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Cardiology Diagnostic Project

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Background of Project and challenges. The Project ... Rheumatology. www.18weeks.nhs.uk. 6. Data from. Nov 2005 to Oct 2006. Dept of Health Attachment #5 ... – PowerPoint PPT presentation

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Title: Cardiology Diagnostic Project


1
Cardiology Diagnostic Project Mary
Currie Innovator lead DH Cardiology Diagnostic
Project Team May 2007
2
Overview
  • Background of Project and challenges
  • The Project structure, vision and approach
  • Cardiology Diagnostic Model
  • Progress on reducing waits
  • Learning from the DH Innovator sites - key
    ingredients for improvement
  • Take home message

3
BackgroundDiagnostic clearance times
  • The initial assessment identified long waits for
  • Echo
  • EP (smaller volumes)

Diagnostic test clearance times
Most significant challenge to reducing diagnostic
waits to below 13 weeks
Demand expected to rise before Dec 2008
Source Pilot site data
Total sample size 100,000 waiters Unvalidated
data, from pilot study of 13 self selected trusts
therefore may not be representative".
4
Challenges contributing to long waits?
  • Process issues within department
  • Poor waiting list management e.g. many using
    paper diaries for booking appointments
  • High DNA rates
  • Lack of investment in technology
  • High demand for useful tests
  • Workforce e.g. recruitment and retention
  • Training
  • Skill Matching
  • Competing interest with the range of cardiac
    diagnostic investigations

5
Potential patient pathways flowing into echo
Falls
Trauma crush injuries
Stroke
Cardiac referrals
Renal transplant
Breathless pts (COPD)
Echo
Rheumatology
ITU patients
Requests for right heart pressures
Elderly
Pre-operative screening
General pre, intra and post chemo surveillance
Murmur ? cause (general medicine)
Pregnancy murmur
6
Dept of Health Attachment 5
Data from Nov 2005 to Oct 2006
7
Assisting delivery of 18 weeks
  • Cardiac diagnostic scans are subject to
    diagnostic test milestones (DH Choice of scan)
  • 13 weeks by March 2007
  • 6 weeks by March 2008
  • RTT 18 weeks (whole patient pathway Dec 2008)
  • Organisations must use all available levers
  • e.g. PBC and tariffs to be in a position to
    deliver the 18 week patient pathway.

8
Project structure
  • Project steering group jointly chaired by
  • Roger Boyle, National Director for Heart Disease,
    DH
  • Sue Hill, Chief Scientific Officer and National
    Clinical Lead for Physiological Measurements DH
  • Clinical reference group
  • Project team Sheelagh Machin, Julie Harries,
    Mary Currie established Autumn 2006
  • Reporting into DH Physiological Measurement
    Strategy Group and 18 weeks Taskforce and
    Executive Board

9
Vision for cardiac diagnostics
  • The vision for people with cardiac disease,
    suspected cardiac disease or where cardiac
    disease needs to be excluded is to ensure cardiac
    diagnostics are performed in an efficient way, in
    an appropriate setting as close to the patients
    home as clinically feasible taking into account
    the needs of the local community.

10
Approach- working with Innovator sites
  • What are Innovator sites?
  • Primary/secondary/tertiary care
  • Sites making significant progress in reducing
    waiting times
  • How were sites identified?
  • Data analysis demonstrating reduced waiting times
    in cardiac diagnostics
  • Intelligence- evidence of proven innovation,
    service model that can deliver and sustain
    diagnostic services

11
Cardiology Diagnostics Model
12
Innovator sites
13
Progress with reducing waits
14
Echo patients still waiting in England at the end
of each month
15
Electrophysiology patients still waiting at end
of each month in England
16
So, what's the big question?
?
how have some organisations managed to
reduce waits?
17
Learning from Innovator sites- key ingredients
  • Systems and Process
  • Workforce
  • Technology
  • .. Coupled with clinical leadership, a
    willingness to change and improve, with
    management support.

18
Systems and Process
Systems and Process opportunities
  • Understand your service, where referrals come
    from
  • Demand and capacity work- release capacity
  • Improved waiting list management and
    administrative process
  • Removing steps of the patient pathway that add no
    value
  • Reducing DNAs (lean thinking) e.g. reminder
    letters, calls, texts
  • Maximising capacity/utilisation of equipment
  • Reviewing staff rota/working patterns
  • Service transformation in some areas e.g.
    introducing new service models e.g. primary care

19
Workforce
  • Ensure the current workforce is sustainable
  • Skill matching, the right people in the right
    place at the right time
  • Willingness to adopt new ways of working
  • Develop support roles to maximise productivity of
    all staff
  • Develop existing physiologist and specialist
    nurse roles
  • Use GPwSI and other practitioners in Primary Care
    to provide, where appropriate, diagnostic
    services to patients.

20
Technology
  • Utilising technology to improve and transform
    services can achieve benefits for patients and
    clinical staff
  • e.g.
  • BNP testing
  • Portable echo machines
  • Provision of ECG in Primary Care including
    Tele-monitoring
  • Electronic report and image transfer
  • IT systems within diagnostic departments
  • Use of Tablet-computers in one-stop clinics
  • Choose and books systems

21
Key outputs
  • Information to guide the NHS in the
    development of modernised and sustainable
    cardiology diagnostics services, which support
    delivery of 18 weeks
  • Contributing to 3 cardiac commissioning pathways
  • Good practice guide (June 2007)
  • National stakeholder event 20th June 2007

22
Conclusion
  • Steady progress is continuing, more work to do
    across the country
  • Sharing best practice
  • Continue to modernise and improve access for
    patients to cardiac diagnostic testing
  • Access to diagnostics must happen early in the
    patient pathway
  • Drive forward improvements for patients in order
    to deliver a whole patient pathway from referral
    to treatment in 18 weeks

23
Take home message
  • Success requires
  • A vision for the services we want for patients
  • (accessible, timely, high quality)
  • Good communication
  • A willingness to change
  • Radical transformation, in some areas with new
    service models
  • Strong clinical leadership, be it a clinician,
    physiologist or nurse, to introduce and sustain
    improvement

24
Further information available from
  • Mary Currie- mary.currie_at_lewishampct.nhs.uk
  • Sheelagh Machin- sheelagh.machin_at_heart.nhs.uk
  • Julie Harries- julie.harries_at_heart.nhs.uk
  • 18 week website- http//www.18weeks.nhs.uk

25
Thank you
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