The Royal Cornwall Hospital NHS Trust, has been in the news recently due to cash flow problems, however although many hospitals throughout the UK suffer similar problems, the Royal Cornwall has been very proactive in relation to getting the budget back on track.
The hospital has a modern open plan feel with very friendly and helpful staff, both of which are often lacking in many bigger hospitals.
This interview was completed in October 2006. For up-to-date comments please refer to the video.
Hospital and Cardiac Labs:
The Royal Cornwall Hospital Trust (RCHT), in the extreme south west of England, serves a population of 400.000 people in Cornwall and the Isles of Scilly. Cornwall is a popular holiday destination all year around and the population increases noticeably during the summer months. We frequently treat patients that have become unwell during their holiday. The Cardiac Catheter Laboratories (CCL) are based at Treliske Hospital in Truro, a busy District General Hospital (DGH). Truro is the only city in Cornwall.
There are two labs comprising of the Siemens Coroscope Plus and Axiom Artis Flat Plate. The digital archiving system is Medcon, and there is also a TOMCAT database. Haemodynamic monitoring is via a Marquette Mac Lab 5000 and a Fysicon system.
The first CCL opened in May 2000 for diagnostic angiography, pacing procedures and EP studies. In 2001 a selective PCI service was introduced. Since 2005 we have a second CCL and provide 17 to 20 sessions a week. We work closely with our 18-bedded Cardiac Investigation Unit (CIU). The CIU team organise a pre-assessment clinic for all elective patients and provide nursing care pre and post all CCL procedures. Inpatients from non-cardiac wards are also admitted here, usually the day before the CCL procedure, to ensure thorough preparation of the patients. Overall, since the opening of the CIU in 2005, the CCL have been able to work more efficiently.
Staff Roles:
We currently work in the ‘traditional’ CCL set up. Nurses are responsible for all aspects of patient care as well the overall organisational running of the labs. Nurses act as scrub nurse or runners during the procedure.
Radiographers are responsible for operating the X-ray machine and all aspects of image storage. The fairly new PACS (Picture Archiving and Communication System) system allows viewing of all clinical images on computer monitors within the trust.
Cardiac Technicians are responsible for the haemo-dynamic monitoring during procedures as well as recording of procedural details on the TOMCAT system.
CCL staff have their own roles but will help each other out and multi-task as and when required.
Generic Working:
We are working towards a generic working programme by developing a competency based, in-house ‘Cath Lab Practitioner’ training course.
Day case procedures:
All patients awaiting elective angiogram, EPS, TOE and Cardioversion are day case procedures. These patients have been pre assessed and are cared for on CIU (Cardiac Investigation Unit). Patients, without an adult carer available at home for the night following the procedure, are admitted over night.
Private Cases:
We regularily perform private procedures outside the regular NHS lists. Most of these patients are cared for on the CIU or the nearby Capio Duchy Hospital.
Types / Volume of Procedures per Year (2005/06):
Diagnostic angiography = 2600
PCI = 850 (in 70% of procedures DES used; 28% of procedures GPllb/llla blocker used)
PPM = 450
EP/RF = 30
ICD = 40
IVUS = 13
PWS = 78
Surgical Back-up:
The nearest Cardio-thoracic operating theatre is Derriford Hospital in Plymouth, Devon. Failed PCI patients requiring urgent surgical intervention are transferred by Air Ambulance.
Haemostasis:
60% of all procedures are performed using radial arterial access. Radial arterial sheaths are removed in the CCL and a Terumo TR band is applied for later removal on the wards.
75% of CCL nurses are trained in the deployment of Angio Seals, which are frequently used.
Femoral arterial sheaths are removed by nursing staff on the cardiology wards using digital pressure or Femo stop devices.
Inventory:
All stock is purchased outright.
Nurses in the CCL and our Health Care Assistant are involved in ordering and stock control by accepting responsibility for a specific area, e.g. guide catheters, wires, DES, pharmacy, disposable procedure packs. This system seems to work well and no single person is overwhelmed by this time consuming task.
Due to storage restrictions, orders have to be placed weekly. There is an annual stock check for the benefit of the finance department.
Cost Cutting and Alliances:
Continuously rising procedure costs have to be balanced against budgetary restrictions.
The Catheter Laboratories in Plymouth, Exeter, Torbay and Truro are part of the South West Peninsula Purchasing Alliance. The main aim of the alliance is to reduce purchasing costs by combining the requirements of four hospitals. Tender contracts are negotiated for the alliance and not individual hospitals. High cost items are tendered annually.
For example, disposable procedure packs have been standardised between the participating Catheter Labs to reduce the purchase price.
Training / Continuing Education:
New staff benefit from an orientation program as well as multi disciplinary formal and informal teaching. The RCHT has an extensive in house training program for continuous clinical and non-clinical education. There are regular educational meetings within the cardiology directorate.
Staff are encouraged to attend meetings and conferences and to develop special interests. Self directed learning is expected of all members of the multi disciplinary team to continuously further their knowledge of cardiology.
CCL nursing staff from Plymouth, Torbay, Exeter and Truro founded SWING – South West Interventional Nurses Group. Generous sponsorship has made this regular professional and social meeting possible and provides a lively discussion forum. Past topics include payment by results, primary PCI, and generic working.
Competencies:
Staff are expected to achieve competencies in IV cannulation, basic and immediate life support/ defibrillation. Nurses should also achieve competencies in groin management and femoral arterial sheath removal.
Challenges:
The usual… staffing shortages, high demand on service, lack of money.
The best bit about working at the Royal Cornwall Hospital Cath Lab:
Working with a lively team of committed and hard working individuals.
And finally, there is Cornwall, with hundreds of the most beautiful beaches, fantastic recreational opportunities, pasties and, if you want, a different life style.
As a recent survey said, ‘…people living in Cornwall are the happiest in the UK…' |
