The following interview questions have been answered by Dr John Paisey, Consultant Cardiologist and Electrophysiologist at the Royal Bournemouth Hospital.
What are the sizes of your Cardiology Department and Hospital?
The Hospital has 632 beds and there are 4 cardiac wards (CCU, 2 in patient wards and an Electives ward)
What is the geographical intake area and population served by your hospital?
We serve Bournemouth and the surrounding towns of East Dorset and West Hampshire for secondary referral (300,000). Angioplasty and ICD/CRT services to the Poole and Salisbury area (750,000), and Ablations to all of these areas as well as Dorchester and West Dorset (1.2 Million).
How many staff? Roles?
The Cardiac department as a whole employs 263 staff, mostly ward nurses. The Labs have a complement of 24 physiologists (who also cover other aspects of the service), 17 nurses and 6 radiographers.
There are 9 consultants, 4 PCI, 3 EP, 1 imaging, 1 pacing. We also have visiting cardiologists from Poole and Salisbury, and work closely with colleagues in radiology.
Types of procedures?
We perform a full range of Interventional coronary, device implantation/extraction and electrophysiology procedures.
Types of equipment used?
We have 4 new Siemens labs and a pacing theatre as well as a full range of non invasive investigations, cardiac CT and MRI.
We use Laser systems for lead extraction and PCI, Rotablation PCI, Pressure wires, IVUS and Electro-anatomical mapping systems. Image archiving is through Medcon.
How many procedures are performed a year?
PCI: 2000
Pressure Wire: 650
IVUS: 650
Pacemakers: 650
Ablations: 500
ICD/CRTD: 150
CRT P: 50
What is the approximate percentage of cath lab cases performed radially compared with femorally?
70% of cases are performed radially.
What protocols has your department implemented to reduce door-to-balloon time?
We have a direct link from the ambulance service to the Lab, giving an average door to balloon time of 40 minutes.
Are any of your staff cross-trained (generic workers)?
Some of our staff are dual trained in nursing/ODP. We plan to introduce more generic working in the future.
What new procedures have you implemented into the department recently?
With the increasing financial pressures we are working hard to get maximal value with out compromising on quality. Staff are now aware of the cost of each consumable to focus efficient working.
How is your inventory managed?
Barcodes
How does the lab handle haemostasis?
Most femoral cases receive angioseals.
What measures has the department implemented to cut costs?
Consultants have introduced a flexible working regime to cover inpatient work. We are working hard to reduce our length of stay.
What kind of training can new employees expect to receive?
New employees receive extensive on the job and off site training opportunities.
What kinds of continuing education programs are available to staff?
There is a funded study budget and staff our encouraged to enrol on industry sponsored events.
What kinds of competency checks do staff have to undergo once employed?
Staff are expected to keep up to date with their training and practice. This is monitored through HR.
Please outline the Department Management structure.
Cardiology falls within the general medicine directorate which has a general manager answerable to the board. Cardiology has its own departmental manager and she supervises leads from each of the disciplines. Radiology is a separate directorate.
How do you deal with late finishing of cases? For example staggered working hours or just staff overtime?
We have an on call team with responsibility for mopping up late cases. They are paid an availability allowance and for the in-hospital work they do out of hours. Other overtime is attempted to be reduced to the minimum manageable.
What is your 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?
We welcome reps bearing gifts of food. No value line please.
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?
Where possible we reduce frame rates on fluoroscopy, and we use Radpads for CRT cases to reduce scatter. Everyone always hangs their leads up.
What are the advantages for SpR’s training at your facility?
We have 5 SpRs, 3 PCI fellows, 2 EP fellows and an Imaging fellow. SpRs receive training in pacing, Echo, TOE, angiography and where appropriate PCI/EP. PCI fellows perform 500 procedures per year, EP fellows learn all aspects of device implantation and ablation including AF ablation. The imaging fellow has opportunities in echo, TOE, CT and MRI.
What is the best part of working at your facility?
We are a tight knit friendly group who all get on well and are focused on providing an excellent service. The knowledge of the quality of service we provide and appreciation our patients express is very rewarding.
We are also a forward looking centre, and are the only UK centre performing tertiary services such as complex EP and extraction from a DGH setting. On the PCI front we are prominent in running 4 laser workshops a year as well as having hosted BCIS last year.
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