concluding thoughts
Concluding thoughts:
  • This system works well
    • Champagne for everyone
  • If it isn't broken don’t fix it
  • 99% of Cardiologists would have their PCI in a tertiary centre
    • The other 1% misheard the question
  • What would you design if starting over?
  • If they were the same price would you buy a Rolls Royce or a Mondeo?
      • Would you ever buy a Skoda?
concluding thoughts1
Concluding thoughts
  • If you remember nothing else about Liverpool, don’t forget
  • There are two football teams
  • And one tertiary cardiac centre manned by talented Dinosaurs!
    • And they’re not for turning!