Dear all (in England so apologies to the rest and
for this being a long message!!!)
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-
As a National Clinical Lead I am very happy to talk
to anyone who wants to speak to me- e mail or contact my sec on 0208 510
7124
Dr Katherine Henderson
Consultant in Accident and Emergency
Medicine
Homerton Hospital
London
E9 6SR