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The Cardiothoracic Centre Liverpool

The Cardiothoracic Centre Liverpool. Dr Raphael Perry Clinical Director. Advanced Angioplasty 2007. No conflict of Interest to Declare. Liverpool/Merseyside. Capital of Kulcha 2008 Two Liver Birds Two Cathedrals Two great football teams Everton Everton reserves

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The Cardiothoracic Centre Liverpool

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  1. The Cardiothoracic Centre Liverpool Dr Raphael Perry Clinical Director

  2. Advanced Angioplasty 2007 • No conflict of Interest to Declare

  3. Liverpool/Merseyside • Capital of Kulcha 2008 • Two Liver Birds • Two Cathedrals • Two great football teams • Everton • Everton reserves • One Tertiary Cardiac Centre

  4. Models of PCI Service Delivery • Trend is for devolution • Plan for lots of smaller local centres • People think it’s better to have local services • May have to defend central model • You cannot be serious!

  5. Centralism Rules OK • Most services are determined by local history and geography • What is good about it • What is bad about it

  6. Cheshire & Mersey Cardiac Network • Catchment population of around 2.8 million • High SMR • Traditionally underprovided • Includes The Welsh CTC

  7. Traditional Cardiac Unit-Gradual Erosion of Capability Local secondary care demand Service reduction due to local pressures Managers being stupid Bed loss due to emergency GIM

  8. CTC Model

  9. Plus Points • 100% regional resource dedicated to meeting the needs of the network • Network Lead is secondary care cardiologist • Local Cardiology Advisory Board • Flexibility of Response • Potential for expansion • Changing Clinical Indications • Economies of Scale • Needs include • Waiting Times • Transfer Times

  10. Quality, Quality, Quality • High Volume Operators in High Volume Centre • Interactive learning/discussion • Seven operators performing 2,400 PCIs (c.350/operator) • National Average 145 • 24/7 multi operator presence • Named risk adjusted MACE in public domain • Robust Data • Rapid regular feedback

  11. Risk Adjusted MACE*2003-2005 CTC 0.9% * MACE includes in-hospital mortality, Q-wave MI, emergency CABG, and CVA

  12. More Plus Points • ACS Transfer times • Median < one day • Waiting Times Elective PCI • 4-6 weeks • All technology available • Rapid integration of new technology • Research Coordination • North West QIP Transoesophageal rotablator?

  13. Minus Points • No onsite interaction with GIM • No general ITU • No A & E • Different model for primary PCI • Can be seen as Elitist • (I actually think this is a plus point)

  14. Past and Future • 1988 • One cath lab CTC – four cardiologists • One DGH Cardiologist • 2007 • Six cath labs CTC – 11 cardiologists • Six labs in DGHs – 35 cardiologists • Local PCI service • Developing with North Wales “I’m just glad I’m not a Turkey”

  15. Concluding thoughts: • This system works well • Champagne for everyone • If it isn't broken don’t fix it • 99% of Cardiologists would have their PCI in a tertiary centre • The other 1% misheard the question • What would you design if starting over? • If they were the same price would you buy a Rolls Royce or a Mondeo? • Would you ever buy a Skoda?

  16. Concluding thoughts • If you remember nothing else about Liverpool, don’t forget • There are two football teams • And one tertiary cardiac centre manned by talented Dinosaurs! • And they’re not for turning!

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