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Single cardiology service for Liverpool

Analyzing the need for a single cardiology service in Liverpool, with focus on clinical groups, benefits realization, workforce challenges, and next steps for implementation.

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Single cardiology service for Liverpool

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  1. Single cardiology service for Liverpool Glenn N Russell FRCA Clinical advisor LCCG Amanda Brookes Programme Manager LCCG Clinical cardiology Summit held by Liverpool CCG 18 Months ago confirming agreement to forming a single pan –Liverpool service Sign up to Vanguard agreement by CEOs of LHCH, Aintree and RLBUHT

  2. Case for change –cvd outcomes in liverpool Between 2008/09 and 2012/13 Liverpool’s heart failure prevalence increased by 1.21%; this compares to a 2.91% reduction nationally Rightcare –Excess cost compared with peer group £7-9 million

  3. single cardiology service for LiverpoolClinically led.. 1.Chest Pain –Fiona Lemmens/Glenn Russell ACS Undifferentiated chest pain 2.Syncope/pacing- Mark hall 3.Breathlessness/Heart failure - Sima Douglas 4.Healthy imaging - Tim Fairburn 5.Rehabilitation - Joe Mills 6. Prevention – Scott Murray • Define standards for perfect service • Gap analysis current service • Potential benefits realisation-outcomes/finance/ patient experience/transportation

  4. Case for change • Enablers for quality cardiology service • Workforce • Medical – Recruitment problems in most cardiology • departments • Technical staff internal market • Estates • Cath labs • Scanners • Informatics • Up to 5 EPR solutions in the City • Mental Health Services • Impacts almost all elements of cardiovascular disease.

  5. Case for change clinical groups Chest pain ACS All acute cardiology Admissions except Primary PCI Royal Liverpool University Hospital A/E HEC Aintree University Hospital FT A/E HEC Cath labs but no PCI activity • 18,000 chest pain presentations • Ventilated post VF arrest • Cardiogenic shock 2 Cardiology HEC Multiple transfers of sick patients across City Delays in care Liverpool Heart and Chest FT Primary PCI centre Direct ambulance admissions and Transfers from A/Es

  6. Case for change Chest pain What doesn’t work well… • Time to PCI for Non ST elevation ACS : 45% in <72 hours • Care for comatose survivors of Cardiac Arrest • Management of patients with Cardiogenic Shock • Multiple transfers of acutely ill patients between sites. • Lack of 24/7 Specialist cover at receiving site(s) • Lack of other specialist services at Cardiothoracic Centre • Duplicated and Fragmented Services • Inequity for patients

  7. Case for change Undifferentiated Chest pain • 16 -18 000 presentations across city • 0-3 hour triage pathway in RLH and Aintree agreed by December 2016 • Work progressing on 0-1 hour triage • Potential savings across Liverpool, South Sefton and Knowsley of aprox £1.5 million/year in admission avoidance

  8. Case for change Pacing/syncope Transient loss of conscious 2% all admissions. Misdiagnosis as epilepsy common North Mersey excess spend on epilepsy drugs £2.8 million from national models Dedicated TLOC clinics cost effective Temporary pacing Long in-patient delays and multiple complications . Capacity variable/complications common Primary pacing 24 hour target for insertion of permanent system

  9. Case for change HearT failure Very limited community support to keep patients well in community Access to end of life care poor Readmission rates high with expensive in-patient care. Good community model (BHF) would give 35% reduction in readmission and better patient experience

  10. Case for change Cardiac imaging Diagnostic images difficult to view across all three hospitals. Work towards a single server No joined up use of scanning capacity leading to variable access across the City. Work towards common waiting lists Variable diagnostic pathways. Agreed sigle diagnostic pathways to meet new NICE guidelines on new onset chest pain.

  11. Case for change Cardiac rehabilitation Only 45% Liverpool patients access any form of cardiac rehab

  12. Case for change benefits realisation • Admission avoidance • Undifferentiated chest pain algorithm • Transient loss of consciousness clinic • Heart failure ambulatory and community clinics • Access to cardiac rehab and prevention services • Quality/Patient experience • NSTEMI treatment more timely with reduced LOS • Reduced morbidity/mortality bradypacing • Reduced duplication of imaging tests with immediate availability to clinicians • Cardiology expertise available 24/7 in acute phase. • Mental health support integral to cardiology care • Digital innovation • Single server – rationalisation of imaging capacity. • Advantages of common patient record.

  13. Next steps Case for change presented to CEOs and MDs of LHCH, Aintree and Royal Liverpool. SAO versus step change discussed Approval for the establishment of an operational Board to take proposals from clinical groups and deliver implementation plans. AMDs , Finance and Division cardiology managers from all three hospitals, with clinical and managerial support from LCCG 3. Alignment and support from Cardiology Strategic Transformation plan. Wider discussion with Alliance and Cheshire local delivery systems.

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