Myocardial Ischaemia National Audit Project - University College ...

MINAP data is essential to inform service improvement work.Broadly speaking we have three potential sources of delay:Ambulance availability (with a paramedic crew)Assessment and referral at A&E departmentsAccess to catheter labs at the HACWe strive to maintain data that are as current as possible. Wecollaborated with NWAS to ensure our IT systems integrate.As well as call-to-balloon times we monitor every step ofthe patient’s journey. In addition, the co-ordinators act onindividual cases when necessary. The Network also producesaggregated and individual hospital reports on different aspectsof the pathway.Direct referral by the ambulance service will always prove tobe the better option to ensure patients are treated in a timelymanner. Whenever a patient is picked up by NWAS but takento a local A&E rather than the nearest HAC, the primary PCIco-ordinators and NWAS clinical governance team investigatethe reasons why. There are many valid reasons for this, butif it was a missed opportunity for immediate transfer to theHAC then the details are fed back to the crew involved and theAdvanced Paramedic team to assist with training.DIDO?A&E departments have played an invaluable role in heartattack management, especially over the last 25 years, andin our view A&E departments will continue to be a crucialelement of our heart attack service. However, as the servicehas matured, more and more patients are being directlyreferred by the ambulance service to the HACs. As a result,District General Hospital A&E departments are seeing lessand less heart attack patients. Many of them no longerhave the chest pain specialist nurses available from thethrombolysis era. MINAP data shows that only about half ofthe patients that are admitted to a local A&E en route to theHAC achieve the call-to-balloon target of 150 minutes. Closerscrutiny of the data at the A&E shows that many patientshave long Door-In-Door-Out (DIDO) times, averaging about 60minutes for straightforward cases.To help improve this, the primary PCI co-ordinators arerunning educational road shows – highlighting the details ofthe pathway and presenting each A&E’s clinical audit resultsfor their DIDO times.Looking to 2012-13, the Network is also looking at introducinga local quality indicator to measure: the DIDO times forstraight forward cases. Harking back to the days whenpatients were treated with thrombolysis within 30 minutes, wehope patients will be in and out of the A&E within 30 minutes(Figure 24). Another goal is to invite A&E staff to visit catheterlabs as part of their training to see the end results of theirgood work in keeping DIDO times as low as possible.Figure 24. Call to balloon times and breakdown ofjourney stepsAverage time1801501209060300DirectCall to 1st doorTransferCall to balloonDoor-in-door-outHAC Door to balloonNational limitIndirect90 MINAP How the NHS cares for patients with heart attack