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Setting up a STEMI PCI Programme in the UK:
Implications for the cath lab workforce
Setting up a STEMI PCI Programme in the UK:
Implications for the cath lab workforce
Rob HendersonTrent Cardiac Centre
Nottingham
Chair, BCS Working Group onNon-Medical Cath Lab Staffing
Rob HendersonTrent Cardiac Centre
Nottingham
Chair, BCS Working Group onNon-Medical Cath Lab Staffing
NO CONFLICT OF INTEREST TO DECLARE
Estimating the need for Primary PCI Europe and UK
Estimating the need for Primary PCI Europe and UK
0
200
400
600
800
Krako
w
Denm
ark
Czech
Bohem
ia
Wes
t Mids
Yorks
hire
Lond
on
Prim
ary
PC
I p
mp
0
200
400
600
800
Krako
w
Denm
ark
Czech
Bohem
ia
Wes
t Mids
Yorks
hire
Lond
on
Prim
ary
PC
I p
mp
UK population 60 million, at 500 pmp = 30,000 PPCI per annumUK population 60 million, at 500 pmp = 30,000 PPCI per annum
2004 data: Ludman 2004 data: Ludman
92780
1438
30000
62780
0
20000
40000
60000
80000
100000
2004 Future
All PCI
Primary PCI
92780
1438
30000
62780
0
20000
40000
60000
80000
100000
2004 Future
All PCI
Primary PCI
2.3 %2.3 %
2004 data: Ludman 2004 data: Ludman
32 %32 %
1050 pmp1050 pmp 1546 pmp1546 pmp
UK Growth needed for primary PCI (assuming no increase in other types of PCI)
UK Growth needed for primary PCI (assuming no increase in other types of PCI)
Consultant Cardiac Workforce requirements in the UK
Consultant Cardiac Workforce requirements in the UK
To provide To provide 15001500
PCI pmpPCI pmp
To provide To provide 2200-3000 2200-3000 PCI pmpPCI pmp
To provide To provide cardiology cardiology
serviceservice
Consultants pmpConsultants pmp 3.2*3.2* 4.8-8.8*4.8-8.8* 52.7-84.252.7-84.2
Consultants for UKConsultants for UK 196*196* 288-528*288-528* 3162-50523162-5052
David Hackett, BCS Working Group 2005
*Assumes consultants dedicated to PCI; assumes UK population 60 million424 consultants did PCI in 2004 (BCIS) – but majority not dedicated to PCI
710 cardiologists (663 wte) in 2004 (DOH)630 cardiologists in 2003 (RCP)
Non-Medical Cardiac Workforce requirements in the UK
Non-Medical Cardiac Workforce requirements in the UK
To provide To provide 15001500
PCI pmpPCI pmp
To provide To provide 2200-3000 2200-3000 PCI pmpPCI pmp
To provide To provide invasive invasive
cardiology cardiology serviceservice
To provide To provide cardiology cardiology
serviceservice
Non-medical Non-medical clinicians pmpclinicians pmp 7.5*7.5* 11-15*11-15* 50.4-61.050.4-61.0 168-211?168-211?
Non-medical Non-medical clinicians for UKclinicians for UK 450*450* 660-900*660-900* 3024-36603024-3660 10080-12660?10080-12660?
David Hackett, BCS Working Group 2005
*Assumes Nurses, Physiologists, Radiographers dedicated to PCI workAssumes UK population 60 millionInformation about available staff very limited
Available non-medical clinical staff?Available non-medical clinical staff?
RegisteredRegistered Working?Working? Working in Working in cardiology?cardiology?
Working in Working in cath labs?cath labs?
Nursing*Nursing*
(March 2005)(March 2005)
672 897 672 897 registered registered with NMCwith NMC
623 846 623 846 adult general adult general
nursingnursing?? ??
Cardiac Cardiac Physiology**Physiology** ~3500~3500
~1800-2000 ~1800-2000 SCST SCST
membersmembers
~2000-~2000-35003500 ??
Radiography***Radiography***23 39723 397
registeredregistered with HPCwith HPC
16 329 16 329 SOR members SOR members
in NHSin NHS
190190
(1.2%)(1.2%)??
*Nursing & Midwifery Council website – includes staff working overseas **Jackie Howard, Catriona MacGregor – excludes cardiographers*** Audrey Patterson – 1563 SOR members work outside NHS
Estimated UK catheter laboratory vacancies
Estimated UK catheter laboratory vacancies
NursingNursing PhysiologyPhysiology RadiographyRadiography
14 labs14 labs 22 1313 3.53.5
Vacancies Vacancies per labper lab 0.140.14 0.930.93 0.250.25
Extrapolated Extrapolated to 160 labs*to 160 labs* 2222 149149 4040
Preliminary data – includes diagnostic and PCI labsBCS Non-medical Cath Lab Staffing Working Group survey 2005*BCIS 2004
Catheter laboratory workTraditional roles in the UKCatheter laboratory workTraditional roles in the UK
Cardiologist and traineeDo procedure
Cardiologist and traineeDo procedure
Nurses (1-2)Puts patient on table
Draws up drugsOpens equipment
Nurses (1-2)Puts patient on table
Draws up drugsOpens equipmentPhysiologist (1-2)
Sets up & monitors pressure line & ECG
Physiologist (1-2)Sets up & monitors
pressure line & ECG
Radiographer (1)Turns on machine and
controls C arm
Radiographer (1)Turns on machine and
controls C arm
(Perfusionist – IABP)
Catheter laboratory staffing for PCI in the UK
Catheter laboratory staffing for PCI in the UK
4.0 3.84.6
1 1
11 1
1
Any PCI PPCI in hours PPCI out of hours
SpR
Consultant
Non-medical
4.0 3.84.6
1 1
11 1
1
Any PCI PPCI in hours PPCI out of hours
SpR
Consultant
Non-medical
BCS Non-medical Cath Lab staffing Working Group survey 2005Preliminary data from 6 PCI centres
6.0 5.86.6
Catheter laboratory staffing for PCICatheter laboratory staffing for PCI
UK UKNumber PCINumber PCI 12001200 600600 40004000 430430 29002900 900900
CardiologistCardiologist 11 11 11 11 11 11
Trainee/SpRTrainee/SpR 11 00 11 00 11 11
NursingNursing 11 22 22 22 22 22
PhysiologyPhysiology 11 22 11 00 11 22
RadiographyRadiography 00 00 00 00 11 11
TotalTotal 4*4* 55 55 3**3** 66 77
*and a cleaner **and a porter
Catheter laboratory staffing for PCICatheter laboratory staffing for PCI
111111111111CardiologistCardiologist
3**3**
00
00
22
00
430430
66
11
11
22
11
29002900
UK
7755554*4*TotalTotal
11000000RadiographyRadiography
22112211PhysiologyPhysiology
22222211NursingNursing
11110011Trainee/SpRTrainee/SpR
9009004000400060060012001200Number PCINumber PCI
UK
*and a cleaner **and a porter
Catheter Laboratory Multi-skilling
Catheter Laboratory Multi-skilling
• Cardiac Cath Lab practitioner project
– London South Bank University
• Middlesbrough generic worker training
– In house programme
• Nottingham nurse radiography training
– In house programme
• Need national coordination and funding
• Cardiac Cath Lab practitioner project
– London South Bank University
• Middlesbrough generic worker training
– In house programme
• Nottingham nurse radiography training
– In house programme
• Need national coordination and funding
ConclusionsConclusions
• A national primary PCI service will need additional medical and non-medical staff capacity - but there are currently significant staff shortages
• More trainees and multi-skilling will help but may not solve the problem entirely
• If primary PCI is to be rolled out across the UK we need multidisciplinary, flexible, and innovative solutions to medical & non-medical workforce problems
• There is an urgent need for robust information about non-medical catheter laboratory staffing to facilitate future planning
• A national primary PCI service will need additional medical and non-medical staff capacity - but there are currently significant staff shortages
• More trainees and multi-skilling will help but may not solve the problem entirely
• If primary PCI is to be rolled out across the UK we need multidisciplinary, flexible, and innovative solutions to medical & non-medical workforce problems
• There is an urgent need for robust information about non-medical catheter laboratory staffing to facilitate future planning
BCS non-medical catheter laboratory staffing survey 2006
BCS non-medical catheter laboratory staffing survey 2006
All cath lab managers
….please, Please, PLEASE……
complete the survey formand return to BCS
All cath lab managers
….please, Please, PLEASE……
complete the survey formand return to BCS
Physiology staff vacanciesSCST survey November 2003
Physiology staff vacanciesSCST survey November 2003
1812
3020
320
533
6241040
0
1000
2000
3000
4000
Trained staff Support staff Trained staff Support staff
Post vacant
Post filled
1812
3020
320
533
6241040
0
1000
2000
3000
4000
Trained staff Support staff Trained staff Support staff
Post vacant
Post filled
60% response Extrapolated to 100%
15%
8%
2005 London survey estimated physiology vacancy rate at 23% (79 wte)
Catheter Laboratory Multi-skilling
Catheter Laboratory Multi-skilling
• Multiple projects across UK
• Often driven by local need
• Cost of training and release from work
• Need transferable qualification
• Multiple projects across UK
• Often driven by local need
• Cost of training and release from work
• Need transferable qualification
National guidelines and staffingNational guidelines and staffing
• BCIS/BCS recommendations 2005
– ‘….dedicated multidisciplinary team…’
– ‘….multi-skilling should be encouraged…’
– No statement on appropriate staffing levels
• ESC PCI guideline 2005
– No statement on staffing
• ACC/AHA PCI guideline 2005 & STEMI guideline 2004
– No statement on staffing
• BCIS/BCS recommendations 2005
– ‘….dedicated multidisciplinary team…’
– ‘….multi-skilling should be encouraged…’
– No statement on appropriate staffing levels
• ESC PCI guideline 2005
– No statement on staffing
• ACC/AHA PCI guideline 2005 & STEMI guideline 2004
– No statement on staffing
Estimating the need for Primary PCIEstimating the need for Primary PCI
58 NHS PCI units 58 NHS PCI units (2004)(2004)
STEMI in STEMI in EnglandEngland
(MINAP)(MINAP)
All MI in UKAll MI in UK
(Dawkins)(Dawkins)
3700037000 137000137000
3052530525
(75% PCI)(75% PCI)
3425034250
(25% PCI)(25% PCI)
PCI / unit / dayPCI / unit / day 1.41.4 1.61.6
Modified from David Hackett, BCS Working Group 2003
Primary PCI in the UK 2004-2005Primary PCI in the UK 2004-2005
1628
7
13
0
10
20
30
40
50
2004 2005
24h 7day service
Working hours
1628
7
13
0
10
20
30
40
50
2004 2005
24h 7day service
Working hours
2004 data: Ludman
In 2004 51 centres did 3447 PCI for STEMI (1438 PPCI)Data from 55 of 58 NHS centres
In 2004 51 centres did 3447 PCI for STEMI (1438 PPCI)Data from 55 of 58 NHS centres
Number of centres doing routine primary PCI
Catheter laboratory staff trainingCatheter laboratory staff training
StaffStaff RegistrationRegistration TrainingTraining
NursingNursing NMCNMC 3 yr degree course 3 yr degree course &1-2 yr experience&1-2 yr experience
PhysiologyPhysiology HPCHPC(from 2005)(from 2005)
4 yr degree course4 yr degree course
RadiographyRadiography HPCHPC 3 yr degree course 3 yr degree course & 1-2 yr experience& 1-2 yr experience
HPC - Health Professions council
NMC - Nursing & Midwifery Council
