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Published on: January 18, 2018
Reducing transfer times for coronary angiography in patients with acute coronary syndromes: one solution to a
N G Bellenger1, T Wells, R Hitchcock
1Wessex Cardiac Unit, Southampton University Hospitals NHS Trust, Southampton SO16 6YD, UK. nickbellenger@doctors.org.uk
Insights
A new regional transfer unit (RTU) significantly reduced waiting times for acute coronary syndrome (ACS) patients needing revascularisation. This coordinated approach improved access to timely cardiac intervention, benefiting high-risk patients.
Area of Science:
- Cardiology
- Healthcare Management
Background:
- Acute coronary syndrome (ACS) patients require prompt intervention.
- Current transfer delays contravene guidelines and impact patient care.
- Geographical inequities exist in accessing timely cardiac revascularisation.
Purpose of the Study:
- To assess the impact of a regional transfer unit (RTU) on ACS patient care pathways.
- To reduce waiting times for revascularisation in ACS patients.
- To improve access to timely cardiac interventions.
Main Methods:
- Established a regional transfer unit (RTU) for ACS patients.
- Redesigned the care pathway for efficient patient flow.
- Patients undergo angiography within 24 hours of arrival at the RTU.
Main Results:
- Mean waiting time reduced from 20 to 8 days.
- 97% of patients had angiography within 24 hours.
- 61% received percutaneous coronary intervention (PCI) during the same procedure.
Conclusions:
- A coordinated network approach with an RTU significantly cut waiting times for ACS patients.
- This strategy achieved a 62% reduction in waiting times without additional resources.
- The RTU model facilitates evidence-based care and reduces healthcare inequalities.
Background:
Patients with acute coronary syndrome (ACS) are at high risk of further cardiac events and benefit from early intervention, as reflected by international guidelines recommending early transfer to interventional centres. The current average waiting time of up to 21 days contravenes evidence based early intervention, creates geographical inequity of access, wastes bed days, and is unsatisfactory for patients.
Methods:
A regional transfer unit (RTU) was created to expatriate access of ACS patients referred from other centres to the revascularisation service. By redesigning the care pathway patients arriving on the RTU undergo angiography within 24 hours, and then leave the RTU the following day, allowing other ACS patients to be treated.
Results:
During the first six months of the RTU, the mean waiting time from referral to procedure decreased from 20 (SD 15) days (range 0-51) to 8 (SD 3) days (range 0-21) for 365 patients transferred from a district general hospital. Ninety seven per cent of patients underwent angiography within 24 hours, 61% having undergone percutaneous coronary intervention at the same sitting, and 78% were discharged home within 24 hours.
Conclusions:
Delivering standards laid out in the National Service Framework, reducing inequalities of care across the region, and facilitating evidence based strategies of care represents a challenging and complex issue. For high risk patients suffering ACS who need early invasive investigation, a coordinated network wide approach together with the creation of an RTU resulted in a 62% reduction in waiting times for no extra resources. Further improvements can be expected through increased capacity of this verified strategy.
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