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Abstract
Introduction In Northern Ireland, the regional cardiac surgery service is based at the Royal Victoria Hospital, Belfast and serves 12 referring cardiology units for inpatients requiring urgent surgery. A service improvement initiative was commenced in 2014 and included the institution of a regional MDM based at RVH and local MDMs based in the lead hospital in 3 of the other trusts. A video clinic was introduced for remote surgical assessment of inpatients in outlying units. All units were visited by members of the surgical team and guidance for work up of patients for surgery issued. We analysed the effect of these changes on inpatient waiting time for surgery.
Methods Data on 1784 patients referred for inpatient cardiac surgery over the 4 year time period from April 2014 to March 2018 was analysed. The date from admission to the cardiology ward and referral for surgery (referral waiting time – RWT) and the date from referral for surgery and the date of the operation (surgical waiting time – SWT) were taken from the prospective maintained database for referrals (the ‘whiteboard’). The total waiting time (TWT) was the sum of the RWT and the SWT.
Results Overall, 1402 patients (79%) proceeded to surgery in with a mean total waiting time of 32 days (SD 22.1, median 28). The mean values for waiting times for each quarter year (Q) are shown in figure 1. There was a reduction in the mean TWT from 37 days (SD 20.0) in Q1 of 2014/15 to 24 days (SD 11.65) in Q1 of 2018 at the end of the study. This improvement was due to a fall in the mean SWT of 12 days (43%). The RWT, however, did not change.
Wait & referral times
Conclusions Improvements in the pre-operative pathway for cardiac surgery have reduced the time patients wait for urgent inpatient cardiac surgery in Northern Ireland effectively creating 13 additional cardiology beds each day across the province. The value of this to the NHS in Northern Ireland should be self-evident. Further reductions in waiting time could be achieved by improving the pathway in the referring cardiology unit and reducing further the surgical waiting time. The latter requires sustained investment in cardiac surgery and, given the current issues in delivery of acute hospital care, is imperative.