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Cath lab efficiency; The Liverpool model. Karen Wafer Cath lab and Holly Suite Senior Manager

ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

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Page 1: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Cath lab efficiency;The Liverpool model.

Karen Wafer

Cath lab and Holly Suite

Senior Manager

Page 2: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Conflict of interest

• I have no conflicts of interest to declare

Page 3: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

The Liverpool journey……

• Amsterdam 2008: OLVG

Page 4: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

The starting point 2008/09

• Day ward dayroom was turned into a ‘lounge’

for 5 patients undergoing radial procedures as a

trial. This cost just £3000 and took 6 weeks.

• Radial patients remained in their own clothes

• They were allowed to drink freely up until the

time of the procedure, mobilise as they wanted

to, had an internet station to access as required

and papers and magazines to read.

Page 5: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

The traditional day ward patient

Page 6: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

The lounge pilot scheme

Page 7: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Holly suite

• From 20 beds and a 5 patient lounge to:

• Whole business lounge concept for 25 patients

with only 6 trolleys

• True radial lounge section has 15 chairs, the

atrium (lounge suit patients) has 10.

Page 8: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Holly suite radial lounge

Page 9: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

The beverage bay

Page 10: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

The massage area

Page 11: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

The internet station

Page 12: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Additional requirements

• ‘Status at a glance’ board to replace patient

names on a whiteboard

• Interactive scheduling system

• Use of the lounge suit

• Increased integration with cath lab

• Cohesive vision from the Division

Page 13: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Interactive scheduling

Page 14: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Scheduling

Page 15: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Status at a Glance

Page 16: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Weekly schedule of procedures

0

5

10

15

20

25

Mon Tue Wed Thur Fri

Cor EP Pacing Bronch TOE DCCV Prov RALC BT Dental CT

Page 17: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Admission process

• All elective PCI undergo pre-assessment by

CNP in OPD

• Staggered admission to Holly: 8am (morning

list) and 11am (afternoon list)

• No PCI patient is fasted: Beverage bay access

• Access for families also

• Own clothes. Provided with a locker for phones

etc pre lab. Buzzer for family.

Page 18: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Admission process

• Clear allocation of staff to lists

• Discharge planning on walk to the chair

• POCT for rapid INR result

• Team focus on preparation of patients and

communication to the lab

• Holly suite attendance at cath lab operational

meeting

Page 19: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Admission process

• Patient liaison clerk pre call to reduce DNA

• ANP based on Holly suite for clerking and triage

of ACS

• SHO based on Holly for support, TTO,

electronic discharge summary

Page 20: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Process to lab

• Admit on status

• Update LSS

• Communicate with lab co-ordinator through LSS

notes

• Prepare patient based upon detail on

LSS…..next into lab

• Forward wait, efficient lab turnaround

• Direct return to Holly, no ‘recovery’ period

Page 21: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Clinical observations: PCI Protocol

• Baseline on admission

• Post procedure baseline on return

• Re-check in 2 hours

• Re-check pre discharge

• TR band: leave all air for 1 hour then remove

2mls every 20 mins, leave for 1 hour once

• 4 hours to procedure to discharge

Page 22: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

What we DON’T do

• Post procedure ECG

• Cardiac monitoring

• Keep patients NBM

• Separate by gender

Page 23: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

What we focus on

• A relaxed patient experience in a relaxed non

NHS type environment in own clothes

• We encourage family involvement / support

• We encourage patient interaction / support

• We encourage independence and mobility

• Patient engagement, patient stories, patient

shadows to improve practice

Page 24: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Further developments in Holly Suite

• 1 x scope room

• 1 x treatment room

• TOE

• DCCV

• Provocation testing

• GA Bronchoscopy and EBUS

• LinQ devices physiologist led

Page 25: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Key to our progress

• Divisional control

• Expansion of services for patient and family

experience benefits

• Ownership of services through Holly

• Cath lab collaboration

Page 26: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

Coming soon

• RFID tagging for patients

• Care cube (Integration of our digital systems)

• Increased research……..nurse led

• Divisional involvement in cath lab operational

meeting

• Improve divisional patient flow

• Divisional rotation for recruitment

Page 27: ECO10 - Innovation, efficiency, dignity: the Liverpool Heart & Chest model

THANK YOU.

QUESTIONS?