Title: Cardiology Diagnostic Project
1Cardiology Diagnostic Project Mary
Currie Innovator lead DH Cardiology Diagnostic
Project Team May 2007
2Overview
- 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
3BackgroundDiagnostic 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".
4Challenges 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
5Potential 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
6Dept of Health Attachment 5
Data from Nov 2005 to Oct 2006
7Assisting 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.
8Project 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
9Vision 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.
10Approach- 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
11Cardiology Diagnostics Model
12Innovator sites
13Progress with reducing waits
14Echo patients still waiting in England at the end
of each month
15Electrophysiology patients still waiting at end
of each month in England
16So, what's the big question?
?
how have some organisations managed to
reduce waits?
17Learning from Innovator sites- key ingredients
- Systems and Process
- Workforce
- Technology
- .. Coupled with clinical leadership, a
willingness to change and improve, with
management support.
18Systems 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
19Workforce
- 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.
20Technology
- 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
21Key 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
22Conclusion
- 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
23Take 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
24Further 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
25Thank you