Primary Care Acute Chest Pain Awareness. Background BHF Funded Mid & South West Wales Project...
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Transcript of Primary Care Acute Chest Pain Awareness. Background BHF Funded Mid & South West Wales Project...
Primary Care Acute Chest Pain Awareness
<Venue><Date & Time>
<Presenter>
Background
• BHF Funded Mid & South West Wales Project– Report from MINAP (Myocardial
Ischaemia National Audit Project)―2005-6 Data―Higher proportion of people in Wales
called/visited GP rather than calling 999 with chest pain
Background
•MINAP Analysis – Network Level– Admission Diagnosis: Definite MI
9%
20%
3%
Background
Cardiac Networks Co-ordinating Group: Call-to-Needle Subgroup Recommendations– Need to raise awareness of symptoms
and a clear message of what to do if symptoms occur1
– Need ongoing innovative campaigns to raise awareness1
1 Recommendations for improving call-to-needle times in Wales (2007); recommendation 1.5
Background• Annual Operating Framework Target
12(2008-9)
– All patients with MI suitable for thrombolysis will have a CTN time < 60 minutes
• ‘The Golden Hour’ and ‘One minute delay = 11 days loss of life’1
1 Boersma E, Maas ACP et al early thrombolytic treatment in AMI: reappraisal of the golden hour; Lancet 348: 771-775
Background
• Standard 3 - National Service Framework for Coronary heart disease (June 2009)– Point 3.10 ‘If a GP is called for symptoms
suggestive of acute coronary syndromes, the GP should call 999 for an ambulance prior to attending to give assistance’
Aims
• To raise awareness within Primary Care of importance of immediate admission of suspected MI
• To reduce pain-to-call time/pain-to-reperfusion time
Project Outline
• Provide poster pathway and education to Primary care– For clinical staff to support management
of acute MI
• Provide workshops in primary care to implement project and raise awareness
Timeframe• Project implementation across primary
care in Mid & West Wales– Commenced November 2008– To be evaluated March 2011
• Project implementation within HM Prison Service in Wales– Commenced July 2010– To be evaluated March 2011
Measurement of Expected Benefits
• MINAP Data comparison
• Project Evaluation
• Pre/Post project staff survey
Interim Analysis 1
• Increased confidence by both administrative and clinical staff in dealing with acute chest pain calls/presentation
1 2 3 4 5 6 7 8 9 10
0%
5%
10%
15%
20%
25%
30%
35%
40%
Confidence Level
Administrative Staff Confidence LevelsChest Pain Presentation in Person to GP Practice
Pre % (n=110)Post % (n=120)
Source: Post-Implementation Awareness and Confidence Survey
1 2 3 4 5 6 7 8 9 10
0%
5%
10%
15%
20%
25%
30%
35%
40%
Confidence Level
Administrative Staff Confidence LevelsTelephone Call to GP Practice Reporting Chest Pain
Pre % (n=110)Post % (n=120)
Source: Post-Implementation Awareness and Confidence Survey
1 2 3 4 5 6 7 8 9 10
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Confidence Level
Clinical Staff Confidence LevelsChest Pain Presentation in Person to GP Practice
Pre % (n=110)Post % (n=120)
Source: Post-Implementation Awareness and Confidence Survey
1 2 3 4 5 6 7 8 9 10
0%
10%
20%
30%
40%
50%
60%
Confidence Level
Clinical Staff Confidence LevelsTelephone Call to GP Practice Reporting Chest Pain
Pre % (n=110)Post % (n=120)
Source: Post-Implementation Awareness and Confidence Survey
Interim analysis 2
• Fewer patients told by staff to make their own way to hospital
Source: MINAP
Interim analysis
• Stated change in practice towards advising 999 call rather than arranging same day appointment/home visit
• Verified change in practice demonstrated through MINAP data
Method of Admission - Administrative Staff
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
To be seen byGP; GP then calls
999 afterassessment
Patient advisedto call 999 (or
surgery call 999if patient
presents inperson)
bypassing GP
To be seen byGP; GP advises
patients to makeown way to
hospital
Patient is triagedto attend surgeryfor assessment
at next availablesame day
appointment
Method of Admission
Perc
en
tag
e
Pre % (n=110)Post % (n=120)
Source: Post-Implementation Awareness and Confidence Survey
Method of Admission - Clinical Staff
0%
10%
20%
30%
40%
50%
60%
70%
80%
To be seen byGP; GP then calls
999 afterassessment
Patient advised tocall 999 (or
surgery call 999 ifpatient presents
in person)bypassing GP
To be seen byGP; GP advises
patients to makeown way to
hospital
Patient is triagedto attend surgeryfor assessment at
next availablesame day
appointment
Method of Admission
Perc
en
tag
e
Pre % (n=110)
Post % (n=120)
Source: Post-Implementation Awareness and Confidence Survey
Source: MINAP
Conclusions• Improved patient care by
appropriately accelerating admission to paramedic/secondary care
• Structured, evidence-based resources, generic and universally suitable for use in all primary care sites
• Reduce call-to-needle times and accelerate care of all ACS patients
?
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