REDESIGN OF THE
Coventry and Warwickshire Coventry and Warwickshire
Cardiovascular Network Cardiovascular Network
Referral to cardiologist
Clinic visit with ECHO – diagnosis confirmed
Discussion with patient – decision to cardiovert
Added to waiting list
INR’s managed / monitored in the community
Patient referred to Day Procedures Unit
Attends pre-admission anaesthetic assessment clinic
Admitted to D.P.U. as day case
Cardioversion under G.A.
Sp R performs procedure – G.A – Senior Anaesthetist
Lists held monthly
WHAT PROMPTED THE REDESIGN?
Consultant cardiologists at UHCW looking at service delivery
– with a view to performing cardioversion under conscious
Admit patient to cardiology ward as day case – nursed
by staff with cardiac expertise.
Perform procedure in the Cardiac Catheter Suite.
Reduce risk associated with general anaesthesia.
Prevent potential overnight stay.
Allow speedy access to cardiac consultant in
Support junior doctor training (SHO) - Deanery review
Supervision by consultant cardiologist.
Network approached to undertake a review of Service.
How did we do this?
Using a multidisciplinary team approach.
Meetings commenced June 2007 to identify
any issues of concern with existing
Baseline data gathering took place.
Process mapping completed.
What did we find?
Inconsistent administration of the waiting list – 86
patients waiting up to 12 months.
Patient suspensions high – 12 – not monitored
Ineffective liaison between waiting list / Day
Procedures Unit / patient.
Patients remained unfit due to inconsistencies – INR
monitoring a major issue.
Poor patient understanding of reason for procedure
and what it entailed.
Sessions underutilised / cancelled in DPU – not
enough patients ready for procedure.
DCCV to be performed in Cardiac Catheter Suite under
Clinic visit – no change.
Cardioversion discussed fully – agreement of patient – signs specific cardioversion
New information booklet given.
Patient on waiting list.
Waiting list given to UHCW Anticoagulation Dept who manage / monitor all INR’s.
Closer liaison between waiting list manager / patient / anticoagulation Dept.
Patient given agreed date for admission.
Patient visits UHCW 48 hrs before admission –
Orientation visit to ward.
Day case admission – home after recovery from sedation.
Weekly lists – increase capacity.
How do we develop a safe and effective service?
Establish and maintain communication pathways.
Ensure efficient waiting list management.
Maintain appropriate INR management / monitoring system.
Provide comprehensive, easily understood patient information
Ensure informed consent by patient discussion and specific
cardioversion consent form.
Provide training for all staff involved:
Administration / titration of sedation – airway
Post sedation recovery.
DOCUMENTS PRODUCED TO
ASSIST THE REDESIGN
Patient information booklets.
Cardioversion consent form.
Integrated clinical pathway.
Junior doctor guideline for cardioversion procedure and
Nursing guidelines for :
Post sedation management.
Training package for airway management.
Staged approach to service redesign is in place to fit in with
existing work pressures / increased activity in Cardiac Catheter
INR and waiting list management – significant reduction in
Wait < 2 months for procedure (10 patients).
Staff training now complete – but has been a major issue.
Increased capacity - cardioversion sessions.
Full service commences 23 May 2008.
Audit of patient satisfaction to be undertaken after 6 months.
Thank you to all staff involved.