dgh v tertiary intervention – is there really a conflict ?
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DGH v Tertiary Intervention – Is there really a conflict ?. Steven Lindsay Bradford Teaching Hospitals NHS Trust. Conflict of Interest I am a “DGH” interventionalist. Bradford. History lesson. Cardiology in Bradford in 1999. 1000 bedded DGH 400,000 population - PowerPoint PPT PresentationTRANSCRIPT
DGH v Tertiary Intervention – Is there really a conflict?
Steven Lindsay
Bradford Teaching Hospitals NHS Trust
Conflict of Interest
I am a “DGH” interventionalist
Bradford
History lesson
Cardiology in Bradford in 1999 1000 bedded DGH 400,000 population 2 cardiologists -non interventional 2 diagnostic angio sessions in
multipurpose lab
105
93
114
92
CHD
SMR
544
641
531
1708
Revasc/million
6781030116Airedale
197347147S + W
25039192North
170361147City
CABG/million
PTCA/
million
Pop
(1,000)
PCT
NSF recommendation (per million) Angio 3200, PTCA 750 CABG 750
Revascularisation in Bradford HA PCTs in 2001
105
93
114
92
CHD
SMR
544
641
531
1708
Revasc/million
6781030116Airedale
197347147S + W
25039192North
170361147City
CABG/million
PTCA/
million
Pop
(1,000)
PCT
NSF recommendation (per million) Angio 3200, PTCA 750 CABG 750
105
93
114
92
CHD
SMR
544
641
531
1708
Revasc/million
6781030116Airedale
197347147S + W
25039192North
170361147City
CABG/million
PTCA/
million
Pop
(1,000)
PCT
NSF recommendation (per million) Angio 3200, PTCA 750 CABG 750
How to get from here……
105
93
114
92
CHD
SMR
544
641
531
1708
Revasc/million
6781030116Airedale
197347147S + W
25039192North
170361147City
CABG/million
PTCA/
million
Pop
(1,000)
PCT
NSF recommendation (per million) Angio 3200, PTCA 750 CABG 750
How to get from here……
1708
1708
1708
to here
Cardiac Labs in West Yorkshire 1999
9 DGH labs – most multi purpose All PCI in Leeds (3 cardiac labs
open) 4 Tertiary Centre Interventionalists 7 DGH visitors
Cardiology in Bradford in 2000 1000 bedded DGH 400,000 population 3 cardiologists -1 interventional 2 diagnostic angio sessions in
multipurpose lab 1 diagnostic session in Airedale 1 PCI session in tertiary centre
Cardiology in Bradford in 2001 1000 bedded Teaching Hospital 400,000 population 3 cardiologists -1 interventional 2 diagnostic angio sessions in multipurpose
lab 1 diagnostic session in Airedale 1 PCI session in tertiary centre 9 month waiting list for PCI
Cardiology in Bradford in 2002 1000 bedded Teaching Hospital 400,000 population 3 cardiologists -1 interventional 1 Associate Specialist Dedicated cardiac lab 2nd Interventional post approved 2 PCI session in tertiary centre
PCI rates in Bradford and Leeds 2002-2006
Airedale
S&W Bradford
WYNCC
0
200
400
600
800
1000
1200
1400
1600
1800
2002-3 2003-4 2004-5 2005-6 2006-7
Year
Rat
e p
mp
Airedale
BradfordCityNorthBradfordS&WBradfordE Leeds
NE Leeds
NWLeedsS Leeds
W Leeds
WYNCC
PCI rates in Bradford and Leeds 2002-2006
Airedale
S&W Bradford
WYNCC
0
200
400
600
800
1000
1200
1400
1600
1800
2002-3 2003-4 2004-5 2005-6 2006-7
Year
Rat
e p
mp
Airedale
BradfordCityNorthBradfordS&WBradfordE Leeds
NE Leeds
NWLeedsS Leeds
W Leeds
WYNCC
2002/2003 total PCI activity in Leeds 1691 cases
NSF targets of 750 pmp by 2004/2005= 2380 cases
Airedale PCI activity corrected for SMR is 1157 pmp (equivalent to 5000 PCIs p.a. across the WYNCC).
But where is the extra capacity?
PCI in West Yorkshire 2002
Bradford NSF targets = 370 cases pa for the 3 Bradford PCTs. The Bradford “patch” is sufficiently large to support a stand-
alone PCI service and more than satisfy the BCIS requirements for a minimum of 200 cases p.a. and individual operator caseloads of at least 75 cases p.a.
3 vacant lab sessions are available for PCI. 3 cases per session and working year of 40 weeks = 360 cases
p.a. Retain one session for “high risk” cases and adjunctive
technologies (IVUS, rotablator, presssure wire) Release one session in Leeds -a further 120 cases can be
carried out. Network capacity increased by 480 cases
What we actually did
Jan 05 started with 1 acute session in Bradford April 2005 1 elective session in Bradford All Bradford PCI sessions in am Not a 24/7 service Out of Hours cover from Leeds (never utilised) May 2006 Bradford Interventionalists occupy 1
slot on W York's PPCI rota in Leeds
Bradford Interventional activity 2005-2007 453 at LGI Jan 05 to Jan 07 349 at BRI Jan 05 to Jan 07
2 operators 3 lists/wk at BRI Ad hoc acute activity during working
week 2 lists/wk (1 all day list) at LGI
PCI rates in Bradford and Leeds 2002-2006
Airedale
Bradford City
North Bradford
S&W Bradford
S&W Bradford
W Leeds
WYNCC
0
200
400
600
800
1000
1200
1400
1600
1800
2002-3 2003-4 2004-5 2005-6 2006-7
Year
Rat
e p
mp
Airedale
BradfordCityNorthBradfordS&WBradfordE Leeds
NE Leeds
NWLeedsS Leeds
W Leeds
WYNCC
BRI PCI Starts
Thankyou
West Yorkshire Network
Jim McLenachan and Stacey Hunter LTHT
Chris Durkin BTHT
John Kurian BTHT