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Reducing transfer times for coronary angiography in patients with acute coronary syndromes: one solution to a national problem

Reducing transfer times for coronary angiography in patients with acute coronary syndromes: one solution to a national problem
Reducing transfer times for coronary angiography in patients with acute coronary syndromes: one solution to a national problem
Background: Patients with acute coronary syndrome (ACS) are at high risk of further cardiac events and benefit from early intervention, as reflected by international guidelines recommending early transfer to interventional centres. The current average waiting time of up to 21 days contravenes evidence based early intervention, creates geographical inequity of access, wastes bed days, and is unsatisfactory for patients.
Methods: A regional transfer unit (RTU) was created to expatriate access of ACS patients referred from other centres to the revascularisation service. By redesigning the care pathway patients arriving on the RTU undergo angiography within 24 hours, and then leave the RTU the following day, allowing other ACS patients to be treated.
Results: During the first six months of the RTU, the mean waiting time from referral to procedure decreased from 20 (SD 15) days (range 0-51) to 8 (SD 3) days (range 0-21) for 365 patients transferred from a district general hospital. Ninety seven per cent of patients underwent angiography within 24 hours, 61% having undergone percutaneous coronary intervention at the same sitting, and 78% were discharged home within 24 hours.
Conclusions: Delivering standards laid out in the National Service Framework, reducing inequalities of care across the region, and facilitating evidence based strategies of care represents a challenging and complex issue. For high risk patients suffering ACS who need early invasive investigation, a coordinated network wide approach together with the creation of an RTU resulted in a 62% reduction in waiting times for no extra resources. Further improvements can be expected through increased capacity of this verified strategy
radiography, prognosis, female, risk, middle aged, patient transfer, time, percutaneous coronary, therapy, great britain, angioplasty, hospitals, waiting lists, referral and consultation, humans, methods, coronary artery bypass, standards, time factors, syndrome, coronary angiography, coronary disease, district, male, transluminal, statistics & numerical data, prospective studies, no, length of stay
0032-5473
411-413
Bellenger, N.G.
9a739760-3daf-41b3-95a5-d2e417b5b827
Wells, T.
011e2299-dad8-4563-8a93-b0100fda105a
Hitchcock, R.
27fa934f-7eb6-4ffb-a80d-0c6bbd7fcc5f
Watkins, M.
ffaedc23-772b-4c65-983a-4c7d169e48cb
Duffet, C.
ab9a90d7-99f9-4f65-b383-7f94de4b7995
Jewell, D.
af3ce58b-4d5c-465d-8e78-be10c060d7c7
Palliser, D.L.
fb0faeb3-60a0-4619-a004-2da7e04b1f0e
Shapland, L.
715edb26-d7ba-4cc8-bb61-64696be5a739
Curtis, R.
481b253e-09ea-4055-805f-108a0e255bb2
Scrase, S.
90e4e982-2b11-412b-a155-4596ab867540
Burns, R.
00e35224-48b6-44d7-a037-93e5a86d9a39
Curzen, N.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Bellenger, N.G.
9a739760-3daf-41b3-95a5-d2e417b5b827
Wells, T.
011e2299-dad8-4563-8a93-b0100fda105a
Hitchcock, R.
27fa934f-7eb6-4ffb-a80d-0c6bbd7fcc5f
Watkins, M.
ffaedc23-772b-4c65-983a-4c7d169e48cb
Duffet, C.
ab9a90d7-99f9-4f65-b383-7f94de4b7995
Jewell, D.
af3ce58b-4d5c-465d-8e78-be10c060d7c7
Palliser, D.L.
fb0faeb3-60a0-4619-a004-2da7e04b1f0e
Shapland, L.
715edb26-d7ba-4cc8-bb61-64696be5a739
Curtis, R.
481b253e-09ea-4055-805f-108a0e255bb2
Scrase, S.
90e4e982-2b11-412b-a155-4596ab867540
Burns, R.
00e35224-48b6-44d7-a037-93e5a86d9a39
Curzen, N.
70f3ea49-51b1-418f-8e56-8210aef1abf4

Bellenger, N.G., Wells, T., Hitchcock, R., Watkins, M., Duffet, C., Jewell, D., Palliser, D.L., Shapland, L., Curtis, R., Scrase, S., Burns, R. and Curzen, N. (2006) Reducing transfer times for coronary angiography in patients with acute coronary syndromes: one solution to a national problem. Postgraduate Medical Journal, 82 (968), 411-413. (doi:10.1136/pgmj.2005.040162).

Record type: Article

Abstract

Background: Patients with acute coronary syndrome (ACS) are at high risk of further cardiac events and benefit from early intervention, as reflected by international guidelines recommending early transfer to interventional centres. The current average waiting time of up to 21 days contravenes evidence based early intervention, creates geographical inequity of access, wastes bed days, and is unsatisfactory for patients.
Methods: A regional transfer unit (RTU) was created to expatriate access of ACS patients referred from other centres to the revascularisation service. By redesigning the care pathway patients arriving on the RTU undergo angiography within 24 hours, and then leave the RTU the following day, allowing other ACS patients to be treated.
Results: During the first six months of the RTU, the mean waiting time from referral to procedure decreased from 20 (SD 15) days (range 0-51) to 8 (SD 3) days (range 0-21) for 365 patients transferred from a district general hospital. Ninety seven per cent of patients underwent angiography within 24 hours, 61% having undergone percutaneous coronary intervention at the same sitting, and 78% were discharged home within 24 hours.
Conclusions: Delivering standards laid out in the National Service Framework, reducing inequalities of care across the region, and facilitating evidence based strategies of care represents a challenging and complex issue. For high risk patients suffering ACS who need early invasive investigation, a coordinated network wide approach together with the creation of an RTU resulted in a 62% reduction in waiting times for no extra resources. Further improvements can be expected through increased capacity of this verified strategy

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More information

Published date: June 2006
Keywords: radiography, prognosis, female, risk, middle aged, patient transfer, time, percutaneous coronary, therapy, great britain, angioplasty, hospitals, waiting lists, referral and consultation, humans, methods, coronary artery bypass, standards, time factors, syndrome, coronary angiography, coronary disease, district, male, transluminal, statistics & numerical data, prospective studies, no, length of stay

Identifiers

Local EPrints ID: 60909
URI: http://eprints.soton.ac.uk/id/eprint/60909
ISSN: 0032-5473
PURE UUID: 6e202305-62cf-4cb2-925a-9d588f15f969

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Date deposited: 23 Sep 2008
Last modified: 13 Mar 2019 20:29

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Contributors

Author: N.G. Bellenger
Author: T. Wells
Author: R. Hitchcock
Author: M. Watkins
Author: C. Duffet
Author: D. Jewell
Author: D.L. Palliser
Author: L. Shapland
Author: R. Curtis
Author: S. Scrase
Author: R. Burns
Author: N. Curzen

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