GUEST BLOG: How we achieve timely DTB for STEMI patients in the Belfast Health and Social Care Trust (BHSCT)
To provide consistent DTB < 90 minutes for all STEMI patients within the catchment area of the BHSCT.
Since 2009 when the pPCI service was piloted in the BHSCT, the focus has been to ensure all patients receive timely treatment when presenting with STEMI. The subsequent roll out of the regional pPCI service increased demand and the challenge of ensuring equitable, high quality care for patients in Northern Ireland including minimising DTB times in the pPCI centre.
Several steps have been taken to allow the BHSCT to achieve timely DTB for STEMI patients.
- A concise, clear, universal regional pathway has been developed for all pPCI referrals.
- The number of Cath labs available for pPCI was increased with a minimum of 2 operators available.
- A close working relationship has been developed between the cardiology wards across three acute sites and the Cath lab staff in BHSCT to ensure timely patient flow and bed management.
- Through the Repatriation policy developed by the BHSCT with the other regional cardiology units and the Northern Ireland Ambulance Service (NIAS), there is a smooth flow of patients through the system.
- There is daily scrutiny of performance times to troubleshoot and minimise “bottlenecks”.
- BHSCT has established a protocol for an on-call team and a dedicated phone to receive pPCI referrals.
- The commitment of the multidisciplinary team (MDT) in the BHSCT to provide the service has ensured a consistent DTB of < 90 minutes.
With the steps taken by the BHSCT we are now able to ensure that each patient goes directly to the Cath lab on arrival. By engaging with all the members of the MDT, the Cath lab is mobilised quickly to receive the patient once a referral has been accepted. Due to the close association between the three cardiology departments in the BHSCT, the stakeholder trusts and NIAS, we can manage the flow of patients through the service enabling timely treatment for all STEMI patients. This ensures that the DTB is within the national benchmark guidelines.
“From the time I sought help until I had my test seemed to go very quickly. There was very little delay. The whole process seemed to run smoothly. Everyone I met was helpful and professional. I’m so relieved that it’s all behind me. I feel lucky that there is an excellent service like this here.”
John, 29, Inferior STEMI patient at BHSCT.
The pPCI service in the BHSCT has been running for 9 years. Its success is due to one important aspect collective TEAM WORK. Without shared decision making and effective team work the service would not run as smoothly as it does. With so many components to a complex service, having a team that can work so closely together allows the BHSCT to achieve timely DTB for STEMI patients.
This case study was submitted by Aine Hynes (MINAP Nurse) and Mary McGeough (pPCI Coordinator), BHSCT