Royal Alexandra Cardiovascular Health Electronic Links RACHEL

1
Royal Alexandra Cardiovascular Health Electronic
Links (RACHEL)
Tele-Cardiology
Dr Iain Findlay
2
Central Database
CareNet
CCU Discharge Summaries
Rapid Access Clinic
3
(No Transcript)
4
(No Transcript)
5
(No Transcript)
6
First symptoms..
John Smith (male, 46) visits his family doctor,
Dr McCormick describes recent onset of mild
chest pain Dr McCormick decides Mr Smith needs
to see a local cardiologist Dr McCormick
connects to the hospitalrapid access system via
NHS network
John Smith (male, 46) visits his family doctor,
Dr McCormick describes recent onset of mild
chest pain Dr McCormick decides Mr Smith needs
to see a local cardiologist

• John Smith (male, 46) visits his family doctor,
  Dr McCormick
• describes recent onset of mild chest pain

7
Chest pain classification

• 1. precipitation by exercise
• 2. brief duration
• 3. prompt relief by rest or GTN
• 4. substernal location
• 5. radiation from chest to jaw, left arm or neck
• 6. absence of other causes of pain

TYPICAL CHEST PAINCriteria 1-3 positive, orany
four criteria positive
ATYPICAL CHEST PAINAny two criteria positive, or
only criteria 4-6 ve
NON-ANGINAL PAINOnly one criterion positive
8
Consultation..

• Mr Smith attends hospital two days later
• has exercise test - exercises for 13 minutes on
  modified Bruce Protocol
• 1.3 mm ST depression at peak exercise

9
Family Doctor

• Notified of test result
• can view test on-line

10
(No Transcript)
11
Six weeks later..

• Mr Smith is suddenly aware one evening of tight
  central chest pain
• calls his GP within 10 minutes

• ambulance takes Mr Smith to hospital within 45
  minutes
• admission via emergency department database
• ECG performed

12
If in doubt..

• The receiving doctor in the emergency room wants
  to be sure the ECG shows an acute infarct before
  commencing therapy
• ECG performed and faxed to consultants mobile
  communicator for review
• consultant can go on-line from home (via NHS Net)
  and review ECGs in Museweb

13

• Consultant instructs receiving doctor to treat as
  MI and repeat ECG in 10 minutes
• Consultant connects to hospital intranet and
  reviews ECG

VIEW NEXT ECG
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
How are we feeling today..

• Mr Smith makes good progress
• His serial ECGs and enzymes show he had an
  inferior infarction
• Before discharge he is reviewed and placed on a
  statin, aspirin and beta blocker
• his discharge medications are electronically
  checked and confirmed by pharmacy
• he joins the rehabilitation programme

18

• IDD and script
• Discharge data
• patient leaflets
• stats

SCI Incremental Discharge Letter module
Treatment
Step 6. Supporting discharge letter production