Primary Care Acute Chest Pain Awareness. Background BHF Funded Mid & South West Wales Project...

Primary Care Acute Chest Pain Awareness

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Background

• BHF Funded Mid & South West Wales Project– Report from MINAP (Myocardial

Ischaemia National Audit Project)―2005-6 Data―Higher proportion of people in Wales

called/visited GP rather than calling 999 with chest pain

Background

•MINAP Analysis – Network Level– Admission Diagnosis: Definite MI

9%

20%

3%

Background

Cardiac Networks Co-ordinating Group: Call-to-Needle Subgroup Recommendations– Need to raise awareness of symptoms

and a clear message of what to do if symptoms occur1

– Need ongoing innovative campaigns to raise awareness1

1 Recommendations for improving call-to-needle times in Wales (2007); recommendation 1.5

Background• Annual Operating Framework Target

12(2008-9)

– All patients with MI suitable for thrombolysis will have a CTN time < 60 minutes

• ‘The Golden Hour’ and ‘One minute delay = 11 days loss of life’1

1 Boersma E, Maas ACP et al early thrombolytic treatment in AMI: reappraisal of the golden hour; Lancet 348: 771-775

Background

• Standard 3 - National Service Framework for Coronary heart disease (June 2009)– Point 3.10 ‘If a GP is called for symptoms

suggestive of acute coronary syndromes, the GP should call 999 for an ambulance prior to attending to give assistance’

Aims

• To raise awareness within Primary Care of importance of immediate admission of suspected MI

• To reduce pain-to-call time/pain-to-reperfusion time

Project Outline

• Provide poster pathway and education to Primary care– For clinical staff to support management

of acute MI

• Provide workshops in primary care to implement project and raise awareness

Timeframe• Project implementation across primary

care in Mid & West Wales– Commenced November 2008– To be evaluated March 2011

• Project implementation within HM Prison Service in Wales– Commenced July 2010– To be evaluated March 2011

Measurement of Expected Benefits

• MINAP Data comparison

• Project Evaluation

• Pre/Post project staff survey

Interim Analysis 1

• Increased confidence by both administrative and clinical staff in dealing with acute chest pain calls/presentation

1 2 3 4 5 6 7 8 9 10

0%

5%

10%

15%

20%

25%

30%

35%

40%

Confidence Level

Administrative Staff Confidence LevelsChest Pain Presentation in Person to GP Practice

Pre % (n=110)Post % (n=120)

Source: Post-Implementation Awareness and Confidence Survey

1 2 3 4 5 6 7 8 9 10

0%

5%

10%

15%

20%

25%

30%

35%

40%

Confidence Level

Administrative Staff Confidence LevelsTelephone Call to GP Practice Reporting Chest Pain

Pre % (n=110)Post % (n=120)

Source: Post-Implementation Awareness and Confidence Survey

1 2 3 4 5 6 7 8 9 10

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Confidence Level

Clinical Staff Confidence LevelsChest Pain Presentation in Person to GP Practice

Pre % (n=110)Post % (n=120)

Source: Post-Implementation Awareness and Confidence Survey

1 2 3 4 5 6 7 8 9 10

0%

10%

20%

30%

40%

50%

60%

Confidence Level

Clinical Staff Confidence LevelsTelephone Call to GP Practice Reporting Chest Pain

Pre % (n=110)Post % (n=120)

Source: Post-Implementation Awareness and Confidence Survey

Interim analysis 2

• Fewer patients told by staff to make their own way to hospital

Source: MINAP

Interim analysis

• Stated change in practice towards advising 999 call rather than arranging same day appointment/home visit

• Verified change in practice demonstrated through MINAP data

Method of Admission - Administrative Staff

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

To be seen byGP; GP then calls

999 afterassessment

Patient advisedto call 999 (or

surgery call 999if patient

presents inperson)

bypassing GP

To be seen byGP; GP advises

patients to makeown way to

hospital

Patient is triagedto attend surgeryfor assessment

at next availablesame day

appointment

Method of Admission

Perc

en

tag

e

Pre % (n=110)Post % (n=120)

Source: Post-Implementation Awareness and Confidence Survey

Method of Admission - Clinical Staff

0%

10%

20%

30%

40%

50%

60%

70%

80%

To be seen byGP; GP then calls

999 afterassessment

Patient advised tocall 999 (or

surgery call 999 ifpatient presents

in person)bypassing GP

To be seen byGP; GP advises

patients to makeown way to

hospital

Patient is triagedto attend surgeryfor assessment at

next availablesame day

appointment

Method of Admission

Perc

en

tag

e

Pre % (n=110)

Post % (n=120)

Source: Post-Implementation Awareness and Confidence Survey

Source: MINAP

Conclusions• Improved patient care by

appropriately accelerating admission to paramedic/secondary care

• Structured, evidence-based resources, generic and universally suitable for use in all primary care sites

• Reduce call-to-needle times and accelerate care of all ACS patients

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