Susan Convery, Business Support Assistant, NESCN

Transcription

1 Meeting: Heart Disease Clinical Advisory Group Business Meeting Date: 23 March 2016 Time: :30 Venue: Evolve Business Centre, Sunderland Present: Louise Smyth Network Delivery Lead - NESCN Alison Featherstone CVD Manager - NESCN Dave Richley Cardiac Physiologist NESCN Douglas Muir Clinical Lead NESCN John Bourke Clinical Lead NESCN/NUTH Joanne Ashton Principal Cardiac Physiologist CDDFT Sam McClure Clinical Lead Consultant Cardiologist CHS Nicholas Child Cardiologist North Tees Peter Dixon Senior Service Specialist NHS England Abdul Nasser Consultant Cardiologist South Tees Admin: Apologies: Susan Convery, Business Support Assistant, NESCN Dan Higham Northumbria HCT Nigel Rowell South Tees Jackie Tough South Tees Ian Purcell NUTH Andrew Sutton Vineet Wadehra - NTH MINUTES 1. INTRODUCTION Lead Enclosure 1.1 Welcome and Apologies The Chair welcomed the group and introductions were made. 1.2 Declaration of Interest There were no declarations of interest. 1.3 Minutes of the previous meeting (25/11/15) Enc 1 Have been ratified already. 1.4 Matters arising No matters arising. 2. AGENDA ITEMS DR /7 working update CP Services Summary Table Cardiology OOH Summary Cardiology OOH Presentation Enc 2 1

2 Dave Richley gave a presentation to the group a copy is attached with these minutes. The groups discussed the report and also what other staff groups are needed to provide 24/7 cardiology. The group agreed to look at BCS recommendations. The group noted there is a network physiology event planned for 4 th April 2.2 PPCI clinical incident reporting systems PPCI numbers The group discussed how to capture data on patients with STEMI who are turned-down by either PPCI centre and end up in the wrong place. What system(s) is currently in place and is there inconsistency in data collection across the region? The group agreed that to take this forward SMcC will send what data he has on PPCI pathway failures to JPB to try to audit why patients were not accepted on the basis of the data available at the time. If a PPCI pathway problem is confirmed, a wider exercise will be needed to capture the experiences of other hospitals. The group discussed how to capture the data should a patient be triaged inappropriately from a PPCI centre. Comments from the group included: Unclear whether this is happening and at what frequency Unclear how incidents are being captured The use of the DATIX system not all areas are using this but alternative systems are in place where DATIX not being used Whether feedback was received and whether it was useful. How often is feedback received in each area? How do we capture reliable data? We need some systematic way of collecting data. We need to sort something out rather than going around in circles All calls around PPCI are logged but auditing the entire cohort would be impossible due to volume. There is a need to identify contentious cases from receiving units to form a basis for further assessment If you are unable to see the ECGs then you are relying on a verbal description of the ECG which will be less reliable It was agreed that the network team would DR DR SMcC/JB 2

3 try to capture details of any cases of pathway failure. It was further agreed that the network team and clinical leads would be the appropriate neutral source of opinion on any cases when differing opinions on management existed Action: to contact Trust leads to be asked for information 2.3 Telemetry AF The new supplier has been agreed by NEAS plans are being put in place for roll out. NEAS has agreed a new supplier of defibs with telemetry capability. Timescales for implementation and restoration of telemetry has been reported by Paul Fell to be summer NOAC Cards Evaluation There will be an evaluation of NOAC cards which will be supported by industry. The group discussed some points that any evaluation may wish to take note of. Example of one patient holding a card who had not been prescribed a NOAC 2.5 Cardiac MRI Scans NC NC gave a short presentation on the picture across the Network for CMR scans. The group discussed a number of matters including: - Future demand and projected capacity - Current quality of service. - Anticipated need for the NE (excluding Cumbria) would be 6000 scans per year and currently Current capacity is around 3000 scans in next year (excluding N Cumbria) - The service has a large radiology component. - The major bar to expansion is the lack of trained cardiologists / radiologists in cardiac MRI. The group discussed other potential models for delivery. - Waiting times for scans has been an issue across the region recently due to scanner down time. - The group agreed that it is unacceptable that units close to regional referrals or prioritise local patients over those living in other areas of the NECVN. - It was felt that Commissioning should discuss access issues with existing providers to ensure that all patients in all localities should have CRM access. Even if this increases waiting times, this would be preferable to some patients having no 3

4 access at all 2.6 Network Update AF Review of NHS improvement architecture on going on for last 2 years (Smith review).significant budgetary cuts to networks (36%) on top of last year s 27% and reprioritisation around national networks. AF discussed the SCN national priorities. The group expressed their dismay at the lack of focus on CVD in general. The group were keen to maintain some element of a Heart Disease work stream. AF explained that the next step was to define whether and what aspects of the NECVN work-streams could continue to be supported. The Educational CAG meeting planned for 29June will go ahead and Prof Huon Gray NCD for Heart Disease will be present. AF would welcome any suggestions/thoughts on how to maintain some of the network clinical engagement. ALL Discussion the group was unanimous in the view that the loss of the NECVN would hamper innovation and make it more difficult to ensure a uniform standard of care across the Network hospitals Action: A good portion of the June CAG is to be devoted to the discussion of this meetings future 2.7 Visbion JB/ Enc 3 A query about the system was raised by CDDFT. has looked at current use of visbion across the network (attached) It is recommended that scans follow patients from centre to centre in future (e.g. echo images for inpatient transfers) Trust leads should ensure this happens as a routine for each site rather than by request. Lack of transmitted images risks incorrect clinical decisions and/ or unnecessary repetition of tests 2.8 NSTEACS pathway DM This is identified as a national priority for heart Disease. A small working group is needed to review NICE guidance and formalise this pathway. C&M Network have a pathway which can be used as a basis The group needs to be comprised of a mix of PCI cardiologists and DGH representatives. Action: to Trust leads to see who would like to be involved in this working party. 3. STANDING ITEMS 4

5 3.1 Sub Groups Update CRM Atrial fibrillation pathway has been circulated for endorsement. This has been agreed by CRM. Chair recommended that these be signed off by the group if no dissent by 13 April 2016 NECVN Cardiac Implantable Electronic Device Report - DRAFT This report has been compiled by Chris Plummer, chair of the CRM group. The report is intended to be helpful to implanting sites as a record of workload and to help with future planning. The data presented reflects the NICOR data set but is ready to present earlier in the year than the NICOR report. The data has been approved by each member of the CRM team who submitted the figures and the report is being reviewed by the CAG Business members for sign off before the document is put onto the Network webpage. Following discussion it was commented that the complication data could be open to misinterpretation. Is there a way of having a 3 year cycle amalgamated together this would help interpret data on complications which will randomly fluctuate around a baseline Action: to send the report out to Trust leads for comment and ask for reply by 13 April Enc 4 ICD/CRT Referral Proforma NESCN Guidance of Referral for ICD/CRT These two documents have been designed and agreed by the CRM and HF group to aid the referral of patients from DGH to implanting centre as part of the HF event recommendations Action: to circulate to Trust leads for comment and for reply by 13 April 2016 Heart Failure 5

6 NESCN NT-Pro BNP Cut offs updated the group with the latest information and the document released prior to this meeting was reviewed. The HF group continue to support the North of Tyne guideline for CHF with age related cut offs Discussion: There may be implications for these guidelines in light of the new heart failure drugs which are coming onto the market. Primary Care Cardiac Rehabilitation AHPs Breakout Session No time for updates on last 3 areas. 3.2 Any other business There were no matters raised. 3.3 Next meeting 29 June Education Event and Business Meeting 21 September TBC 2 November TBC 4. MEETING CLOSE 6