Karen Wafer, CathLab Manager, Liverpool Heart & Chest Hospital

1. Cath lab efficiency;
The Liverpool model.
Karen Wafer
Cath lab and Holly Suite
Senior Manager

2. Conflict of interest
• I have no conflicts of interest to declare

3. The Liverpool journey……
• Amsterdam 2008: OLVG

4. The starting point 2008/09
• Day ward dayroom was turned into a ‘lounge’
for 5 patients undergoing radial procedures as a
trial. This cost just £3000 and took 6 weeks.
• Radial patients remained in their own clothes
• They were allowed to drink freely up until the
time of the procedure, mobilise as they wanted
to, had an internet station to access as required
and papers and magazines to read.

5. The traditional day ward patient

6. The lounge pilot scheme

7. Holly suite
• From 20 beds and a 5 patient lounge to:
• Whole business lounge concept for 25 patients
with only 6 trolleys
• True radial lounge section has 15 chairs, the
atrium (lounge suit patients) has 10.

8. Holly suite radial lounge

9. The beverage bay

10. The massage area

11. The internet station

12. Additional requirements
• ‘Status at a glance’ board to replace patient
names on a whiteboard
• Interactive scheduling system
• Use of the lounge suit
• Increased integration with cath lab
• Cohesive vision from the Division

13. Interactive scheduling

14. Scheduling

15. Status at a Glance

16. Weekly schedule of procedures
0
5
10
15
20
25
Mon Tue Wed Thur Fri
Cor EP Pacing Bronch TOE DCCV Prov RALC BT Dental CT

17. Admission process
• All elective PCI undergo pre-assessment by
CNP in OPD
• Staggered admission to Holly: 8am (morning
list) and 11am (afternoon list)
• No PCI patient is fasted: Beverage bay access
• Access for families also
• Own clothes. Provided with a locker for phones
etc pre lab. Buzzer for family.

18. Admission process
• Clear allocation of staff to lists
• Discharge planning on walk to the chair
• POCT for rapid INR result
• Team focus on preparation of patients and
communication to the lab
• Holly suite attendance at cath lab operational
meeting

19. Admission process
• Patient liaison clerk pre call to reduce DNA
• ANP based on Holly suite for clerking and triage
of ACS
• SHO based on Holly for support, TTO,
electronic discharge summary

20. Process to lab
• Admit on status
• Update LSS
• Communicate with lab co-ordinator through LSS
notes
• Prepare patient based upon detail on
LSS…..next into lab
• Forward wait, efficient lab turnaround
• Direct return to Holly, no ‘recovery’ period

21. Clinical observations: PCI Protocol
• Baseline on admission
• Post procedure baseline on return
• Re-check in 2 hours
• Re-check pre discharge
• TR band: leave all air for 1 hour then remove
2mls every 20 mins, leave for 1 hour once
• 4 hours to procedure to discharge

22. What we DON’T do
• Post procedure ECG
• Cardiac monitoring
• Keep patients NBM
• Separate by gender

23. What we focus on
• A relaxed patient experience in a relaxed non
NHS type environment in own clothes
• We encourage family involvement / support
• We encourage patient interaction / support
• We encourage independence and mobility
• Patient engagement, patient stories, patient
shadows to improve practice

24. Further developments in Holly Suite
• 1 x scope room
• 1 x treatment room
• TOE
• DCCV
• Provocation testing
• GA Bronchoscopy and EBUS
• LinQ devices physiologist led

25. Key to our progress
• Divisional control
• Expansion of services for patient and family
experience benefits
• Ownership of services through Holly
• Cath lab collaboration

26. Coming soon
• RFID tagging for patients
• Care cube (Integration of our digital systems)
• Increased research……..nurse led
• Divisional involvement in cath lab operational
meeting
• Improve divisional patient flow
• Divisional rotation for recruitment

27. THANK YOU.
QUESTIONS?