Our Passion, Your Care. Recent developments in Cardiology services at Ipswich Hospital NHS Trust Duncan McNab

Our Passion, Your Care. Outline Invasive cardiology services Cardiac physiology services Consultant of the Week Nurse specialists and services Cardiac rehabilitation Intermediate care clinics Future developments

Our Passion, Your Care. Invasive cardiology services What is meant by “invasive cardiology” –Cardiac catheterisation / coronary angiography –Pacemaker and defibrillator implantation –Percutaneous coronary intervention (PCI)

Our Passion, Your Care. Invasive cardiology - new build

Cardiac physiology services PIE led initiative Guided by Mary Unsworth and Di Hegarty Supported by Caroline Cozens and Debbie Bowyer Delivered by the Byron South and the cardiac physiologists Services –Echocardiogram –24 hour tape analysis –Exercise testing –Pacemaker analysis and optimisation

Echocardiogram Service December 2011: Disc storage – costly/difficult to retrieve Long in-patient waits No standardised template December 2011: Disc storage – costly/difficult to retrieve Long in-patient waits No standardised template February 2012: Disposal & recycling discs – saving £8,000 per year Standardised template Weekly echo review meetings February 2012: Disposal & recycling discs – saving £8,000 per year Standardised template Weekly echo review meetings August 2012: Stand alone Cardiology Server by December D echo equipment by September 2012 Visiting Papworth Specialist - teaching sessions Cardiology inpatient referrals waits reduced from 2 weeks to 24hrs August 2012: Stand alone Cardiology Server by December D echo equipment by September 2012 Visiting Papworth Specialist - teaching sessions Cardiology inpatient referrals waits reduced from 2 weeks to 24hrs

24hr Tape Reporting 6 week reporting backlog Interruptions Combined staff room/ reporting area 6 week reporting backlog Interruptions Combined staff room/ reporting area Dedicated reporting room Reporting & analysis at same station Reporting time reduced from 6weeks to 24hrs No double checking reports Dedicated reporting room Reporting & analysis at same station Reporting time reduced from 6weeks to 24hrs No double checking reports 24hr turnaround reporting time for all inpatient requests, same for GPs Looking to repatriate the community tape contract 24hr turnaround reporting time for all inpatient requests, same for GPs Looking to repatriate the community tape contract August 2012 February 2012 December 2011

Physiology Led Exercise Tests December 2011: Late starts Long waits for junior doctors Reporting delays Patients cancelled at short notice December 2011: Late starts Long waits for junior doctors Reporting delays Patients cancelled at short notice February 2012: Physiologist led exercise tests trial Reduction in waits/cancellations Reporting facility in room Junior doctor time released equivalent to £27,000 February 2012: Physiologist led exercise tests trial Reduction in waits/cancellations Reporting facility in room Junior doctor time released equivalent to £27,000 August 2012: 85% of all exercise tests are physiologist led Medical supervision only for high risk in patients 24hr turnaround for inpatients 1week for outpatient referrals Cleared backlog from 6 weeks to 1 week August 2012: 85% of all exercise tests are physiologist led Medical supervision only for high risk in patients 24hr turnaround for inpatients 1week for outpatient referrals Cleared backlog from 6 weeks to 1 week

Room Utilisation Insufficient clinical rooms Up to 1hr wait for ECG’s from clinic No space for additional clinics Insufficient clinical rooms Up to 1hr wait for ECG’s from clinic No space for additional clinics Staff room converted to clinic room Dedicated reporting room Additional admin space sourced Staff room converted to clinic room Dedicated reporting room Additional admin space sourced Admin functions moved out of clinical area Pre-op assessments/ MRSA swabbing/ additional clinics now in Clinic G Plans for pre pacemaker clinic Stand alone seminar room Admin functions moved out of clinical area Pre-op assessments/ MRSA swabbing/ additional clinics now in Clinic G Plans for pre pacemaker clinic Stand alone seminar room December 2011February 2012 August 2012

Staff Room to Clinical Room

Booking & Reporting Tests Hand written referrals for each test by Consultants 5 day delay before referral logged Hand written referrals for each test by Consultants 5 day delay before referral logged Electronic referrals Released time for booking clerk Reduced delay in logging referral from 5 days to 30 secs Electronic referrals Released time for booking clerk Reduced delay in logging referral from 5 days to 30 secs Plan to install updated reporting stations Impact: Less duplication of work Electronic referral of images Plan to install updated reporting stations Impact: Less duplication of work Electronic referral of images February 2012August 2012December 2011

Flexible Working December 2011: 9-5 working/no consistent leadership cover each day Uneven workload dictated by staff availability not service need December 2011: 9-5 working/no consistent leadership cover each day Uneven workload dictated by staff availability not service need February 2012: 8-6 working trialled Staggered lunch hours Leadership presence 5 days per week February 2012: 8-6 working trialled Staggered lunch hours Leadership presence 5 days per week August 2012: 8-6 working rolled out 24hr turnaround time for all in patient tests Reduced out patient waits for all tests Improved work life balance and staff morale August 2012: 8-6 working rolled out 24hr turnaround time for all in patient tests Reduced out patient waits for all tests Improved work life balance and staff morale

Our Passion, Your Care. Consultant of the Week (CoW)

Our Passion, Your Care. Consultant of the Week (CoW) Daily CMU ward round by different consultants / SpR’s Consultant ward round of Claydon patients twice per week Daily CMU ward round by different consultants / SpR’s Consultant ward round of Claydon patients twice per week Consultant of the Week begins Every patient on CMU and Claydon seen by same cardiologist every day for a week Clinic & procedural commitments shifted, not lost Consultant of the Week begins Every patient on CMU and Claydon seen by same cardiologist every day for a week Clinic & procedural commitments shifted, not lost Clinical benefits to patients Reduction in length of stay and increase in discharges Improved doctor performance Nursing and Junior feedback Reduction in junior staff from 7 to 5 Clinical benefits to patients Reduction in length of stay and increase in discharges Improved doctor performance Nursing and Junior feedback Reduction in junior staff from 7 to 5

Our Passion, Your Care. Outcomes - Length of Stay

Our Passion, Your Care. Outcomes - Discharges Start consultant of the week March 2012

Our Passion, Your Care. Consultant of the Week

Our Passion, Your Care. Other developments Nurse specialists and services Cardiac rehabilitation Intermediate care clinics

Our Passion, Your Care. At what cost?

Our Passion, Your Care. Future developments Acute cardiac care unit (inpatient standards) Future consultant appointments Outpatient follow-up