Papworth Practice. Best year ever for cardiac surgery at Papworth. Issue 6 Spring 2011 Issue 6 - Spring 2011

Transcription

1 Issue 6 Spring 2011 Issue 6 - Spring 2011 Papworth Practice in The newsletter for primary care from Papworth Hospital NHS Foundation Trust Best year ever for cardiac surgery at Papworth 1

2 Papworth in Practice We welcome your feedback on this publication. If you have any comments please contact: Papworth in Practice is provided free to primary care. No part of this publication should be reproduced without the written permission of Papworth Hospital. The publishers and printers cannot accept liability for any errors or omissions. Contacts... Papworth Hospital NHS Foundation Trust Papworth Everard Cambridge CB23 3RE General Enquiries Switchboard: Fax: Website: Papworth Direct Booking office: Fax: Website: Respiratory Support and Sleep Centre Booking office: or Fax: Website: Quick Access Chest Clinic Booking office: or Fax: Papworth Clinic at Papworth Hospital NHS Foundation Trust Enquiries: Wards Critical Care: Cardiac Day: Hemingford: Mallard Ward: Thoracic Day: Cystic Fibrosis: Baron: Duchess: Princess: Higginson: Varrier-Jones: Hugh Fleming: RSSC: Welcome Welcome to Papworth in Practice. In this edition you will read about progress on the planned relocation of Papworth Hospital to the Cambridge Biomedical Campus. You will also have the opportunity to read that - despite treating older and more complex patients than the national average - Papworth Hospital reports that survival after cardiac surgery in the last 15 months to November has been the best that the hospital has ever achieved. Also featured is an update on a range of research projects including the ASTER trial which may lead to changes in the way in which patients with lung cancer are diagnosed. Later this year we hope to hold an educational event for General Practitioners. We are keen to develop a format which suits your needs so if you have any ideas of what you might like to see included in the event, please get in touch with us. We look forward to working with you in Dr Sarah Clarke Consultant Cardiologist and Clinical Director Cardiac Services New Papworth Hospital In Summer 2010, Papworth Hospital s Board of Directors agreed to progress the project to relocate Papworth Hospital to the Cambridge Biomedical Campus to the next stage. Following an advert in the Official Journal of the European Union, an information event for potential private-sector bidders was attended by more than 120 delegates resulting in six private-sector consortia being asked to be considered as partners for the project. In November 2010 The Papworth Board approved the names of three shortlisted consortia as: Apex Health The Bouygues Consortium Skanska A detailed selection process will follow which involves input from clinical staff from across the hospital and which will lead to the signing of a contract between the Trust and the preferred bidder in late The construction phase is expected to be complete by late Stephen Bridge, Chief Executive, Papworth Hospital said: The co-location of Papworth Hospital with the other organisations on the Biomedical Campus will bring benefits to our patients as they will have immediate access to a range of services and also bring opportunities in terms of research and education on which the treatments of tomorrow will be based. 1 Stephen Bridge, Chief Executive

3 Issue 6 - Spring 2011 Best year ever for cardiac surgery at Papworth Hospital Patients choose to come to Papworth because, as an international centre of excellence, we are able to attract the best, most highly-skilled staff and deliver the very best results for our patients. Despite treating older and more complex patients than the national average, Papworth Hospital reports that survival after cardiac surgery in the last 12 months has been the best that the hospital has ever achieved. Papworth, Britain s largest specialist cardiothoracic hospital, performed more than 2,000 major heart operations last year. Surgeons at the hospital routinely review the survival of their patients after heart surgery. Every month, the results of the previous twelve months are examined. Survival is compared with the national results and assessed with regard to casemix (how old and sick the patients are). Survival for all operations, including complex, repeat, multiple and emergency operations, was 97.7% and survival for non-emergency operations was 98.3%. Papworth survival exceeded the most recent national figures for all of the following: Coronary bypass surgery Heart valve surgery Surgery on the aorta Combined valve and coronary surgery All other major heart surgery As a specialist centre, patients coming to Papworth for surgery are significantly older and have sicker hearts than the national average, so it is important to take this casemix into account whenever we look at survival results. When we do, the death rate from heart operations at Papworth was 71% lower than expected by a standard risk model (logistic EuroSCORE*). said Mr Sam Nashef, Consultant Cardiac Surgeon. Heart surgery in the UK is now so good that, as a whole, British hospitals have death rates which are consistently lower than the risk model predicts, but even taking this into account cardiac surgery mortality at Papworth last year was 42% lower than expected in comparison with the most recent British results. Mr Nashef added. Patients choose to come to Papworth because, as an international centre of excellence, we are able to attract the best, most highly skilled staff and deliver the very best results for our patients. said Mr Stephen Bridge, Chief Executive, Papworth Hospital. Mr Sam Nashef, Cardiac Surgeon * European System for Cardiac Operative Risk Evaluation 2

4 Papworth in Practice Dr Robert Rintoul, Consultant Chest Physician, performs a bronchoscopy New techniques to improve the diagnosis of lung cancer The way in which patients with lung cancer are diagnosed could change following the publication of important research carried out at Papworth Hospital. The results of the ASTER trial (Assessment of surgical staging versus endoscopic ultrasound in lung cancer: a randomised trial) were published recently in the Journal of the American Medical Association. Lung cancer is the most common cause of cancer death in the UK, killing 95 people every day. An important part of diagnosis is finding out how advanced the cancer is - a process called staging. Accurate staging of a cancer is important for deciding upon the best treatment. The ASTER trial compared two methods of staging to see which one was more beneficial for patients. The established technique of surgical staging (where a patient has a surgical procedure under general anaesthetic) to examine the lymph glands in the centre of the chest was compared to the new, less invasive, technique of endobronchial and endoscopic ultrasound. These new techniques involve passing flexible telescopes through the mouth and into either the airways or the oesophagus (gullet) from where it is possible to take biopsy samples from the lymph glands. This is done under light sedation as a day case. The study has shown that the new techniques are just as effective as the traditional surgical procedures but have fewer complications and are more likely to avoid patients having inappropriate surgical operations to try and remove a lung cancer which has already begun to spread. Leading the research at Papworth Hospital, Chest Physician Dr Robert Rintoul said: This is important research for people with lung cancer and will change how we investigate patients in the future. Staging lung cancer is vital for choosing the best treatment and this research demonstrates that it can be done just as accurately using endobronchial and endoscopic ultrasound, which is easier and quicker for patients. We have also shown that the new method has fewer complications and avoids patients having unnecessary operations for lung cancer. We believe that in future, many patients will benefit from the endoscopic approaches which are now being used more and more in the UK. Papworth Hospital was the only UK centre to take part in the European ASTER trial of 240 patients. The three other centres were in Holland (Leiden) and Belgium (Ghent and Leuven). 3 Dr Robert Rintoul, Consultant Chest Physician

5 Issue 6 - Spring 2011 Family Cardiac Screening Clinic Cystic Fibrosis patient plays on a Wii Fit game 1 million refurbishment The Adult Cystic Fibrosis Centre at Papworth Hospital opened in 1994 with 15 patients in its care. The service has grown and today looks after over 250 patients over the age of 16. The service will continue to grow by 15 patients each year as survival improves through better management of the disease. The care of patients with cystic fibrosis (CF) is multidisciplinary and the team includes doctors, nurses, physiotherapists, dietitians, psychologists, social workers and pharmacists. The eight-bedded Cystic Fibrosis Ward was opened in 1997 and provided single rooms for those individuals requiring admission to hospital. Today the emphasis remains to treat patients primarily as outpatients, unless their condition determines otherwise. One of the clinical challenges that the unit faces is that of Pseudomonas aeruginosa, a pathogen responsible for chronic infection in patients with CF. It is now well established that the presence of this pathogen is linked to increased morbidity and increased risk of mortality. Patients with the transmissible strains of Pseudomonas are likely to have increased numbers of exacerbations, days of intravenous antibiotics and hospital bed days. It is therefore imperative that crossinfection of bacteria is prevented by segregating patients from one another. The Department of Health has also recently stated that there must be separate bathroom and toilet facilities for males and females admitted to NHS wards. A 1 million scheme to renovate the ward has resulted in 10 airconditioned rooms each with ensuite toilet and shower. Each room also has a flat screen TV, a DVD player, a laptop and a Wii Fit which was funded through the generous fundraising by patients and their families. These fabulous facilities allow the Adult CF Centre at Papworth to practice individual segregation in the inpatient environment to minimise the risk of cross-infection and comply with the Department of Health recommendations on mixedsex accommodation. A new Family Cardiac Screening Clinic has been launched at Papworth as part of the regional Inherited Cardiovascular Conditions (ICC) Service. The service provides diagnostic and management care for people affected by or at risk of inherited conditions affecting the heart and blood vessels, many of which can cause sudden death. In some cases of sudden death, the condition responsible is unclear at post mortem examination and the cause of death is given as Sudden Arrhythmic Death Syndrome (SADS). In this instance, the only way to identify the cause of death and ascertain the potential risk to other family members is to carry out a set of cardiac investigations on first degree relatives of the deceased. This is the purpose of the Family Cardiac Screening Clinic. Overall the clinic aims to provide a one-stop multidisciplinary family screening service for relatives of a person who has suffered a SADS death and to make the screening process as smooth and supportive as possible for families. The Family Cardiac Screening Clinic will be held from 10am-5pm on the second and fourth Friday of each month. One family will be booked per clinic. For information about how to refer to the service please contact Anne White, British Heart Foundation Cardiac Genetics Specialist Nurse on Private Patients Centre As well as being treated at the UK s largest specialist cardiothoracic hospital, your patients are now able to access this specialist care from the comfort of our private wing - Papworth Clinic. Clinical Excellence Pioneering Treatment Research & Education Innovation For more information or to a referral please visit our website at For appointments and enquiries please telephone or in confidence +44 (0) privatepatientservice@papworth.nhs.uk 4

6 5 Papworth in Practice Lung Defence Clinic The Lung Defence Clinic at Papworth Hospital specialises in the diagnosis and treatment of difficult lung infections; referrals come from as far afield as the East Midlands, Yorkshire, Wales and the South West. The clinic provides multidisciplinary care delivered by a complete cross section of expertise and runs clinics four days per week with a 16-bed ward dedicated to the care of its patients. Initiatives to enhance patient care in the community, thus reducing the need for outpatient attendances and hospital admissions include: 1. A protocol for New Patient work-up that rapidly establishes a definitive diagnosis. 2. The development of an individualised management plan by a consultant. 3. A comprehensive patient education programme that enables patients to become experts in managing their own condition; this involves patients understanding their steady state and recognising chest exacerbations at an early stage. Patients are given a reserve course of antibiotics so that they Investment Last year the Trust invested in essential key areas to stay at the cutting edge of specialist healthcare. To meet increased demand for Thoracic Services, Radiology purchased a DX-G Digitiser. This small piece of equipment - one of the first to be installed in this country - can scan an image in 10 to 20 seconds (six times faster than previously) and has the added advantage of reducing average radiation dose. Other targeted purchases on medical equipment covered a wide range of specialist requirements, including: 3D Echo machines (both stationary and portable), lung heart apparatus, ventilators and a state of the art electrophysiology laboratory system. can self-medicate if exacerbation criteria are met. 4. Patients are asked to send a sputum sample to the Papworth Microbiology Laboratory if they develop symptoms suggestive of a significant lower respiratory tract infection (before they start their reserve course of antibiotics). If they are not responding to their reserve antibiotic the sputum culture results direct second line treatment. 5. The Lung Defence Telephone Support Line allows patients direct access to specialist advice should they require it; the service is run by the specialist nurses who meet daily with the clinic consultant to discuss the calls. 6. The Lung Defence Clinic nurse consultant (Jane French) lectures on the Community Matron Masters programme at Anglia Ruskin University which provides training in advanced assessment skills, non-medical prescribing and management of longterm conditions. This has led to the community matrons from throughout the East England visiting Papworth, and building these relationships has improved the follow-up and management of patients in the community. 7. The Lung Defence Clinic home intravenous antibiotic programme has introduced a once-daily antibiotic regimen which is suitable for a proportion of patients that previously required hospital treatment. This is particularly pertinent to patients with severe structural lung disease such as bronchiectasis. Reliable intravenous access is provided through long lines, peripherally inserted central catheters (PICC) lines, or Portacaths, and patients attend the Thoracic Day Ward or have a three-day admission to Princess Ward to undergo training in self-administration before completing the course at home. 8. The Lung Defence Clinic is developing links with hospices to provide end of life care in the community rather than in hospital. For example, the Lung Defence Clinic nurse consultant has provided training in accessing and maintaining a Portacath intravenous access device to the staff of St Francis Hospice, Romford to allow end-of-life care in the community. 9. Patients with advanced lung disease who require frequent hospital admissions and often live some distance from Papworth are provided with an Inpatient Management Plan so that local healthcare providers can institute a treatment regimen close to the patient s home. The philosophy of the clinic is to educate patients to become experts in their own condition, while also providing direct access to specialist advice through the Lung Defence Telephone Support Line. If you would like to learn more about the Lung Defence Clinic please visit our website at www. papworthhospital.nhs.uk/ccli

7 Issue 6 - Spring 2011 In brief... Patient safety To improve both patient experience and safety, all our beds are now electrically operated. Top 20% Patients have scored our services very highly in the recent Care Quality Commission national inpatient survey, showing that we are in the top 20% of hospitals; Papworth scored better compared with other trusts in eight of ten categories. Dr Andrew Grace helping those at risk of sudden cardiac death with the new S-ICD device Electrophysiology and devices Papworth is one of the UK s leading centres for Electrophysiology (EP). This rapidly developing sub-specialty is the fastest growing cardiological service at Papworth. Research into cardiac rhythm disturbances and sudden cardiac death is increasingly improving treatments available, particularly in the area of abnormal rhythm ablation, and patients here have access to the latest 3D mapping equipment. Papworth was the first hospital in the UK to use a new mapping/ablation approach to facilitate these procedures. Papworth is also a leading centre for device implantation including pacemakers, biventricular pacemakers and implantable defibrillators. A recent development in this area is the development of a subcutaneous implantable cardioverter defibrillator (S-ICD) - outlined below. Sudden cardiac death is currently responsible for more than 70,000 people losing their lives each year in the UK alone. A seven-year research study published in the New England Journal of Medicine recently highlighted the development and potential benefits of a new device to help patients who are at risk. The S-ICD has two main benefits over currently used devices. Firstly, as there are no leads actually placed into the heart, their removal or replacement is much simpler, therefore reducing the potential risk for infection. In addition, the S-ICD may also have a better capacity than other ICDs to discriminate between normal and abnormal heart rhythms and it is strongly anticipated that patients with this device will receive fewer unnecessary shocks. Dr Andrew Grace, Consultant Cardiologist at Papworth Hospital, who has been working with his Papworth colleague Dr Amo Oduro on this project since its inception, said: Having worked on this research for the past seven years it was very exciting to see it published. This new work shows that not only is it possible to develop a device without any leads being inserted into the heart, but it is now clear, based on the substantial body of work completed, that the device has major benefits for the patient. Although ICDs are an effective treatment for those at risk of sudden cardiac arrest, this new device simplifies the surgery and could lead to more patients receiving effective and bettertolerated treatment to protect them against the risks of sudden cardiac death. Employee awards Last year the hospital was recognised as one of the top 40 best healthcare employers in the country to work for and following a staff survey, 91% recorded that they would be happy with the standard of care provided by Papworth if a friend or relative needed treatment. Amaze trial The largest multi-centre randomised controlled trial ever run at the hospital is now recruiting patients with atrial fibrillation who are about to have heart surgery. The goal is to determine if adding a maze procedure to heart operations makes a difference to patient survival and quality of life. Mr Sam Nashef, Cardiac Surgeon said: We are planning to study 400 patients over the next two years. The Papworth Mesothelioma Support Group meets every month. For more information about this, and the separate carers group please visit our website mesosupportgroup or call Gerry Slade on

8 Critical Care Papworth performs over 2,000 cardiopulmonary bypass operations each year. In addition there are approximately 60 heart, lung or heart-lung transplant procedures and 70 pulmonary thromboendarterectomy (PTE) operations carried out annually. All patients are cared for after these procedures in Critical Care for a minimum of 24 hours but with potential for an extended stay of up to several months. Previously all critical care beds were used flexibly to facilitate admission of a full range of patient dependencies; however in recent years the unit has become increasingly busy and it was recognised that low-risk patients needed a different style of management that was difficult to achieve when they were cared for in close proximity to critically ill patients. There are now two areas within Critical Care. The Cardiac Recovery Unit (CRU) designed to care for routine post-operative patients in a nurse-led recovery area; and the Intensive Care Unit (ICU) focusing on complex critically unwell patients requiring intense medical and nursing care. The CRU, where patients are only expected to have an overnight stay, is staffed to a level appropriate to elective patients. A Critical Care Nurse Practitioner has overall responsibility for the management of recovery patients and shares in the clinical decision-making with the cardiac surgeons. The ICU has a mix of intensive and high-dependency beds and medical care is led by a Consultant Intensivist supported by a large multidisciplinary team. This focused and highly-specialised team is able to focus on the specialised needs of complex cardiac surgical patients - for example in the growing area of cardiac and respiratory extra corporeal life support. Following a successful recruitment campaign, Papworth welcomed additional nurses to its Critical Care area. ECMO services Papworth Hospital is the largest specialist cardiothoracic hospital in the UK and has provided ECMO (Extra-Corporeal Membrane Oxygenation) support for patients with advanced heart and lung failure for many years. We are currently working with six other hospitals commissioned by the National Specialist Commissioning Team to provide respiratory ECMO support for patients with H1N1. We have dedicated four beds in our Intensive Care Unit for this purpose. The aim of ECMO in respiratory failure is to allow the injured lung to recover whilst avoiding certain recognised complications associated with conventional ventilation; it is a highly specialised technique, which requires the expertise of intensive care specialists, cardiothoracic surgeons and ECMO-trained nurses. Courses All these courses will be held at Papworth Hospital. For further details and registration please contact: Anne Scott, Conference Facilitator, Papworth Hospital NHS Foundation Trust Papworth Everard Cambridge CB23 3RE Tel: anne.scott@papworth.nhs.uk Supporting People with Motor Neurone Disease 15 March and 27 September :00pm - 5:00pm To raise awareness of the needs of people affected by MND and to drive up standards of care. For anyone working with people affected by MND but specifically nursing and care staff providing direct support to people affected by this complex condition. Fee: 10 Practical Aspects of Managing the Neuro Muscular Patient with Respiratory Problems 17 May and 4 October :45pm - 4:00pm To demonstrate practical aspects of managing treatment with practical demonstrations of non-invasive ventilation-assisted cough techniques and mini tracheostomy. For people involved in the direct delivery of care to patients with a neuromuscular disease, ie healthcare assistants, nurses, physios and physio assistants. Fee: 10 Diabetes 20 May :00am - 5:00pm To study complications in diabetes, healthy eating and nutrition, tablets and insulin, using insulin safely, latest treatments, and the physiology of diabetes in type 1 and type 2 and Cystic Fibrosis, NICE guidelines. For nurses in hospitals and in the community who care for patients with diabetes. Fee: 25 To find our more about ECMO at Papworth Hospital please visit Papworth Hospital is a member of Cambridge University Health Partners -