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Cardiology Outpatients 18 Week Pathway
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Cardiology Outpatients 18 Week Pathway



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  • Validation saw a reduction of 20% Technician led work 3 days Reducing the burden on department Develop and adhere to a strict referral policy (BCE) given out to all Jnr Docs Pathway for referral ensuring review and recording of activity Support of Consultants Allowed a business case to be developed for a further technician Flexible working within the department reduced in patient waits – whoever is available collects patient ECHO’s to be done in the community – in conjunction with the Cardiac Outpatient Clinics
  • Verified data Except at week ends Now all referrals assessed and entered on system Inpatient reduces outpatient demand To allow Echo to be done in satellite clinics and at bedside
  • Go through Stages COS in consultant only access Letter from TOMCAT advises patient that they be in hopsital 3 hours will have test etc., Constant evaluation of process it has been tweaked and changed. Outcome sheets/Health advice/GP outcome


  • 1.
    • Cardiology
    • Out patients
    • 18 Week Pathway
    • Maxine White - Cardio Respiratory Service Manager
    Kettering General Hospital NHS Trust
  • 2. Overview
    • Kettering General Hospital
    • The reasons why
    • The process
    • Issues
    • Outcomes
    • Examples
  • 3. 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.
  • 4. Out Patient sites Kettering General Hospital Rushden Wellingborough Corby
  • 5. Location of departments Main Out patients Catheter Lab Cardiac Investigations Main Hospital Corridor A&E
  • 6. Heartlands CHD Mortality
  • 7. 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)
  • 8. 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
  • 9. Results
  • 10. Outcomes
    • 3 week 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
  • 11. Kettering General Hospital NHS Trust Time in days from primary care referral to Cardiology appointment
  • 12. Direct Access Cardiac Investigations
  • 13.
    • 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
    What next
  • 14. How are we addressing the changes
    • KGH – working groups
    • LNR – working groups
    • Cardiac Network lead and involvement within groups
    • Communication
  • 15. One Stop pilot- Who involved
    • 2 Consultants
    • Technicians
    • Cardiac Rehab Nurse
    • Outpatient services
    • TOMCAT
  • 16. 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
  • 17. Clinic Waiting times
  • 18. Main Issues
    • Pilot undertaken with only 2 consultants
    • Cardiologist on Long term sick
    • Accessing C&B
    • Space
  • 19. Patient Evaluation
    • All tests same appointment
    • and information specialist
    • available so diagnosis
    • known on same day
    Diagnosis and treatment without waiting follow up Staff from receptionist, nurse to consultant all very helpful All questions answered, friendly and helpful Superb to have tests and consultant together
  • 20. Getting GP’s on board
    • Practice Learning Event
    • Cardiology ‘What we do’ ‘What do you want’
    • Approximately 80 GP’s attended
    • Feedback
  • 21. Cardioversion Pathway Atrial Fibrillation Warfarin ECHO Rate Control Referral to Cardiologist Cardioversion Pre Assessment One Stop ECHO Warfarin Rate Control 18 weeks 2 weeks 16weeks ECG ECG
  • 22. GP Referral One Stop Clinic TOE Angio Surgery           Heart Murmur / Valve Pathway 2 weeks 2 weeks 4 weeks 14 weeks 18 weeks ECHO ECHO Breathlessness Clinic
  • 23. Bradycardia 24- hour tape Referred to Cardiologist Pre assessment Procedure Referred to Glenfield Referred to Glenfield for TILT test 24- hour tape One Stop Clinic Pacemaker Implant 18weeks 2weeks 2weeks 4weeks ECG ECG
  • 24. Angiography 2 weeks 2 weeks 18weeks 4 weeks 10 weeks GP Referral Pre Assessment RACP One Stop Clinic Outpatients ETT Angiography PCI Surgery
  • 25. Choose & Book
    • 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 14 th December was 4.4.
    Thank you for seeing this 82 year old hypothyroid lady who has fast AF made worse by thyrotoxicosis.   I would appreciate your assessment.
  • 26. 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 ?
  • 27. 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
  • 28.
    • Any
    • Questions
    • Contact: [email_address]
    • 01536 492000 Bleep 610
    • 01536 493354