Northampton Heart Centre is one of the first of the FFR upgrades for McKesson (formally Medcon) within the UK. McKesson Horizon Cardiology provides a fully integrated FFR haemodynamic system. The McKesson haemodynamic system is unique as it uses the same database as the Cath reporting module, thus all the data and information that is placed in the haemodynamic system will be already within the cardiologist’s report, this helps to generate reports faster and more accurately.
Interview
What are the sizes of your Cardiology Department and Hospital?
Northampton General Hospital has over 600 beds, serving a population of 360,000 on a regional basis. The Heart Centre consists of a nine-bedded day ward, a cardiac cath lab and a pacing theatre. The Cardiology Ward consists of a four-bedded coronary care unit and 26 cardiology beds.
What is the geographical intake area and population served by your hospital?
Our hospital supports the south Northamptonshire area, with a population of 360,000
How many staff? Roles?
We have six cardiologists: three on-site interventional cardiologists, one visiting interventional cardiologist, one diagnostic cardiologist and one pacing/device cardiologist.
Cath Lab staff:
Chief Cardiac Physiologist (daily rotation of one cardiac technician from the Cardiac Dept for Cath Lab) Superintendant Radiographer, (with rotation of Radiographers from Radiology Dept), Cath Lab Sister, Recovery area Sister and 10 nursing staff rotating within Cath Lab and recovery ward area.
The implementation responsibility and working of FFR as part of the McKesson Horizon Cardiology lab is within the Cardiac Physiologist’s remit and training has been completed.
Types of procedures?
Diagnostic coronary angiography, angioplasty and stenting (including primary PCI), IVUS and PressureWire, basic and advanced cardiac pacing, including bi-ventricular and defibrillator device implantations.
We also provide extensive non-invasive imaging, in the forms of transthoracic, transoesophageal and Dobutamine/contrast stress echocardiography and myocardial perfusion scintigraphy.
Types of equipment used?
The cardiac catheterisation lab opened in June 2008 and has the following equipment:
Image modality: Siemens Artis Zee floor-mounted C-arm system with flat-panel detector. Singo workstation with advanced IC3D facility.
Haemodynamic System: McKesson (Medcon) Horizon Cardiology.
Image Management and Reporting: McKesson (Medcon) Horizon Cardiology, with BCIS export module.
IVUS: Boston Scientific i-lab
Pressure Wire: St Jude Aeris with integrated FFR on McKesson (Medcon) haemodynamic system.
How many procedures are performed a year?
Our cath lab runs 4 days per week and in our first year of opening we performed the following number of studies:
- Angios: 1100
- PCI: 344
- Pressure Wire: 14
- IVUS: 3
- Pacemakers: 229
- ICD/CRTD: 18
- CRT P: 5
What advantages of having FFR on your haemodynamic system?
Using the combined St Jude Aeris wireless pressure wire and McKesson Horizon Cardiology system allows direct recording and storage of the FFR into the haemodynamic full-disclosure. The McKesson Horizon Cardiology system has all the software/interactive capabilities of the St Jude stand-alone system, with the benefit of all measurements presented directly in the haemodynamic report without the need for data transfer or integration. The result is automatically presented in the
physician report.
Direct connectivity with the haemodynamic system, using wireless technology, minimises problems with transfer of data between systems. From a safety aspect, the new system minimises cable connections and trailing wires around cath lab table. The new system also allows the cardiac physiologist to remain at the haemo station and continue full monitoring/documentation.
What protocols has your department implemented to reduce door-to-balloon time?
East Midlands Paramedic crews have been trained to recognise ST-elevation myocardial infarction (STEMI). The Accident and Emergency Department are pre-alerted to the arrival of the patient. As soon as the patient arrives they are assessed by a Cardiac Nurse Practitioner or Cardiac Registrar.
At this stage a 12-lead ECG is taken, and the Cardiac Nurse Practitioner brings the 12-lead ECG to the cath lab to be assessed by the Cardiologist on call. (We are in the process of implementing an ECG server throughout the hospital; this will be provided by McKesson (Medcon) and Mortara DICOM ECG machines. The benefit of this true Dicom connection will result in the consultant’s ability to review ECG as soon as it is being taken through McKesson (Medcon) Horizon Cardiology.)
Monthly cardiology meetings are held between the medical staff and the ambulance team to discuss patients who have had primary PCI’s performed; it is also an opportunity to determine how the process could be improved.
In the period April 09 - March 10, 39 patients had primary PCI, with 88% of patients having a door-to-balloon time of less than 90 minutes and for call-to-balloon, 90% of patients under 150 minutes. Both are compatible with the national average for England and Wales.
What new procedures have you implemented into the department recently?
Introduction of PCI service with primary PCI provided between 8 am and 6 pm, Monday to Friday
How is your inventory managed?
Combination of McKesson (Medcon) Inventory Management barcoding system and electronic procurement service.
How does the lab handle haemostasis?
TR-band for radials, Angioseal for femorals, compression device or manual compression if patient unsuitable for Angioseal.
What is the best part of working at your facility?
In the past, patients requiring interventional procedures were transferred or referred to our neighbouring tertiary centres, over 50 miles away. The introduction of PCI to the Northampton General Hospital has made a significant difference to our patient population. Having the facility to perform primary PCI, in particular, provides effective treatment for the patient, minimising myocardial injury and preserving quality of life.
Our service has benefitted from the good working relationship between our system providers, McKesson (Medcon), St Jude and Siemens. The systems have good connectivity and interaction which ensures a smooth workflow for each patient coming through our Cath Lab.
We are proud to say that the Cath Lab team at the Northampton Heart Centre has evolved into a mature, competent and caring group of healthcare professionals working to provide the best care we can for our patient population.
Thank you to all the Cathlab team of Northampton Heart Centre
