Enabling faster access to specialist care for patients with chest pain

Dr Chris Baker has been a consultant cardiologist at Imperial College Healthcare since 2002. He was instrumental in the development of a new approach to treating patients who have a major heart attack or other, very serious, acute heart problem pioneered in London in 2010 which is now common practice nationally. By enabling ambulance teams to take patients who have a major, acute heart problem directly to a specialist heart assessment centre, rather than to the nearest A&E department, the proportion of patients who survive to be discharged from hospital has risen significantly. Hammersmith Hospital provides one of the eight heart assessment centres in London. Dr Baker is now proposing changes to enable faster access to Hammersmith’s heart assessment centre for patients with chest pain so that more people can benefit from quick access to specialist care. Here, he explains the proposals and encourages patients, carers and local people to share their views.

One of the central principles of our Trust’s clinical strategy is bringing together specialist services in one unit where that will improve safety and quality for patients. This is because, for some services, we need a critical number of patients to make effective use of the very specialist equipment and staff required, and for our specialist clinicians to have the right case mix to maintain and develop their skills. Consolidating key specialist services also supports the roll out of seven day working for urgent care. This is balanced against another principle of our clinical strategy – creating more local services where we can, to improve access.

Bringing together specialist care for major heart attacks has meant patients have fast access to primary angioplasty – a key procedure that opens the blocked artery using balloons and stents, also developed at Hammersmith Hospital from an early stage in 2003. We have also developed similar pathways in specialist centres for stroke and major trauma services.

At Hammersmith Hospital, a team of us have been looking at how we might enable more patients to benefit from our heart assessment centre model. Currently, many patients who arrive at one of our two A&E departments (at Charing Cross and St Mary’s hospitals) with chest pain that is not a full blown heart attack, find that they spend unnecessary time in a general assessment ward waiting for a bed to become available on the heart assessment centre.

In the three months from September to November 2015, 59 per cent of patients admitted with chest pain through A&E waited at least one day to be transferred to the heart assessment centre, and 21 per cent waited four days or more. This is not the best care for patients, nor is it an efficient use of our hospital resources.

So, we have worked up detailed proposals to improve the care pathway for patients with chest pain that is most likely due to a heart problem (rather than, say, a respiratory problem). In the first phase of the proposed changes, patients presenting with this problem at one of our two A&E departments would be transferred directly to the heart assessment centre at Hammersmith Hospital without needing to be admitted to a ward at Charing Cross or St Mary’s hospitals first.

In later phases, we will work with ambulance teams to ensure the chest pain patients identified above, are not even conveyed to one of our A&Es but go straight to the Heart Assessment Centre. This would mean that as well as patients with suspected major heart attack or very serious, acute heart problem, London Ambulance Service (LAS) would also be able to take patients with chest pain of suspected cardiac origin directly to where specialist cardiac care is based.

To allow us to do this, we will improve access for LAS at Hammersmith Hospital, expand and upgrade facilities within the heart assessment centre for assessing patients, and redesign the layout to improve the ‘flow’ of patients through the unit. We will also increase the number of beds available for patients to recover following their procedure and recruit additional nurse practitioners to help us quickly transfer patients after their recovery or safely discharge them home.

We believe the proposed new care pathway will help patients access the right treatment, in the right place, first time.

We want to hear from you about these proposals before our Trust Board makes a decision at the end of July at their next public meeting. A detailed proposal document is available here that also covers related changes to the acute medicine pathways and how to give us your feedback.

Please ensure all comments reach us by Friday 15 July 2016.