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DGH v Tertiary Intervention – Is there really a conflict ?

DGH v Tertiary Intervention – Is there really a conflict ?. Steven Lindsay Bradford Teaching Hospitals NHS Trust. Conflict of Interest I am a “DGH” interventionalist. Bradford. History lesson. Cardiology in Bradford in 1999. 1000 bedded DGH 400,000 population

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DGH v Tertiary Intervention – Is there really a conflict ?

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  1. DGH v Tertiary Intervention – Is there really a conflict? Steven LindsayBradford Teaching Hospitals NHS Trust

  2. Conflict of Interest I am a “DGH” interventionalist

  3. Bradford

  4. History lesson

  5. Cardiology in Bradford in 1999 • 1000 bedded DGH • 400,000 population • 2 cardiologists -non interventional • 2 diagnostic angio sessions in multipurpose lab

  6. Revascularisation in Bradford HA PCTs in 2001

  7. How to get from here……

  8. to here How to get from here…… 1708 1708 1708

  9. Cardiac Labs in West Yorkshire 1999 • 9 DGH labs – most multi purpose • All PCI in Leeds (3 cardiac labs open) • 4 Tertiary Centre Interventionalists • 7 DGH visitors

  10. Cardiology in Bradford in 2000 • 1000 bedded DGH • 400,000 population • 3 cardiologists -1 interventional • 2 diagnostic angio sessions in multipurpose lab • 1 diagnostic session in Airedale • 1 PCI session in tertiary centre

  11. Cardiology in Bradford in 2001 • 1000 bedded Teaching Hospital • 400,000 population • 3 cardiologists -1 interventional • 2 diagnostic angio sessions in multipurpose lab • 1 diagnostic session in Airedale • 1 PCI session in tertiary centre • 9 month waiting list for PCI

  12. Cardiology in Bradford in 2002 • 1000 bedded Teaching Hospital • 400,000 population • 3 cardiologists -1 interventional • 1 Associate Specialist • Dedicated cardiac lab • 2nd Interventional post approved • 2 PCI session in tertiary centre

  13. PCI in West Yorkshire 2002 • 2002/2003 total PCI activity in Leeds 1691 cases • NSF targets of 750 pmp by 2004/2005= 2380 cases • Airedale PCI activity corrected for SMR is 1157 pmp (equivalent to 5000 PCIs p.a. across the WYNCC). • But where is the extra capacity?

  14. Bradford • NSF targets = 370 cases pa for the 3 Bradford PCTs. • The Bradford “patch” is sufficiently large to support a stand-alone PCI service and more than satisfy the BCIS requirements for a minimum of 200 cases p.a. and individual operator caseloads of at least 75 cases p.a. • 3 vacant lab sessions are available for PCI. • 3 cases per session and working year of 40 weeks = 360 cases p.a. • Retain one session for “high risk” cases and adjunctive technologies (IVUS, rotablator, presssure wire) • Release one session in Leeds -a further 120 cases can be carried out. • Network capacity increased by 480 cases

  15. What we actually did • Jan 05 started with 1 acute session in Bradford • April 2005 1 elective session in Bradford • All Bradford PCI sessions in am • Not a 24/7 service • Out of Hours cover from Leeds (never utilised) • May 2006 Bradford Interventionalists occupy 1 slot on W York's PPCI rota in Leeds

  16. Bradford Interventional activity 2005-2007 • 453 at LGI Jan 05 to Jan 07 • 349 at BRI Jan 05 to Jan 07 • 2 operators • 3 lists/wk at BRI • Ad hoc acute activity during working week • 2 lists/wk (1 all day list) at LGI

  17. BRI PCI Starts

  18. Thankyou • West Yorkshire Network • Jim McLenachan and Stacey Hunter LTHT • Chris Durkin BTHT • John Kurian BTHT

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