Southampton General Hospital, part of the Southampton University Hospitals NHS Trust, is located on the south coast of England, only two hours train journey from London. The hospital itself is recognised internationally as one of the UK’s most successful healthcare organisations, with the cardiology department recently undergoing a major expansion, becoming one of the largest cardiac departments in Europe. The population served by the unit is a staggering 2.8 million people coming from southern England, the channel islands, and occasionally mainland Europe itself.
1) Cath lab facilities?
Southampton General is a 1200 bed acute site, including the regional centre for cardiology. The cardiac services are now provided in a brand new £60 million new build including 5 catheter labs, 2 labs have biplane x-ray and these are used as a dedicated paediatric lab, the other lab is dedicated for EP. The 5th lab is being commissioned to include advanced navigation equipment for PCI/EP. Included in the new build is a dedicated cardiac MRI scanner, plane x-ray film room and a 16 bed cardio-thoracic Intensive Therapy Unit (ITU).
2) Staff Numbers?
- 13 (WTE) radiographers, the extended roles include IVUS.
- 12 (WTE) nurses extended roles include sedation and contrast injections for angiograms.
- 4 Healthcare Assistants
- The cardiac physiologists rotate between invasive and non–invasive and extended roles include pressure wires and non industry supported ICD/CRT implants.
Full range of diagnostic and interventional procedures in paediatrics including trans-catheter valve replacement, EP (including Ensite/NavX and Carto), routine and complex PCI (including rescue and 24/7 primary PCI). Southampton is also involved in international PCI, EP, and implantable device clinical trials.
4 Siemens axiom artis. MRI avanto 1.5 T. GE mac labs Bard EP lab system J & J Carto advanced mapping St Jude Ensite advanced mapping IVUS, pressure wire Medcon archive
5) Procedures performed in a year?
4500 procedures a year, including paediatric diagnostic and interventional, adult diagnostic and interventional agiography, adult and paediatric EP and pacemaker, ICD and CRT implants
6) Day Cases?
Yes. At the moment only routine angiograms and pacemaker generator replacements are performed as day cases. Routine EP day cases are to start soon.
7) Surgical back-up?
Yes. We have 24/7 internal surgical cover for both paediatric and adult patients.
8) New procedures recently implemented?
Primary PCI. Percutaneous valve replacement. New cutting edge techniques for PCI.
Almost exclusively arterial closure devices are used. Digital pressure for venous haemostasis performed by nurses.
10) Private cases? Any special considerations?
Occasionally private cases are performed at SGH which in the past we have had an arrangement for waiting list initiative cases.
11) Inventory Management?
We have barcode computerised stock control system and a full time stores person dedicated to cath labs.
12) Alliances with other hospitals for the treatment of patients?
We have a hub and spoke approach for rescue and primary PCI and complex EP cases.
13) Measures implemented to cut costs?
Procurement of consumables. Shared contracts for radiology with other departments. Negotiation of new equipment. Regular cath lab user group meeting s to improve efficiency.
14) Cross Training?
Within the lab there is high degree of flexibility and co-working between the professions, but no formal generic training programme is in place. The cath lab coordinators role is also rotated on a daily basis between the senior nurses, cardiac physiologists, and radiographers to ensure an efficient throughput of patients.
15) Training for new employees?
Full trust induction. Also the nurses, cardiac physiologists and radiographers have their own departmental signing off of competencies.
16) Continuing education programs for staff?
All staff are encouraged and funded to attend national conferences and study days.
Trustwide manadatory study half days once a month. In the cath lab we use this time for individual study, ALS training, mandatory training, ECG training and cross discipline training in new techniques.
Frequent study days as part of a cardiology education programme with a 1 million ‘heart beat education centre’ with all labs, theatres, TOE room linked with audio and camera’s.
Several live case study days have been performed since the September opening including live link ups to us for TCT in Washington DC, and to Minneapolis for teaching and ‘first’ implants of new medical devices.
17) Some of the challenges setting up the department?
It is a similar story throughout the United Kingdom that we have sometimes struggled to find the experienced roles often needed for a regional cardiac centre. Three years of design work and negotiation with architects, planners, builders, and equipment manufacturers to implement the 60 million new build. This was a co-ordinated by a commissioning team set up by the senior members of each discipline who use the lab, led by the lead superintendent radiographer. Dealing with cardiologists, anaesthetists and surgeons!!
18) What is the best part of working at your facility?
A significant amount of our staff have worked within the cath labs for a number of years creating a ‘family’ environment. The cath lab is known locally as the rest home for radiographers!! We’re not all that old!!