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

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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
A guide to commissioning cardiac surgical services Improving interhospital transfers • Electronic referral systems. • Standardised referral method • Central management of referral • Minimum dataset • Image transfer.(Angiogram) • PACS • Medcon • This can improve communication for referring centres and help manage: • Numbers waiting • Waiting times • Disruption • Identification of anticipated waits for procedure • Referral pack for patients awaiting transfer: • Physical/psychological preparation • Discharge requirements • Video • Agreed pathway for high-risk patients • Network-wide policy agreed. Includes emergency transfers/balloon pump transfers • Standardised documentation between units Agree local escalation policy to manage waiting times Information Making the referral system work Interhospital Transfers: Making Connections Fit for procedure? Transfer co-ordinator Assess patient needs and match to transfer type Communication with Ambulance Service • Single point of contact • Robust communication links • Ownership of the problem • List scheduling • Ensure treatment according to clinical priority • Provide timely and accurate information • Ambulance crew type • Paramedic crew • Technician crew • Intermediate crew • Transfer crew • PTS crew • Skill-mix appropriate to patient needs. • Escort required. • Type of vehicle • Dedicated transfer code agreed with Ambulance service • Time ready agreed with Ambulance service • Emergency or Urgent? Blue light – 8 mins/ or longer. • Agreeing pre-transfer patient work-up to ensure patient is fit for procedure. This should include guidance on: • MRSA • Dental screening • Medication • Anticoagulation • Tests • Documentation www.improvement.nhs.uk/heart 31
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