Myocardial Ischaemia National Audit Project - University College ...

Part Three: Case Studies1. Call activation system for primary PCIsMichelle Holt - Senior Sister, CCU SandwellSandwell West Birmingham Hospitals NHS TrustWhen primary PCI first became continuously available – a 24hour service, 7 days a week (24/7) – once an ‘alert call’ wasreceived from A&E, staff on the Cardiac Care Unit (CCU) hadto contact each member of the on-call PCI team individuallyto call them to the cardiac catheter (angiography) laboratory.This was often time-consuming and sometimes frustrating,particularly when occasionally the call was not answeredimmediately and voicemail-messaging services needed tobe activated. This would cause small but significant delaysto a service that was intended to provide rapid intervention.Consequently we developed our current PCI activation system.This simply requires the CCU staff to click on the appropriatecomputer icon, which is available on all CCU computers. Onentering a code and activating the call all on-call staff receivea simultaneous mobile telephone alert, informing them allthat there is a patient requiring primary PCI. Each member ofthe on-call team then enter a response code. This confirms toCCU that they have received and accepted the call, are on theirway, and records an estimated time of arrival. This system hasproved to be easy to use and much more convenient for allconcerned. Delays to catheter lab access have reduced.Staff at CCU2. Streamlining MINAP data collectionAmelia Hilton - Clinical Audit Co-ordinator (Pathology,Imaging and Medicine)Sandwell West Birmingham Hospitals NHS TrustWe have participated in MINAP from its inception. By so doingwe believe that we have been forced to look critically at ourpractice to ensure we meet nationally agreed targets andoptimise the outcomes for our patients.Over the years, we have changed not only the way we manageheart attack but also our approach to collecting data. Wewould like to share our ‘best practice’, with the MINAPcommunity, of a data collection process that takes minimaltime, while remaining highly accurate; inaccurate data isn’tworth collecting.Our A&E, CCU, Catheter laboratory and Clinical Effectiveness(audit) department, work together to get the best out ofMINAP. Cases are identified mainly via CCU, as the majorityof patients with chest pain are admitted to this ward (unlessthey require ITU admission, e.g. out of hospital cardiacarrest). Because the CCU staff start a MINAP form duringthe admission process, all the information available whilstthe patient is on the ward. They also photocopy relevantparts from case notes (i.e. ambulance sheet, ‘Casualtycard’, ECGs, patient ward admission form, Catheter labprocedure report) and attach these to the MINAP form.Dedicated “MINAP champions”, on each hospital site (mainlysenior staff nurses, ward managers and selected cardiologyconsultants) help check forms. We ensure all cases werecorrectly identified for the month and a form for each eligiblepatient is completed. We examine the BCIS database (i.e.a list of all non-elective PCI cases). The forms then cometo the Clinical Effectiveness department where the ClinicalAudit Co-ordinator for Medicine assesses each for accuracy,using the copied information from notes, CDA (clinical dataarchive) electronic patient records (i.e. GP details, patientdemographics, test results, ward activity, discharge summaryand any referrals for surgery), Ambulance data downloadsand BCIS database. It may sound extensive, but, having allthree databases open simultaneously allows a quick scanthrough the form and electronic data to ensure all fields werecompleted correctly. It only takes me about 5mins. Our trusthas around 60-70 MINAP eligible cases per month. With thisprocess I’m able to verify data quality and input data ontoNICOR via Lotus notes within one week. We hold a MINAPmeeting each month to discuss any queries and to learn fromany cases with a delay in reperfusion time. Minutes of thismeeting are circulated to all cardiology staff.MINAP Eleventh Public Report 201283