1. Nurse Co-ordinated Rapid Access Chest Pain Clinic
The Belfast City Hospital Experience
Str Helen Greene
Clinical Nurse Specialist

2. Coronary heart disease is the most common cause of death in the UK, with around one in five men and one in seven women dying from the disease.
It is also the most common cause of premature death (<75yrs), accounting for 19% of men and 10% of women.
Allender. S et al Coronary heart disease statistics. British Heart Foundation, London
Although these statistics sound startling we are actually making inroads here in NI. Through initiatives like obesity management and smoking cessation. In addition we are catching patients earlier through services like the RACPC.

3. Guidelines
The Rapid Access Chest Pain Clinic was initially set up as a response to the National Service Framework guidelines for Coronary Heart Disease (2000). As a means of improving the patients experience.
Prior to RACPC patients would have been referred to A&E or to OPD.
Patients to be seen within 2 weeks.

4. ► The RACPC was first opened in 2002
► The RACPC was first opened in ► To date Approximately 9000 patients have been seen. ► Average 1000 patients per year.
These are patients who are being diverted from A&E and OPD which are already over stretched

5. Patients are referred from GPs.
► Presenting with symptoms suggestive of coronary artery disease (CAD) ♦ No previous history of CAD ♦ Previous history of CAD with worsening symptoms.

6. The patient experience:
►Blood samples ►Clinical history ►Physical examination ►ECG, BP ►Exercise stress testing (EST) ►Results and management plan (inc meds)
Patient arrives and is met by the nurse specialist who performs a full examination which includes:

7. EST outcomes
Positive EST discussed with consultant on call and booked for coronary angiography or dye test.
Therefore reducing the waiting time for this at risk group.

8. Coronary Angiography Outcomes
PCI : Stent insertion
CABG : Coronary artery bypass grafting
Med Mx: Medical management
NCA: Normal coronary arteries

9. Satisfaction surveys:
GP and Patient satisfaction surveys every 2 years. GP’s - 100% very satisfied with the service. Patients – 100% very satisfied.

10. Conclusion:
Key word is Rapid ►Rapid appointment allocation ►Patient results on the day ►Rapid referral for further investigation (therefore reducing waiting times) ►Commencement of medication by nurse prescriber ►GP results within 24 hours

11. Questions?