London Cardiovascular Project

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Non elective cardiac surgery


A significant proportion of cardiac surgery conducted in London is on an urgent or non-elective basis.

Patients requiring urgent surgery often wait longer than they should. Clinical evidence shows that the risk of death increases month on month the longer a patient waits for surgery.


The London Cardiac Networks are responsible for implementation with the South London Cardiac and Stroke Network leading the collaboration.

Project aims

Develop a new pathway that optimises an electronic referral system for inter-hospital transfer (IHT) patients.

A significant proportion of cardiac surgery conducted in London is on an urgent or non-elective basis.

To address the issues that exist, the clinical expert panel recommended the following for patients requiring non-elective cardiac surgery:

  • Mandatory use of an electronic referral system for non-elective inter-hospital transfer patients
  • Agreed evidence-based clinical protocols
  • The panel also proposed that waiting times are monitored.

Waits should not exceed the following standards for 90% of firth time CABG patients:

  • The total pathway length should not exceed 21 days
  • The time between admission to the local hospital and referral to a surgical unit should not exceed five days
  • Time between referral and transfer should not exceed five days
  • Length of stay (LOS) at the surgical centre should be 11 days or less.

Implmentation update

  • Site assessments have been completed in all non elective cardiac surgery sites with action plans developed to ensure full implementation by March 2012.
  • Network teams have agreed analysis criteria for non elective IHT LOS reporting (first time isolated CABG).
  • Data for non-elective patients will be captured on the inter-hospital transfer electronic referral system.
  • To demonstrate the proportion of IHT patients referred electronically comparison will be made with Hospital Episode Statistics data.

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Cardiac Surgery Service Specification - Contains baseline data, quality standards and implementation timeframes

Project documents

Model of care (summary)
Model of care (detailed)
Patient perspective
Responses to engagement
Case for change
Co-dependencies framework
Financial analysis

More on the
patient perspective