Cardiology peer review June 2015

Dr S J Desilva

Agenda

12 – 1pm Registration and Lunch Start 1pm 1. Update and summary Dr S J Desilva

Review of learning and Actions from previous peer review 2014 New suspected angina referral form – Joint feedback and

recommendations e-consultations - update Wakefield cardiology network – summary

2. Peer review of cases NA/SDS 3. Medicines optimisation team, ImPP (KM) Break 3. MYDIAGNOSTICKS update – SDS 4. AF/Grasp and stroke – quick updated (Gillian Richardson) 5. RAIDR - quick summary – CH 6. Big white wall – update - CH

NDF – Network development framework

All practices are required to take part in two external peer reviews of outpatient specialities with consultants - in relation to the “OUTCOMES AND VALUE FOR MONEY” domain of NDF

The purpose of the peer review is to improve QUALITY and SAFETY OF CARE .

By improving quality we can achieve efficiencies.

Process

Part one - practices to capture discussions at practice meetings to identify case studies prior to external peer review

Part two - Network /target session to capture discussions with consultants and clinicians

Part three - used to identify key learning points and develop action plans.

Key learning points from previous meetings – Dr Artis presentation

If patients don’t have suspected angina, DO NOT TEST FOR IT! Testing can result in unnecessary non invasive and invasive procedures – which are associated with risk.

Screening questions for angina – If answer NO for the 3 suspected angina questions, then Highly unlikely patient has angina. Referral, imaging and testing not necessary.

Key learning points cont

New suspected angina form presented to network who agreed to pilot it

Why stable angina needs to be seen quickly and those with severe CAD need to be identified

Angioplasty will not stop heart attacks (no tests which will identify which plaques will rupture),but for improvement of symptoms.

Stenting supports symptom control but does not save lives.

Network Action Plan

1. Implement and pilot of NEW “Rapid access” suspected angina clinic forms

2. participate in audit and feedback (via survey monkey)

3. support the joining up of services and ways of working together between specialities to stop patients being passed around the system.

4. Arrange a 2nd follow-up peer review and update with Dr Nigel Artist (Consultant cardiologist)

Suspected angina referral form

Feedback and discussion

e-consultations

Feedback

Changes to BNP

From Aug changing to NT-BNP Reference values changing Currently B-BNP levels 100 New range NT-BNP levels 400

New TLOC pathway

Community cardiology website

Wakefield cardiology network

Paul Brooksby - Consultant Cardiologist MYHTSom de Silva – GPwSI Cardiology and Network 6 Representative (Wakefield) Pravin Jayakumar (GP) – Network 5Nigel Artis – Consultant Cardiologist MYHTDwayne Conway – Consultant Cardiologist MYHTGillian Richardson – Public Health Emma Smith – Health Improvement Specialist, Wakefield Public Health Viv Nicholson – Senior Commissioning Manager NKCCGCaroline Ellis – Locala Cardiology and Admissions Avoidance Team Leader

Alison Carr – Senior Cardiac Technician MYHTGed Oliver – Strategic Clinical Network RepresentativeSharon Stockdale – Heart Failure Nurse - LocalaPrincipal, Wakefield CCG and Public HealthKeith Marshall – Patient representativeRepresentative (Wakefield)Gill McDonald – Medicines Optimisation Wakefield CCGDavid Fearnley – Heart Failure Nurse, LocalaHazel White – Consultant Cardiologist MYHTFiona Dudley - Lead Nurse, Cardiology Services MYHTPhil Batin – Consultant Cardiologist MYHT and Strategic Clinical Network Clinical Lead

Wakefield cardiology network Current ongoing agenda items

New stable angina pathwaye-ConsultationsCommunity heart failure pathway/clinicEnhance-HFGrasp AFHeart failure guidelinesCommunity IV diuretics pathwayFamilial Hypercholesterolemia (FH) /genetic testingNorthkirklees community cardiology service

Dr Nigel Artis – Consultant cardiologist MYT

Peer review of cases

Medicines optimisation team, ImPP (KM)

MYDIAGNOSTICK

UPDATE – finally ready to go !

Gillian Richardson

ATRIAL FIBRILLATION/strokes

Dr Clive Harries

RAIDR

Dr Clive Harries

The big white wall