A guide to commissioning cardiac surgical services - NHS ...

A guide to commissioning cardiac surgical services
In order to minimise delays for the
patient and to maximise efficiency
we recommend the following:
• Use of network-wide agreed clinical
protocols, to establish the need for
surgery and referral.
• Use of a risk stratification system to
determine priority for treatment.
• Use of existing electronic referral
systems to refer and transfer
patients for urgent cardiac surgery.
• Network standards for waiting
times.
Considerable work led by cardiac
networks in local health economies
undertaken across each part of the
patient journey to improve the
experience and outcomes for this
group of patients and staff; to reduce
the impact of avoidable bed days and
associated challenges for trusts and
ambulance services around accident
and emergency (A&E) waits and
achieving category ‘A’ targets has
been captured within Signposts to
Improving Cardiac Interhospital
Transfers (HIP 2007).
Escalation policies to help manage
waiting times across a local health
economy and to accelerate patient
flow have been developed by several
networks and are aimed at setting
locally agreed performance targets
which are monitored and if exceeded
allow for alternative arrangements to
be made to treat patients. The Essex
Cardiac and Stroke Network
summarise the benefits of developing
a network wide policy as providing:
• A framework to ensure that
numbers of patients waiting,
waiting times and disruption to
trusts is kept at a minimum.
• Reassurance for patients on
anticipated waits for their
procedure.
Delays in the patients journey can
occur if the patient is not fit for
surgery following their transfer. These
delays can be caused by a number of
reasons including absence of MRSA
and dental screening, or completion
and availability of pre operative
investigations and tests. These delays
can be addressed through joint
policies on issues such as MRSA
screening, anticoagulant treatment
and pre operative tests and
investigations. Clarity is needed about
which tests should be carried out
prior to transfer, where they should
be carried out and what
documentation should accompany
the patient on transfer (Making
Moves, Heart Improvement
Programme, 2006).
“
So far, improvements in the pathway and transfer arrangements have
saved the equivalent of some 959 NHS beds each year across England.
We know that there is a lot more that can be done to take this further
saving the NHS a great deal of money and patients a great deal of stress
”
and worry.
Professor Roger Boyle CBE, National Director for Heart Disease and Stroke
Signpost to Improving Cardiac Inter Hospital Transfers,
Heart Improvement Programme, (2007)
30 www.improvement.nhs.uk/heart