NO CONFLICT OF INTEREST TO DECLARE J.M. McLENACHAN, LEEDS.

Slides:



Advertisements
Similar presentations
Degli Studi e dei Registri: sul Territorio
Advertisements

Door to Balloon Times: Achieving 90 Minutes and Less.
BASE HOSPITAL GROUP ONTARIO Chapter 3 for 12 Lead Training -WHY 12 LEAD- Ontario Base Hospital Group Education Subcommittee 2008 TIME IS MUSCLE.
Part I: STEMI BootCamp The 5 “R’s” of Reperfusion”
GAP-D2B An Alliance for Quality. GAP-D2B Goal n To achieve a door-to-balloon time of
D2B: Door-to-Balloon Initiative Guidelines for Kaleida Health.
Can STEMI patients Transferred for Primary PCI Receive Treatment within 90 Minutes in a Rural Setting? C Randolph Hubbard, James C Blankenship, Marie Sledgen,
Time 1 day = 24 hours 1 hour = 60 minutes 1 minute = 60 seconds 1 year
SW London Hub and Spoke Thrombolysis model Hugh Markus St George’s NHS Healthcare Trust and St George’s University of London.
Treatmant patients with acute myocardial infarcton in Bosnia and Herzegovina BH Heart Centre Tuzla Terzić I, Čaluk J, Delić A, Osmanović E, Porović E,
PPCI – National Update NCBC Workshop Jim McLenachan, National Clinical Lead for PPCI, NHS Improvement, England. London, 24 th November, NCBC Annual.
Dallas 2015 TFQO: Karen Woolfrey COI #261 EVREV 1: Karen Woolfrey COI #261 EVREV 2: Daniel Pichel COI #513 Taskforce: ACS ACS 873: Pre-hospital STEMI Activation.
Setting up a STEMI PCI Programme in the UK: Implications for the cath lab workforce Rob Henderson Trent Cardiac Centre Nottingham Chair, BCS Working Group.
Measuring Time.
Very Rapid Treatment of STEMI: Utilizing Pre-Hospital ECGs to Bypass the Emergency Department Kenneth W. Baran, MD Medical Director for United Hospital’s.
Improved Care for Acute Myocardial Infarction Linking Referral and Receiving Centres – How can We Communicate Better? Dr. James McMeekin AMI Faculty Cardiologist,
Professor Roger Boyle CBE National Director for Heart Disease and Stroke Department of Health PCI in the UK: Fit for service? A view from the Department.
Developing a Primary PCI Service - A practical guide Dan Blackman Leeds General Infirmary Advanced Cardiovascular Intervention January 29 th 2009.
What Do We Mean By Quality In PCI Institutional Requirements Dr Bernard Prendergast John Radcliffe Hospital, Oxford.
Around-the-Clock Primary Angioplasty: A Process of Care Analysis Comparing Off-Hours and Normal Hours Treatment of Acute STEMI R Leung, D Lundberg, D Galbraith,
Partner meeting Aprile, Alberto Cremonesi.
AMI Strategy How to Achieve Door-to-Balloon Times of 90 Minutes and What to Do Next? Aaron Kugelmass, MD Director, Cardiac Cath Lab Associate Division.
A modern thrombolysis service is superior to primary angioplasty
Ambulance Victoria and MonashHEART Acute Myocardial Infarction (Mon-AMI) 12 lead ECG project. An update On behalf of the MonAMI Team A Hutchison, Y Malaiapan,
Regional Showcase West Tennessee. Speakers: John Baker M.D./Emily Garner RN Presentation: Regional Showcase – West Tennessee Presenter Disclosure Information.
Quality Standards for Patients Treated by PCI Peter F Ludman.
Door to Balloon Times: How we got to where we are Brittany Cunningham, RN, MSN VHVI Quality Consultant July 27 th, 2011.
Forsyth ML Receiving Center Report New Slide for Transfer in patients #2.
Toronto STEMI Project 24/7 Primary PCI in the GTA.
Assoc Prof Dr Mohd Idzwan bin Zakaria
1 Primary Angioplasty for Acute STEMI Dr Adam Jacques Dr Sola Odemuyiwa February 2010.
“The Doctor said another 5 minutes and I would have been dead” A regional approach to saving heart muscle Vanessa Thornton Clinical Head Emergency Care.
BCIS Annual Meeting London January 2006 Dr Bernard Prendergast DM FRCP Wythenshawe Hospital Manchester UK Primary Angioplasty for Acute MI Who are the.
Management Of AMI Does time matter?? What is the best strategy: PPCI Vs TT.
Virginia Heart Attack Coalition/Mission Lifeline.
National AMI Information Call February 5, 2008 Patient Safety Initiative.
PPCI - it’s 24/7 or not at all? Dr JIM HALL CONSULTANT CARDIOLOGIST JAMES COOK UNIVERSITY HOSPITAL MIDDLESBROUGH.
Myocardial Ischaemia National Audit Project Are we replacing good fibrinolytic treatment with poor primary PCI? John Birkhead who has NO CONFLICT OF INTEREST.
Advanced Angioplasty 2005 Primary PCI making it happen Data collection and Timings Peter Ludman University Hospital Birmingham.
Heart Attack Centres: Every Network Should Have (at least) One Dr Rod Stables The Liverpool Heart and Chest Hospital.
Our STEMI Program Leesa Wright, RN, CCCC, CCRN
AA 2008 Session III: STEMI The UK data Mark de Belder The James Cook University Hospital Middlesbrough.
A MODEL FOR CO-OPERATION - some inconvenient truths Mark Signy Worthing and Brighton.
Lysis and Beyond: ESC Guidelines and Reality J N Townend Queen Elizabeth Hospital Birmingham.
West Hertfordshire Primary Angioplasty Service Masood Khan.
The Health Roundtable Saving heart muscle by reducing delays to getting patients to the overnight regional catheter lab Presenter: Debby Hailstone Middlemore.
Presenter Disclosure Information Kevin Daniel, RN, CEN Clinical Data Supervisor Northside Hospital System Metro Atlanta Mission Lifeline Quality & Data.
Acute Coronary Syndromes in West Hertfordshire Masood Khan.
The Leeds Teaching Hospitals NHS Trust PHARMACOLOGY IN ACS OVERVIEW OF THE DATA : PRACTICAL ADVICE JIM McLENACHAN, LEEDS. 25 th January, 2007.
Dr Martyn Thomas Kings College Hospital Primary angioplasty “A UK Experience” “The UK experience”
ANNA PRICE CHD PROJECT MANAGER BEDFORDSHIRE & HERTFORDSHIRE LOCALITIES EAST OF ENGLAND AMBULANCE SERVICE.
RACE: Reperfusion of acute myocardial infarction in North Carolina emergency departments Christopher Granger, MD Director, Cardiac Care Unit Duke University.
Acute Myocardial Infarction February 8, 2006.
11 Kansas Heart & Stroke Collaborative September 22 and 23, 2014.
Women reaching equality in health, despite the differences Nowadays women remain the largest CAD population subgroup being under-diagnosed and under-treated.
Mel Pickup, Chief Executive Warrington & Halton Hospitals NHS FT Andy Davies, Accountable Officer Warrington Clinical Commissioning Group Achieving the.
Overview of the Winnipeg CODE STEMI Project Implemented May 2008 Dr.J.Tam MD, FRCP(C), FACC Section Chief Cardiology WRHA and University of Manitoba Lillian.
Challenges in Pre Hospital Diagnosis & Management of Acute MI
Telemedicine To Expedite Patient’s Transfer: The Introduction of the Videophone Lowell Satler, MD Washington Hospital Center.
Urban and rural implementation of prehospital STEMI diagnosis
Challenging Case Presentations From South Texas Methodist Hospital
What Have We Learned From the Mission: Lifeline Registry?
Optimising STEMi Care- Role of Nurses and Paramedics
Eva Kline-Rogers RN, NP, AACC University of Michigan
Singapore’s Experience in Primary PCI in the Last Ten Years
Heart Failure Prevention: Mission Impossible?
Primary PCI Monitoring Performance
Primary PCI Monitoring Performance
Circulation 2001;104: Circulation 2001;104:
Mid and South West Wales Primary Angioplasty update
Presentation transcript:

NO CONFLICT OF INTEREST TO DECLARE J.M. McLENACHAN, LEEDS

PRIMARY PCI FOR STEMI Is a 24 / 7 service sustainable? Jim McLenachan, Leeds 26 th January, 2006

PRIMARY PCI SERVICE AT LEEDS HOW IT WORKS u Commenced 7/3/05 u 24 / 7 service (after much discussion) u Initial phase covering Leeds only (population 800,000) u Plan to roll out to rest of West Yorks over 2 years (total population 3.1 million) u Interventionist on-call 1 in 6 u 2 full-time PPCI nurses and 1 PPCI support officer u Referrals via cath lab scheduler 8 – 4 Mon to Fri and via SpR out of hours

PRIMARY PCI SERVICE AT LEEDS TARGETS u DOOR TO BALLOON TIME < 120 MINUTES u CALL TO BALLOON TIME < 90 MINUTES u DOOR TO REFERRAL TIME < 20 MINUTES u HOSPITAL DISCHARGE AT 3 DAYS (achieved in 75%)

TOTAL NUMBERS OF PPCI PATIENTS (data for first 10 months) TOTAL NUMBER OF PATIENTS 203 MEDIAN NUMBER OF PATIENTS PER MONTH 20 MEAN NUMBER OF PATIENTS PER MONTH 18

MEDIAN DOOR TO BALLOON TIMES MINUTES

HOSPITAL MORTALITY MORTALITY % 7/3/05 – 12/1/067/9/04 – 6/3/0528/4/03 – 28/10/03 6.2% 9.1% 9.9%

PPCI AT LEEDS DAY OF THE WEEK AND TIME OF THE DAY (first 137 patients) 63%16%21%

EXPECTED ANNUAL NO. OF PPCI PATIENTS (population of 3.1 million) 8 am – 8 pm pm - midnight 90 midnight – 8 am 190

EXTERNAL CHALLENGES u Convincing healthcare commissioners u De-skilling of A and E staff u De-skilling of CCU staff in non-PCI centres u Uncertainty / anxiety among thrombolysis nurses u Ambulance issues : pre-hospital thrombolysis longer transfer times “displaced” ambulances

INTERNAL CHALLENGES u WORKING TIME FOR CATH LAB STAFF: finish before midnight - normal hours next day finish after midnight- 11 hours off u WORKING TIME FOR CONSULTANTS: SPA session on morning after on-call

ESC GUIDELINES FOR STEMI 2005 PCI STEMITHROMBOLYSIS

ESC GUIDELINES FOR STEMI 2005 Consider thrombolysis PCI Contra-indication to thrombolysis or shock ECG resolution thrombolyse No ECG resolution STEMI < 3 hours since onset 3-12 hours since onset salvage PCI within 24 hours

IS A 24 / 7 PCI SERVICE SUSTAINABLE? Yes, but………… u Simple guidelines and routes of communication needed u Requires flexibility u ??Easier in a large centre where the frequency of on- call is less but the expectation of being called out-of- hours is higher