JISCMail - ACAD-AE-MED Archives

I have just been appointed a National Clinical Leader to CHD Collaborative (part of the Modernisation Agency and similar to the Cancer Collaboratives). I am keen for more A&E people to be aware of the work and be involved- some of you are already I know.

The CHD Collaborative has been in existence for 18 months and I have just come back from its 5th National meeting which marked the end of Phase 1 and the beginning of the national roll out - another 20 programmes in addition to the existing 10. It is likely there will be a Collaborative near you!

The Collaborative goal is ' to improve the experience and outcomes for patients with suspected or diagnosed CHD by optimising the care delivery systems across the whole integrated pathway of cardiac care'. The standards come from the NSF for CHD. Each programme has had 6 projects- AMI, Revasc, heart failure, secondary prevention, Rehab and stable angina. The programme uses a methodology of small trials of change leading to big changes and sustainable improvement- PDSA cycles for those of you who know the jargon- with a big focus on streamlining care delivery and reducing delays and uncertainty. Each team has had to report on a series of measures monthly to chart progress.

I was involved in one of the Collaboratives (East London) right from the beginning - the bidding process! I have been the Clinical Lead on the AMI project locally. All the Collaborative projects have shown improvements in the delivery of clinical care as shown by a variety of measures including pain to needle time and its components, the prescription of beta blokers, post MI test provision, patient satisfaction and discharge information reaching primary care. Nearly all have exceeded the NSF standard of> 75% of patients thrombolysed in under 30 minutes. I have no doubt that there are examples of excellent practice in non Collaborative sites which would be good to know about. However the RCP database MINAP which currently 200/219 hospitals have signed up to, shows that the national median door to needle time is 35 minutes. There is therefore still some way to go and next years target is 20 minutes!

There are relatively few A&E doctors involved in any of the existing Collaboratives - with the exception of Gillian Park, Mr Brayley and Dr Nash. I was very pleased to see Phil Moss and Rik Pullinger at the meeting today!! I have worked hard to keep A&E in peoples minds as an important area of Emergency Medicine expertise and activity. I have stated very publicly that I believe providing treatment for a patient with an Acute Coronary syndrome is one of the core services A&E provides the public. (Confession- The audience included Lord MacDonald aka 'The Cabinet Enforcer' - Special advisor on Health and separately Yvette Cooper Minister for Health).

There are lots of A&E departments thrombolysing successfully, some have started relatively recently such as Northwick Park. There it has been a huge achievement and Median Door to Needle times have been consistently under 30 minutes. However I have been asked about A&E departments where there is strong apparently unmoveable resistance to giving thrombolysis, departments where medics/cardiologist have to pronounce before thrombolysis is prescribed and arrangement made to bypass A&E because of mistrust.

I hope that if you encounter an AMI Collaborative team you get involved. I have found the experience rewarding and the methodology transferable to other improvement initiatives. For more info on the Collaborative there is a good web site-