Revascularisation workstream

Rapid access chest pain clinic and diagnostics: Impact analysis

This paper presents the analysis of how changes in practice for the diagnosis of coronary artery disease in stable patients could impact the activity and charges of the service provision in London. The analysis is based upon data collected as part of a national Rapid Access Chest Pain Clinic (RACPC) survey and recommendations produced at the pan-London clinical consensus meeting.

Read the full report (Spring 2011).

Baseline report

The key objectives of the South London Revascularisation Report were to map a baseline of the revascularisation services provided in South London, and to show the activity of revascularisation services in South London.

Read the full report (November 2009).

National priority projects

St George's Hospital surgery service process redesign: Change and innovation to improve the patient journey

View the poster as displayed at the National Cardiac Conference March 2010.

The opportunity to take part in a National Priority Project in cardiac surgery was a good prompt to address some longstanding problems with which the St George's cardiac surgery service had been struggling.

The service was not performing at an optimum level, with levels of pre-assessment, length of stay, and cancellations not meeting national or trust standards. The elective and non-elective pathways all had room for improvement. The patients deserved a better service, and with several new members of staff in place, the time was right for change.

The project developed into a total pathway re-design. In total, the SLCSN identified six key workstreams:

  • Pre-assessment
  • Theatre scheduling
  • Electronic referral systems
  • Inpatient and inter-hospital transfer patients
  • Admission on the day
  • Length of stay (LOS)

The project yielded substantial financial and process benefits, including

  • A reduction in non-clinical cancellations from 10.1 per cent of cases per month to 2.3 per cent of cases per month,
  • A reduction in length of stay for elective cardiac surgery reduced from 8.8 days to 7.6 days and
  • An increase in admission on the day from 9.9 per cent of cases per month in to 24.6 per cent of cases per month.

While the project involved the recruitment of two additional staff, a pre-assessment nurse and a cardiothoracic nurse practitioner, the project concluded as a cost-neutral undertaking. The savings earned by the improvements, specifically, the reductions in LOS and cancellations, offset the cost of the new employees' wages.

Colleagues around the country should be encouraged that improvement does not need to come at a financial cost - but that by working more efficiently and more productively, patients can receive better care that is value for money.

By working more efficiently and more productively, patients can receive better care that is value for money.

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The London Cardiovascular and Stroke Networks have developed IHT user guides for receiving and referring hospitals.

Guide for receiving hospitals

Guide for referring hospitals

E-learning guides for IHT users will be published soon.

Rapid access chest pain clinic report

Three management options for patients with ischaemic heart disease

• Medical therapy and risk factor modification
• Coronary artery bypass graft surgery (CABG)
• Percutaneous coronary intervention (PCI)