The Royal Berkshire NHS Foundation Trust is situated in the centre of Reading covering western and central portions of Berkshire. It is one of the largest general hospital trusts in the country, which has recently undergone £132 Million redevelopment. The hospital provides 813 inpatient beds together with 204 day beds, in doing so it employs 4000 staff.
The specialty of Cardiology provides a combination of inpatient work, a large outpatient service and a full range of Cardiac Investigations. The Cardiac Catheterisation Laboratory is named after the late Dr. Jim Shahi, a Consultant Cardiologist who helped set up the unit in 1994. We have 2 Catheterisation Laboratories which offers an extensive range of elective and emergency procedures. Alongside the labs we have a 16 bedded day bed unit which opens from 8:00 am to 6:00 pm. In 2009 we introduced the Primary PCI service 24/7. This has been implemented very successfully with a median call to balloon time (CTB) of 77 minutes and door to balloon time (DTB) of 28 minutes in the first 12 months. South Central ambulance service provides an excellent response to emergency calls for patients with chest pain. The PPCI team members all live locally and are able to be at the Cath Lab within 20 minutes. This enables patients to receive early reperfusion and optimal treatment and outcomes.
The ward base consists of an 18 bedded CCU Department with 1 Chest Pain assessment bed and a 28 bedded Cardiology Ward including 6 Telemetry beds. The Cardiology Department provides a full range of Cardiac Investigations along with outpatient’s clinics, Rapid Access Chest Pain Clinic and Heart Failure Clinics. A full range of Cardiac Rehabilitation is offered as an inpatient and outpatient service.
What are the sizes of your Cardiology Department and Hospital?
- Jim Shahi Unit – 16 beds
- CCU 18 beds + 1 Chest pain assessment bed
- Whitley Ward – 28 beds
What is the geographical intake area and population served by your hospital?
- Half a million catchment
- PPCI catchment is up to 750,000
How many staff? Roles?
- 5 Consultant Interventionalist Cardiologists
- 1 Consultant Electrophysiologist (visiting)
- 1 Consultant Cardiac Surgeon (visiting)
- 1 Consultant Cardiac Imaging (CT/MRI)
- 2 Associate Specialist
- 3 SpRs
- 3 ST grades
- 2 FY grade juniors
- JSU = 8.2 Nurses WTE
- 3.6 Radiographers WTE
- 24 Cardiac Physiologists (10 Rotates in the Lab)
- 2 Waiting List Officers
- 5 Secretaries
- 5 Admin Staff
- 3 Volunteers
- CCU = 33.5 Nurses WTE
- Whitley Ward = 34.74 Nurses WTE
- Heart Failure Nurses- 2.66
- Cardiac Rehab Nurses - 3
Types of procedures?
Jim Shahi Unit :
- Angiograms (Inpatients and Outpatients)
- PCI
- Permanent Pacemakers
- PPM Box Changes
- Reveals
- Cardioversions
- ICD’s and CRT’s
- EP’s
- Pressure Wire Study
- IVUS
- Rotablation
Cardiac Outpatients:
- Echo
- Stress Echo
- TOE
- Stress Test
- Holter Monitoring
- Tilt Testing
- 12 Lead ECG’s
- Pacemaker Checks
- Cardiac MRI
- Cardiac CT
Types of equipment used?
- Siemens Axiom Artis Dfc & Dtc
- Boston Scientific Rotablation Machine
- Boston Scientific iLab IVUS Machine
- St. Jude Pressure Wire
- Phillips Echo Machines
How many procedures are performed a year? Please list according to type.
• April 2010- April 2011:
Angio’s - 1400
PCI – 618
Elective PCI – 232
Primary PCI – 202
Permanent Pacemakers- 300
EP- 60
Cardioversions- 166
ICD 20
Bi vents 10
CRT 10
What is the approximate percentage of cath lab cases performed radially compared with femorally?
approximately 50%
Does your department offer a Primary Angioplasty Service? If yes, what have been some of the challenges setting it up?
YES 24/7 since April 2009
Challenges:
- Having sufficient staff to cover the service e.g. extra Radiographers recruited and trained up to on call standard.
- Providing training to CCU staff to call PPCI team members, to prepare the Cath Lab for the incoming PCI and to act as runners during the case.
Are any of your staff cross-trained (generic workers)? Future?
- Yes – One Nurse
- Keen to expand this to radiographers and physiologists
What new procedures / techniques have you implemented into the department recently? Future?
- IVUS
- Rotablation
What are the benefits to patients attending your facility?
The best Door to Balloon Time in the Country. See link below:
http://www.bbc.co.uk/news/uk-england-berkshire-11441743
We offer a complete cardiac service and have very low waiting times
How is your inventory managed?
pen and paper
How does the lab handle haemostasis?
- Digital pressure
- TR bands
- Angioseal
- Femstops
What measures has the department implemented to cut costs?
- we use fewer Angioseals these days to cut cost
- Regular Tendering especially high cost consumables
What kind of training can new employees expect to receive?
- In House Training
- Charity fund to assist with training and attending courses for continuing CPD
What kinds of continuing education programs are available to staff?
- Critical Care Course
- Mentorship Course
- IVUS and Rotablation Study Days
- Leadership/management courses
What kinds of competency checks do staff have to undergo once employed?
- General Competency Booklets to all trained staff
- Departmental specific competencies i.e. ECG, BLS, ILS, IABP Training
- They are available for on call rota
Please outline the Department Management structure.
- Consultant Lead
- Operations Manager
- Ward Sister
How do you deal with late finishing of cases? For example staggered working hours or just staff overtime?
Staggered working hours and overtime
What is you policy for company reps within the labs? Are reps allowed to bring food for sharing amongst doctors and staff into the department when they visit?
No
Reducing radiation dose is a high priority in the cath labs. What techniques are employed by your radiographers to ensure dosage during cases is kept to a minimum? Also what is the maximum dose limit a patient can receive in your labs before it is recorded in their notes, and what is the follow-up process?
- Reduced Pulse Rate ( 4pps or 6 pps) dependant on Consultants
- Appropriate collimation
- If dose is 10,000 mcGy m2 or above the radiographer informs the operator who will advise the patient of possible erythema.
What are the advantages for SpR’s training at your facility?
- high volumes of interesting work
- hands on experience
- work with different Consultants
- full spectrum of work
- strongly Consultant led service
- high volume of teaching
What is the best part of working at your facility?
- friendly atmosphere
- good working team
- positive feedback from patients, patient relative, student nurses and other members of staff
- Good and sustained publicity
- staff retention
- efficient service
