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  1. 1. Redesign of Cardiology Services in NHS Lothian
  2. 2. <ul><li>Redesign Drivers </li></ul><ul><li>Current Service Configuration </li></ul><ul><li>Proposed Service Configuration </li></ul><ul><li>Activity Data </li></ul><ul><li>Patient Pathways </li></ul><ul><li>Benefits of the proposed Redesign </li></ul>Presentation
  3. 3. <ul><li>Sustainability of Cardiology and General Medicine in Lothian </li></ul><ul><li>Equity of access to all levels of cardiology services across Lothian </li></ul><ul><li>Consistent cardiology support for unselected medical takes and in-patient aspects of specialty service delivery at WGH, SJH & RIE </li></ul><ul><li>Uniform management of STEMI across Lothian </li></ul><ul><li>Support for capacity planning and modelling in terms of elective activity and achieving national waiting times targets </li></ul><ul><li>Creation of a single interventional site for cardiology services in Lothian </li></ul><ul><li>Places cardiology services in a position to deliver new developments eg primary PCI and electrophysiology </li></ul>Purpose of Redesign
  4. 4. Current Service Model Primary Care 3 o RIE Out Patient Emergency SJH Out Patient Emergency 3 o WGH Out Patient Emergency
  5. 5. Redesigned Service Model Primary Care 3 o Single standards, protocols, pathways Emergency Out Patient RIE Out Patient Emergency WGH Out Patient Emergency SJH
  6. 6. Current Cardiology Activity in Lothian
  7. 7. 2004/5 Activity – 10,437 episodes 1336 13 RIE non-Lothian 3671 35 RIE Lothian 1666 17 WGH non-Lothian 1803 16 WGH Lothian 1961 19 SJH Episodes % Site
  8. 8. 2004/5 Activity – 10,437 episodes 1313 13 WGH non-Lothian elective 781 7 WGH Lothian elective 1336 13 RIE non-Lothian 3671 35 RIE Lothian 353 3 WGH non-Lothian emergency 1022 10 WGH Lothian emergency 1961 19 SJH Episodes % Site
  9. 9. 2004/5 Activity – 10,437 episodes 1313 13 WGH non-Lothian elective 781 7 WGH Lothian elective 1336 13 RIE non-Lothian 3671 35 RIE Lothian 353 3 WGH non-Lothian emergency 1022 10 WGH Lothian emergency 1961 19 SJH Episodes % Site
  10. 10. 2004/5 Activity – 10,437 episodes 98 1 WGH Lothian STEMI 1313 13 WGH non-Lothian elective 781 7 WGH Lothian elective 1336 13 RIE non-Lothian 3671 35 RIE Lothian 353 3 WGH non-Lothian emergency 924 9 WGH Lothian emergency 1961 19 SJH Episodes % Site
  11. 11. <ul><li>Consultant delivered cardiology service on all three sites </li></ul><ul><li>Consistent support for unselected medical takes – scheduled consultant time </li></ul><ul><li>CCU / Medical HDU facilities on all three sites </li></ul><ul><li>Standardised STEMI pathway </li></ul><ul><li>Impact of emergency activity on elective procedures minimised </li></ul><ul><li>Equity of access and treatment </li></ul><ul><li>Kerr compatible – local delivery of all but the more specialised aspects of care </li></ul>Service Model
  12. 12. Current Configuration of Services
  13. 13. Future Configuration of Services
  14. 14. Future Configuration of Services
  15. 15. Emergency Patient Pathway - WGH / SJH Chest Pain CCU RIE SAS Triage STEMI Yes No Angioplasty CCU/HDU WGH or SJH Medical Ward Rehab Home Local Rehab Thrombo lysis ARU-WGH MAU-SJH LOCAL SYSTEM
  16. 16. Elective Patient Pathway GP Referral Investigation / Intervention Catheter Unit RIE Local OPD Angiography required Yes No Angiography Angioplasty Investigations ECG Echo ETT DISCHARGE Management Plan Follow up LOCAL SYSTEM
  17. 17. Emergency Patient Pathway – Heart Failure Heart Failure Community Triage Refer to Hospital No Yes CCU/HDU WGH or SJH Medical Ward Post Acute Care Home Local Follow-up (Long Term Condition) ARU-WGH MAU-SJH Assessment Manage at Home Input from Heart Failure Clinical Nurse Specialist LOCAL SYSTEM
  18. 18. <ul><li>One cardiology service delivered across three sites </li></ul><ul><li>Consultant-delivered cardiology service on all three sites </li></ul><ul><li>Full range of non-invasive investigations and support staff on 3 sites </li></ul><ul><li>Support for three hospitals providing unselected medical takes </li></ul><ul><ul><li>General medicine </li></ul></ul><ul><ul><li>STEMI </li></ul></ul><ul><ul><li>CCU (critical care) </li></ul></ul><ul><li>Support for co-located specialties on all three sites </li></ul><ul><li>Support for primary care on all three sites </li></ul><ul><li>Locally delivered out-patient clinics </li></ul>3 Acute Hospitals - Benefits
  19. 19. <ul><li>3 co-located laboratories (RIE) </li></ul><ul><li>Supported by one team of medical, nursing and technical staff matched to activity </li></ul><ul><li>Minimal impact of emergency on elective activity (1+2 labs) </li></ul><ul><li>Single waiting list </li></ul><ul><li>Consistent list management </li></ul><ul><ul><li>Numbers per list </li></ul></ul><ul><ul><li>Angioplasty becomes a follow-on rather than a return procedure </li></ul></ul><ul><li>One location for non-Lothian activity </li></ul>1 Suite of Cardiac Laboratories - Benefits
  20. 20. <ul><li>Quality </li></ul><ul><li>Equity </li></ul><ul><li>Single waiting list </li></ul><ul><li>Single rotas </li></ul><ul><ul><li>consultants </li></ul></ul><ul><ul><li>middle grade doctors </li></ul></ul><ul><ul><li>cath lab staff </li></ul></ul><ul><li>Consistent practice </li></ul><ul><li>Economies of scale – release of costs </li></ul><ul><li>Sustainability </li></ul>Benefits

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