GUEST BLOG: How we achieve timely Door To Balloon for STEMI patients in the Belfast Health and Social Care Trust (BHSCT)
Challenge – ensuring equity, maintaining quality
Since 2009 when the primary PCI service was piloted in the BHSCT, our focus has been on ensuring that all patients presenting with STEMI receive timely medical and interventional treatments. The subsequent ‘roll out’ of primary PCI at BHSCT as a regional service was associated with increased demand from a larger catchment population. Our challenge was to ensure equitable, high quality, care for all patients, regardless of their location in Northern Ireland or their proximity to the tertiary centre, ensuring that the greater throughput of patients did not come at the cost of a poorer service. We set ourselves the target of providing primary PCI within 90 minutes of arrival at hospital – a Door-to-Balloon (DTB) time of <90 mins – for all patients within the catchment area of the BHSCT.
As part of an overall Quality Improvement strategy we have implemented a number of steps to achieve such timely DTB for STEMI patients. These include changes in facilities, patterns of working and quality assurance, as follows:
- A concise, clear, universal regional pathway has been developed for all referrals to the primary PCI service.
- The number of Cardiac Catheter laboratories (‘Cath Labs’) available for primary PCI has 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 efficient 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.
- We perform daily scrutiny of performance times to troubleshoot and minimise “bottlenecks”.
- BHSCT has an established protocol for the on-call team and a dedicated phone line to receive primary PCI referrals.
- The multidisciplinary team (MDT) in the BHSCT has been given responsibility for providing, and monitoring, the service so as to ensure a consistent DTB of < 90 minutes.
As a result we are now able to ensure that each patient with STEMI 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 collaborative relationships that exists 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 primary PCI 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 (Primary PCI Coordinator), BHSCT