Download Parallel session 6: Rethinking, redesigning care

Re-thinking,
re-designing care
Dr Mark Taylor - Bengoa expert panel member
Contributors
Dr Albert McNeill - Cardiac Specialist, Western Health and
Social Care Trust
Karen McCammon - Clinical Engagement Lead, British
Heart Foundation
Deirdre McCloskey - Project Co-ordinator for the Mid and
East Antrim Active Aging Partnership
#NICON17
Primary percutaneous coronary
intervention:
change and challenge
Albert McNeill
Consultant Cardiologist,
& Clinical Lead for Cardiology WHSCT
Management of
heart attacks 1982:
treating complications
Heart failure
Cardiac arrest
Death
Treat the cause, not the complications
OPEN THE CORONARY ARTERY
Thrombus
totally
occludes
lumen
Reduplicated
elastic laminae
indicating
previous
hypertensive
damage
Recanalisatio
n within
original
plaque
How to open a blocked coronary artery: thrombolytic drugs
GISSI study group, Lancet 1986
Shortfalls of thrombolytic therapy
•
•
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•
•
About 80% reperfusion rate
Residual stenosis and risk of re-occlusion
Bleeding risk
Contraindications
Alternative reperfusion strategy: primary
angioplasty (PPCI)
• Feasibility of transfer for PPCI; DANAMI and
PRAGUE studies
ESC guidelines for STEMI
• Primary PCI revascularistion of choice
• For pts seen > 2hrs: time from 1st medical
contact to 1st balloon inflation < 120
minutes
• For pts seen within 2 hrs of pain onset:
<90min delay
• ESC guidelines 2012: immediate transfer to
PCI capable centre even after lysis
NI Executive programme for
government 2012
• Followed international guidelines (ESC)
• “Expand cardiac catheterisation capacity to
improve access to diagnostic intervention and
treatment and further develop a new primary
percutaneous coronary intervention (PPCI)
service model to reduce mortality and
morbidity arising from myocardial infarction
(heart attack)”
How?
•
•
•
•
Pre-existing cardiology network
Revascularisation subgroup
Clinicians and managers (and commissioners)
Co-ordinated by former senior nurse(s) seconded
to HSCB
• Chaired by senior public health doctor
• Robust but fair and respectful meetings
• Look at overall service (not just PPCI, also PCI for
non STEMI, non invasive)
Changes in MI management
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2 centres for primary PCI: Belfast and L’derry
Direct admission to cathlab from ambulance
Avoid admission to non PPCI centre
Province wide transfer
Following ESC guidelines; 24/7 service
Co-ordination inter-trust incl NIAS
Repatriation to local hospital at 6 hours
(except overnight)
Catchment areas (by postcode)
Challenges in effecting change
• Staff recruitment to allow robust rotas (but also
maintain skills)
• Peripatetic consultants( SWAH and Causeway)
• Clinical physiology/ nurse/ radiogrpahy
recruitment
• Overcoming the fear factor
• Second cath lab: where? In CCU
• Acceptance of a new way of working
• Communication: GPs/ED/ other Trusts
Why did it work?
• Multiagency buy in:
minister/DHSSPS/HSCB/Trusts incl NIAS
• Multidisciplinary buy in: medical/nursing/CP/
radiography/support services
• Strong management-clinician relationships
• Strong clinician-clinician relationships
• Careful planning (what if?)
• Skilled experienced workforce (snowball effect)
• Trouble shooter/problem solver/message boy!
The team
Multi-professional team, senior managers, commissioners (and politicians)
Outcome
• Evidence based, guideline driven management
for myocardial infarction
• Best practice
• Equitable and province wide
• Allowed other developments ( incl cross
border) and non invasive developments,
permanent pacing
• Reduced length of stay
Change is the law of
life. And those who
look only to the past
or present are
certain to miss the
future.
John F. Kennedy
Re-Designing
Cardiovascular
Care
Karen McCammon
Health Service Engagement
Lead
BHFNI
THE CHALLENGE
£412
THE CONTEXT
COMPLICATIONS
CVD
BURDEN
RISK
FACTORS
AGEING
POPULATION
LONG TERM
CONDITIONS
VICIOUS CYCLE
The Context for Change
IV Diuretics at Home
Pilot Project
External evaluation
Cost
effective
Safe
Clinically
effective
Improved
patient
and carer
experience
How we can help: Our Best
Practice Portfolio
Miles Frost
Fund
Heart
Failure
Community
IVD
Palliative
Care/
Hearty Lives
Caring
Together
FH/
Projects
Genetics
Arrhythmia
Prevention
&
Preventative
Research
Cardiac
Rehab
Blood
Pressure
Integrated
Care
CDC Role
A Possible Solution:
CVD Framework
Between 2010 and 2014 there were 16,381
preventable deaths in Northern Ireland.
Of those, heart disease was the most significant cause
of preventable death, accounting for 3,372 deaths of
males and females under the age of 75
Thank You
©MEAAP08052017
Who are MEAAP?
We are an older
people’s charity set up
in 2011 with the “aim
of improving the lives
of older people within
the Mid & East Antrim
area.”
£1:£6.62 investment!
©MEAAP08052017
MEAAP’s Position
• Aware of the gaps, priority is to continue to fulfil
the aim of ‘joining the dots’ – particularly
continuing to be a facilitator / catalyst.
• Sees the requirement for the ‘shift left’ in terms of
services for older people and knows CVSE can &
should play an important and necessary role.
• It is a complex challenge which can only be tackled
in an integrated way – no-one has all the answers.
• MEAAP wishes to proactively contribute to making
the response truly effective.
Rethinking, Redesigning Care…
• Opportunity via Dunhill Medical Trust to
“Develop a Network of Care for Older People
at a Local Level.”
Nov 2015 – Feb 16
Call for Outline
Proposals
©MEAAP08052017
Apr – June 16
Shortlisted
Full Business Plan
Aug 16
Dunhill Medical
Trust visit to
IMPACT team
Oct 16
Final presentation
& interview
Assessed Against 5 Key Areas...
• Continuity of Care;
• Considerate Care;
• Cost Effectiveness of Care;
• Completeness of Care;
because it
• is Community Focussed
©MEAAP08052017
Our Vision
Improve the quality of life for older people by
providing them with person centred services
and support to improve and meet the health and
wellbeing outcomes that matter most to them putting wellbeing on par with medical needs
using an integrated healthcare model - thereby
reducing dependency on the unscheduled use
of primary & secondary health and social care
services.
©MEAAP08052017
https://www.youtube.com/watch?v=dH8Iq9Hwlqk
IMPACTAgewell Aims
Improve health &
wellbeing
Build knowledge &
diversity
Older People
Integrated, valued &
safe partnerships
©MEAAP08052017
Reduce cost of
health & social care
support
IMPACTAgewell Joins the Dots!
•
•
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•
•
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‘Bottom Up’ community led approach.
‘Back to basics’ whole systems approach.
Supports prevention & early intervention.
Gives older people a strong voice – active vs
passive.
Invests & nurtures communities vs signpost.
Transferable model because it is flexible.
Can influence change not only in our immediate
area but further afield.
It will produce the evidence of the “Invest to Save
Return” of the IMPACT Model.
©MEAAP08052017
For further information
#IMPACTAgewell
@meaapni
©MEAAP08052017
Please contact
MEAAP Project Coordinator
Deirdre McCloskey
Tel: 028 2565 8604
Email: [email protected]