Barnet Hospital forms part of the Barnet and Chase Farm Hospitals NHS Trust and is located in north London. The hospital was modernised between 1999 and 2002 through a private finance initiative and was re-opened in 2003 by HRH The Princess Royal.
The Care Quality Commission recently publicly congratulated the Trust as one of the 13 most improved NHS trusts in the country.

Interview

What are the sizes of your Cardiology Department and Hospital?

Barnet and Chase Farm Cardiac Services
Cardiology Service
The specialty of cardiology lies within the directorate of General Medicine and Pharmacy. The specialty provides a combination of inpatient work, a large outpatient service, and a full range of cardiac investigations. In addition there are elective and emergency procedures undertaken mainly as day cases.

The ward base consists of 8 bedded CCUs on both sites, a 24 bedded cardiology ward,   Rowan, at Barnet, and 11 beds on Melbourne ward at Chase Farm, with access to further beds on Toronto ward at Chase Farm. There are cardiac departments providing a full range of non-invasive cardiac investigations at both Barnet and Chase Farm, with a more limited service at Edgware hospital. Outpatient clinics are run from these sites as well as Cheshunt Community Hospital and Potters Bar, and include 7 Rapid access chest pain clinics weekly. Cardiac Rehabilitation is offered as an inpatient and outpatient service at both sites and extended into the community. Outreach heart failure clinics are run for Enfield patients at Forest Road. Myocardial perfusion scanning is also undertaken at Barnet in the Radiology department.

The cardiac catheterisation lab and a six bedded day case unit is sited at Barnet, opening in April 2008. This is a trust-wide service providing facilities for diagnostic cardiac catheterisation, CRT, ICD and permanent pacemaker implantation for elective and emergency admissions. We are expecting to increase our service to include elective PCI in 2011.

The purpose built cardiology department at Barnet carries out:

• 12 lead interpretative ECG
• Treadmill exercise testing
• Nuclear scanning
• M-Mode, 2D, 3D, Doppler, Stress and trans-oesophageal echocardiography
• Trans-telephonic monitoring
• 24 hour ambulatory rhythm monitoring
• Event recording
• 24 hour ambulatory blood pressure monitoring

What is the geographical intake area and population served by your hospital?

Barnet and Chase Farm hospitals are part of the North Central Sector which has a catchment of 1 million, 50% of which being served by Barnet and Chase Farm Hospital

How many staff? Roles?

Staffing

• 7 Consultants, all with commitments at other hospitals/community services.
• 1 Associate specialists
• 2 Specialty doctors
• 4 SpRs
• 4 ST grade juniors
• 2 FY grade juniors
• 1 Physician Assistant
• 2 Consultant Cardiac Surgeons – 1 PA activity weekly each
• 2 Consultant Electrophysiologists – 2 PA total activity weekly.

Nursing
Cardiology matron.
Cardiology Nurse Specialists
5 WTE – RACPC, Heart Failure, Pre assessment and Revascularisation and Research
CCU (Barnet)
19.5 WTE
Cath Lab, Day Unit, Pre assessment
15.29 WTE
Barnet cardiology ward
27.95 WTE
Chase Farm Melbourne (CCU & step down) ward
26.24 WTE
Cardiac Rehab team
4.5 WTE

Cardiac Physiologists
22 WTE (all sites, and including respiratory service)

Admin Staff
8 WTE (all sites, and including waiting list management)

Secretarial support
8.5 WTE

Types of procedures?

Currently performing diagnostic Angiography.

Device implantation including, temporary and Permanent Pacemaker insertion, ICD, and CRT-P. We have completed our training and BCIS evaluation and hope to commence PCI in the early part of 2011

Types of equipment used?

• Siemens Axiom Artis  (X-Ray)
• McKesson – Medcon:  Horizon Cardiology (CVIS and Haemodynamic)
• Philips iE33 (Echo)
• Siemens Cyprus (Echo)

How many procedures are performed a year?

What is the approximate percentage of cath lab cases performed radially compared with femoral?

Approximately 36%

Does your department offer a Primary Angioplasty Service?

Barnet Hospital hope to start a PCI service in 2011, Primary Angioplasty will remain in the established centres.

What new procedures / techniques have you implemented into the department recently? Future?

CRT, ICD, future PCI, FFR

What are the benefits to patients attending your facility?

They no longer need to commute into London for treatment.

How is your inventory managed?

Electronic Stock ordering through EROS, will use McKesson - Medcon inventory module for consignment and PCI when we start.

How does the lab handle haemostasis?

TR Band for Radial approach, Angioseal for approximately 80 percent of femoral access, remainder of femoral Manual compression.

What measures has the department implemented to cut costs?

Careful stock management, stock rotation, consignment stock, early diagnostic procedures to reduce length of stay.

What kind of training can new employees expect to receive?

Off site training under honorary contract with the London Chest for PCI procedures, we hope to access the same support through Bart’s for Complex device therapies.

We also schedule training days on site during Lab down time, inviting external trainers and industry to ensure ongoing education and training.

What kinds of competency checks do staff have to undergo once employed?

General competencies relative to all trained nurses.

Department specific competencies such as IABP set up and transportation, ECG interpretation, IV Cannulisation, BLS, ILS. Assisting with Cardiac interventional procedures. Scrub Technique.

How do you deal with late finishing of cases?  For example staggered working hours or just staff overtime?

Nursing Staff work Long days 07.30-19.00 so as to overlap the lab operating time of 09.00-17.00. Physiologists and radiographers claim overtime for overruns or take time back.

What is the best part of working at your facility?

We are well supported by our Managers to provide an excellent service for our patients, waiting time for elective Angiography is usually less than three weeks. Great People, hard working, a busy lab that gets through a large volume of work for a single Lab with no after hours work. It is a great environment for learning, and our young staff are proving to be excellent Cath lab professionals who will no doubt remain in this speciality for many years to come.