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NO CONFLICT OF INTEREST TO DECLARE

NO CONFLICT OF INTEREST TO DECLARE. J.M. McLENACHAN, LEEDS. PRIMARY PCI FOR STEMI Is a 24 / 7 service sustainable?. Jim McLenachan, Le eds. 26 th January, 2006. PRIMARY PCI SERVICE AT LEEDS HOW IT WORKS. Commenced 7/3/05 24 / 7 service (after much discussion)

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NO CONFLICT OF INTEREST TO DECLARE

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  1. NO CONFLICT OF INTEREST TO DECLARE J.M. McLENACHAN, LEEDS

  2. PRIMARY PCI FOR STEMIIs a 24 / 7 service sustainable? Jim McLenachan, Leeds 26th January, 2006

  3. PRIMARY PCI SERVICE AT LEEDSHOW IT WORKS • Commenced 7/3/05 • 24 / 7 service (after much discussion) • Initial phase covering Leeds only (population 800,000) • Plan to roll out to rest of West Yorks over 2 years (total population 3.1 million) • Interventionist on-call 1 in 6 • 2 full-time PPCI nurses and 1 PPCI support officer • Referrals via cath lab scheduler 8 – 4 Mon to Fri and via SpR out of hours

  4. PRIMARY PCI SERVICE AT LEEDSTARGETS • DOOR TO BALLOON TIME < 120 MINUTES • CALL TO BALLOON TIME < 90 MINUTES • DOOR TO REFERRAL TIME < 20 MINUTES • HOSPITAL DISCHARGE AT 3 DAYS (achieved in 75%)

  5. TOTAL NUMBERS OF PPCI PATIENTS(data for first 10 months)

  6. MEDIAN DOOR TO BALLOON TIMES MINUTES

  7. HOSPITAL MORTALITY 9.9% 9.1% MORTALITY % 6.2% 7/3/05 – 12/1/06 7/9/04 – 6/3/05 28/4/03 – 28/10/03

  8. PPCI AT LEEDSDAY OF THE WEEK AND TIME OF THE DAY(first 137 patients) 63% 16% 21%

  9. EXPECTED ANNUAL NO. OF PPCI PATIENTS(population of 3.1 million)

  10. EXTERNAL CHALLENGES • Convincing healthcare commissioners • De-skilling of A and E staff • De-skilling of CCU staff in non-PCI centres • Uncertainty / anxiety among thrombolysis nurses • Ambulance issues : pre-hospital thrombolysis longer transfer times “displaced” ambulances

  11. WORKING TIME FOR CATH LAB STAFF: finish before midnight - normal hours next day finish after midnight - 11 hours off WORKING TIME FOR CONSULTANTS: SPA session on morning after on-call INTERNAL CHALLENGES

  12. ESC GUIDELINES FOR STEMI2005 STEMI THROMBOLYSIS PCI

  13. ESC GUIDELINES FOR STEMI2005 < 3 hours since onset Consider thrombolysis thrombolyse STEMI 3-12 hours since onset No ECG resolution ECG resolution Contra-indication to thrombolysis or shock salvage PCI PCI within 24 hours PCI

  14. IS A 24 / 7 PCI SERVICE SUSTAINABLE?Yes, but………… • Simple guidelines and routes of communication needed • Requires flexibility • ??Easier in a large centre where the frequency of on-call is less but the expectation of being called out-of-hours is higher

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