Primary PCI for STEMI How to negotiate changes in

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					  Primary PCI for STEMI:
How to negotiate changes in
         practice
        Jim McLenachan,
  National Clinical Lead for PPCI
  British Cardiovascular Society, 1st June 2009
Author:

Dr Huon Gray,
Consultant Cardiologist,
Southampton
Negotiate?
With whom should we negotiate?
 •   Commissioners
 •   Ambulance service
 •   Accident and Emergency Staff
 •   Interventionists
 •   Non-interventionists
 •   Cath lab staff
 •   DGHs
With whom should we negotiate?

• Commissioners
           - concerns about escalating costs
           - concerns largely unfounded
     - Leeds PCT acute MI spend
 reduced by £ 750,000 during first           year of
 PPCI
 With whom should we negotiate?

• Ambulance staff
     - generally very receptive               -
 comparisons with stroke care, major trauma   -
 paramedic / advanced EMT / EMT crews
With whom should we negotiate?

 •   Commissioners
 •   Ambulance service
 •   Accident and Emergency Staff
 •   Interventionists
 •   Non-interventionists
 •   Cath lab staff
 •   DGHs
With whom should we negotiate?
 •   Commissioners
 •   Ambulance service
 •   Accident and Emergency Staff
 •   Interventionists
 •   Non-interventionists
 •   Cath lab staff
 •   DGHs
  With whom should we negotiate?

• Interventionists
     - PA negotiations
     - Rest period after night on-call
     Possible cardiology rota
• PCI centre cardiologists do 1 in 8 weekdays
      (i.e. a fixed weekday night every 2   weeks).
• “Office” session the following morning.
• 1 in 6 weekends
      -       no CCU / ward responsibility
      -       cover Friday and Sunday only       -
      8am Sat – 8 am Sunday
      by DGH colleagues
With whom should we negotiate?
•   Commissioners
•   Ambulance service
•   Accident and Emergency Staff
•   Interventionists
•   Non-interventionists
•   Cath lab staff
•   DGHs
With whom should we negotiate?
•   Commissioners
•   Ambulance service
•   Accident and Emergency Staff
•   Interventionists
•   Non-interventionists
•   Cath lab staff
•   DGHs
  With whom should we negotiate?

• Cath lab staff
     - European Working Time Directive         -
 11 hours’ continuous rest in 24 hour period   -
 need to plan for staff being in overnight
With whom should we negotiate?
•   Commissioners
•   Ambulance service
•   Accident and Emergency Staff
•   Interventionists
•   Non-interventionists
•   Cath lab staff
•   DGHs
With whom should we negotiate?

• DGHs
         - ? early transfer
         - ? Tariff split
         - change in function of CCU
    Sustainability


= being prepared
           Sustainability
• Leave PPCI “slots”

• Plan for night work

• Plan for EWTD

• Plan for staff not being available in am
      Be upfront about knock-on effects:
• Under payment by results (PBR), poor care brings more
  income:
       - separate payment for MI
       - separate payment for angiogram (as OP)         -
  separate payment for late PCI

• PPCI may be a financial “hit” to PCI centre
       - no big increase in PCI numbers
       - tariff not affected by time of presentation    -
  increased staffing costs

• Ambulance commissioning                               -
  longer journeys
Stand 318,

BCS Exhibition
                    Summary
•   Network wide planning (at least)
•   Plan with ambulance service.
•   Plan with A and E (all of them)
•   Plan with CCU.
•   Plan for ICU.
•   Plan cath lab staff timetables.
•   Plan consultant timetables.
•   Plan for rehabilitation.
•   Plan the financial changes.