DGH v Tertiary Intervention – Is there really a conflict ?

transcript

DGH v Tertiary Intervention – Is there really a conflict?

Steven Lindsay

Bradford Teaching Hospitals NHS Trust

Conflict of Interest

I am a “DGH” interventionalist

Bradford

History lesson

Cardiology in Bradford in 1999 1000 bedded DGH 400,000 population 2 cardiologists -non interventional 2 diagnostic angio sessions in

multipurpose lab

Revasc/million

6781030116Airedale

197347147S + W

25039192North

170361147City

CABG/million

million

(1,000)

NSF recommendation (per million) Angio 3200, PTCA 750 CABG 750

Revascularisation in Bradford HA PCTs in 2001

Revasc/million

6781030116Airedale

197347147S + W

25039192North

170361147City

CABG/million

million

(1,000)

Revasc/million

6781030116Airedale

197347147S + W

25039192North

170361147City

CABG/million

million

(1,000)

How to get from here……

Revasc/million

6781030116Airedale

197347147S + W

25039192North

170361147City

CABG/million

million

(1,000)

How to get from here……

to here

Cardiac Labs in West Yorkshire 1999

9 DGH labs – most multi purpose All PCI in Leeds (3 cardiac labs

open) 4 Tertiary Centre Interventionalists 7 DGH visitors

Cardiology in Bradford in 2000 1000 bedded DGH 400,000 population 3 cardiologists -1 interventional 2 diagnostic angio sessions in

multipurpose lab 1 diagnostic session in Airedale 1 PCI session in tertiary centre

Cardiology in Bradford in 2001 1000 bedded Teaching Hospital 400,000 population 3 cardiologists -1 interventional 2 diagnostic angio sessions in multipurpose

lab 1 diagnostic session in Airedale 1 PCI session in tertiary centre 9 month waiting list for PCI

Cardiology in Bradford in 2002 1000 bedded Teaching Hospital 400,000 population 3 cardiologists -1 interventional 1 Associate Specialist Dedicated cardiac lab 2nd Interventional post approved 2 PCI session in tertiary centre

PCI rates in Bradford and Leeds 2002-2006

Airedale

S&W Bradford

2002-3 2003-4 2004-5 2005-6 2006-7

Airedale

BradfordCityNorthBradfordS&WBradfordE Leeds

NE Leeds

NWLeedsS Leeds

W Leeds

Airedale

S&W Bradford

2002-3 2003-4 2004-5 2005-6 2006-7

Airedale

NE Leeds

NWLeedsS Leeds

W Leeds

2002/2003 total PCI activity in Leeds 1691 cases

NSF targets of 750 pmp by 2004/2005= 2380 cases

Airedale PCI activity corrected for SMR is 1157 pmp (equivalent to 5000 PCIs p.a. across the WYNCC).

But where is the extra capacity?

PCI in West Yorkshire 2002

Bradford NSF targets = 370 cases pa for the 3 Bradford PCTs. The Bradford “patch” is sufficiently large to support a stand-

alone PCI service and more than satisfy the BCIS requirements for a minimum of 200 cases p.a. and individual operator caseloads of at least 75 cases p.a.

3 vacant lab sessions are available for PCI. 3 cases per session and working year of 40 weeks = 360 cases

p.a. Retain one session for “high risk” cases and adjunctive

technologies (IVUS, rotablator, presssure wire) Release one session in Leeds -a further 120 cases can be

carried out. Network capacity increased by 480 cases

What we actually did

Jan 05 started with 1 acute session in Bradford April 2005 1 elective session in Bradford All Bradford PCI sessions in am Not a 24/7 service Out of Hours cover from Leeds (never utilised) May 2006 Bradford Interventionalists occupy 1

slot on W York's PPCI rota in Leeds

Bradford Interventional activity 2005-2007 453 at LGI Jan 05 to Jan 07 349 at BRI Jan 05 to Jan 07

2 operators 3 lists/wk at BRI Ad hoc acute activity during working

week 2 lists/wk (1 all day list) at LGI

Airedale

Bradford City

North Bradford

S&W Bradford

W Leeds

2002-3 2003-4 2004-5 2005-6 2006-7

Airedale

NE Leeds

NWLeedsS Leeds

W Leeds

BRI PCI Starts

Thankyou

West Yorkshire Network

Jim McLenachan and Stacey Hunter LTHT

Chris Durkin BTHT

John Kurian BTHT

DGH v Tertiary Intervention – Is there really a conflict ?

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