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Setting up a STEMI PCI Programme in the UK: Implications for the cath lab workforce

Setting up a STEMI PCI Programme in the UK: Implications for the cath lab workforce. Rob Henderson Trent Cardiac Centre Nottingham Chair, BCS Working Group on Non-Medical Cath Lab Staffing. NO CONFLICT OF INTEREST TO DECLARE . 2004 data: Ludman .

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Setting up a STEMI PCI Programme in the UK: Implications for the cath lab workforce

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  1. Setting up a STEMI PCI Programme in the UK: Implications for the cath lab workforce Rob Henderson Trent Cardiac Centre Nottingham Chair, BCS Working Group on Non-Medical Cath Lab Staffing NO CONFLICT OF INTEREST TO DECLARE

  2. 2004 data: Ludman Estimating the need for Primary PCI Europe and UK UK population 60 million, at 500 pmp = 30,000 PPCI per annum

  3. 2004 data: Ludman UK Growth needed for primary PCI (assuming no increase in other types of PCI) 1050 pmp 1546 pmp 32 % 2.3 %

  4. Consultant Cardiac Workforce requirements in the UK *Assumes consultants dedicated to PCI; assumes UK population 60 million 424 consultants did PCI in 2004 (BCIS) – but majority not dedicated to PCI 710 cardiologists (663 wte) in 2004 (DOH) 630 cardiologists in 2003 (RCP) David Hackett, BCS Working Group 2005

  5. Non-Medical Cardiac Workforce requirements in the UK *Assumes Nurses, Physiologists, Radiographers dedicated to PCI work Assumes UK population 60 million Information about available staff very limited David Hackett, BCS Working Group 2005

  6. Available non-medical clinical staff? *Nursing & Midwifery Council website – includes staff working overseas **Jackie Howard, Catriona MacGregor – excludes cardiographers *** Audrey Patterson – 1563 SOR members work outside NHS

  7. Estimated UK catheter laboratory vacancies Preliminary data – includes diagnostic and PCI labs BCS Non-medical Cath Lab Staffing Working Group survey 2005 *BCIS 2004

  8. Catheter laboratory workTraditional roles in the UK Cardiologist and trainee Do procedure Radiographer (1) Turns on machine and controls C arm 5-7 staff Nurses (1-2) Puts patient on table Draws up drugs Opens equipment Physiologist (1-2) Sets up & monitors pressure line & ECG (Perfusionist – IABP)

  9. Catheter laboratory staffing for PCI in the UK 6.6 6.0 5.8 BCS Non-medical Cath Lab staffing Working Group survey 2005 Preliminary data from 6 PCI centres

  10. Catheter laboratory staffing for PCI *and a cleaner **and a porter

  11. UK UK Number PCI 1200 600 4000 430 2900 900 Cardiologist 1 1 1 1 1 1 Trainee/SpR 1 0 1 0 1 1 Nursing 1 2 2 2 2 2 Physiology 1 2 1 0 1 2 Radiography 0 0 0 0 1 1 Total 4* 5 5 3** 6 7 Catheter laboratory staffing for PCI *and a cleaner **and a porter

  12. Catheter Laboratory Multi-skilling • Cardiac Cath Lab practitioner project • London South Bank University • Middlesbrough generic worker training • In house programme • Nottingham nurse radiography training • In house programme • Need national coordination and funding

  13. Conclusions • A national primary PCI service will need additional medical and non-medical staff capacity - but there are currently significant staff shortages • More trainees and multi-skilling will help but may not solve the problem entirely • If primary PCI is to be rolled out across the UK we need multidisciplinary, flexible, and innovative solutions to medical & non-medical workforce problems • There is an urgent need for robust information about non-medical catheter laboratory staffing to facilitate future planning

  14. BCS non-medical catheter laboratory staffing survey 2006 All cath lab managers ….please, Please, PLEASE…… complete the survey form and return to BCS

  15. Physiology staff vacanciesSCST survey November 2003 15% 8% 60% response Extrapolated to 100% 2005 London survey estimated physiology vacancy rate at 23% (79 wte)

  16. Catheter Laboratory Multi-skilling • Multiple projects across UK • Often driven by local need • Cost of training and release from work • Need transferable qualification

  17. National guidelines and staffing • BCIS/BCS recommendations 2005 • ‘….dedicated multidisciplinary team…’ • ‘….multi-skilling should be encouraged…’ • No statement on appropriate staffing levels • ESC PCI guideline 2005 • No statement on staffing • ACC/AHA PCI guideline 2005 & STEMI guideline 2004 • No statement on staffing

  18. Estimating the need for Primary PCI Modified from David Hackett, BCS Working Group 2003

  19. 2004 data: Ludman Primary PCI in the UK 2004-2005 Number of centres doing routine primary PCI In 2004 51 centres did 3447 PCI for STEMI (1438 PPCI) Data from 55 of 58 NHS centres

  20. Catheter laboratory staff training HPC - Health Professions council NMC - Nursing & Midwifery Council

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