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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 • • • • • 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 • • • • • • • 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! • • • • • • • • ‘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]