Cardiology

All hospitals must deliver cardiology services as part of a defined and agreed network model. a) GIRFT will work with NHSE/I to scope a strategy for clinical networks. b) GIRFT will work with networks to conduct an audit of services in preparation of a move to a network model of care.

All hospitals receiving acute medical admissions must have a consultant cardiologist on-call 24/7 who is able to return to the hospital as required. There should be a consultant job planned specifically to review newly admitted and acutely unwell inpatients 7/7 and a consultant job planned (note this may be the same consultant) to deliver 7/7 review of other inpatients, ensuring continuity of care. a) GIRFT to work with Health Education England (HEE), NHSE/I and professional societies to audit workforce requirements for a comprehensive 24/7 cardiology service.

All NHS consultant cardiologists should, by default, participate in an on-call rota for general and/or specialist cardiology. a) GIRFT to work with HEE, NHSE/I and professional societies to audit workforce requirements for a comprehensive 24/7 cardiology service.

All members of the wider heart team should be supported to work in extended roles and trusts should ensure that appropriate staff (including ACPs, specialist nurses and cardiac physiologists) are trained, accredited and authorised to prescribe medications relevant to their role. a) GIRFT to work with HEE, NHSE/I and professional societies to audit workforce requirements for a comprehensive 24/7 cardiology service.

Each network must ensure that there are clearly defined patient pathways covering all acute hospitals for the provision of 24/7 emergency temporary pacing and 7/7 permanent pacing. a) GIRFT to work with HEE, NHSE/I and professional societies to audit workforce requirements for a comprehensive 24/7 cardiology service.

All outpatient referrals should be triaged with maximum use made of the ERS–Advice and Guidance function. Appropriate investigations should be requested so that all results are available for advice or review in clinic. Clinics should, by default, be conducted virtually unless not feasible for the patient or if 'face-to-face' is required to progress clinical decision-making. a) GIRFT to work with the Outpatient Transformation Programme (OTP) to scope strategy for continued cardiology outpatient transformation. b) GIRFT will support the Royal College of General Practitioners (RCGP) and NHSE/I to create referral guidance that covers outpatients and imaging in primary care. c) Digital solutions should be exploited to improve patient pathway and access to information across the system.

Networks should ensure that stable chest pain pathways are consistent with the recommendations of NICE CG95. Invasive angiography should, as a default, be performed as '?proceed' and must be performed in PCI-enabled cath lab by a PCI-trained operator. a) GIRFT will support NHSE/I regions and networks to audit current level of trust implementation of clinical pathways.

Networks must ensure that all hospitals performing PCI have a 24/7 on-site rota for urgent return to the cath lab. a) GIRFT will support NHSE/I regions and networks to audit current level of trust implementation of clinical pathways.

All designated PPCI centres must provide a 24/7/365 service and all PCI operators should, by default, participate in a PPCI on-call rota. a) GIRFT will support NHSE/I regions and networks to audit current level of trust implementation of clinical pathways.

For the acute chest pain pathway, all networks should provide 7/7 ACS lists, accessible to all hospitals in the network. Coronary angiography '?proceed' should be performed within 72 hours for patients without high risk features, within 24 hours for high risk patients and within 2 hours for the highest risk patients. Where cardiac surgery is required, this should by default be undertaken within seven days of coronary angiography. a) GIRFT will support NHSE/I regions and networks to audit current level of trust implementation of clinical pathways.

In each hospital there should be a specialist consultant lead for HF, supported by a multidisciplinary HF team. Secondary care services should be integrated with community teams, with regular joint multidisciplinary meetings (MDMs). a) GIRFT will support NHSE/I regions and networks to audit current level of trust implementation of clinical pathways.

All networks should ensure that rehabilitation is offered to all eligible patients, including those with HF. a) GIRFT will support NHSE/I regions and networks to audit current level of trust implementation of clinical pathways.

All networks should ensure pathways are in place for the diagnosis and management of patients with heart valve disease, including referral to specialist aortic and mitral/tricuspid teams at a tertiary centre. a) GIRFT will support NHSE/I regions and networks to audit current level of trust implementation of clinical pathways.

Arrhythmia pathways should incorporate rapid access clinics, which may be led by ACPs, specialist nurses or cardiac physiologists, for the assessment of palpitations and suspected or confirmed AF. Cardioversions should, by default, be nurse, physiologist or ACP led and undertaken outside the cath lab. a) GIRFT will support NHSE/I regions and networks to audit current level of trust implementation of clinical pathways.

Networks should ensure that all hospitals admitting acute cardiology patients have 24/7 access to emergency echo including the facility for immediate remote expert review as required. Elective/urgent echo should be routinely undertaken 7/7. Urgent TOE should be available 7/7 and delivered on a network basis). a) GIRFT to work with NHSE/I, BSE and cardiac networks on creating new models for cardiac imaging, ensuring timely investigations using the most appropriate modalities for patients.

Networks should ensure that all hospitals have ready access either on site or at network level to CTCA including CT-FFR, with all of the images reported by appropriately trained cardiologists and/or radiologists. a) GIRFT to work with NHSE/I and cardiac networks on creating new models for cardiac imaging, ensuring timely investigations using the most appropriate modalities for patients.

Networks should ensure that all hospitals have ready access on a network basis to dedicated sessions of CMR, including stress CMR, with all of the images reported by appropriately trained cardiologists and/or radiologists. a) GIRFT to work with NHSE/I, BSCI, BSCMR and cardiac networks on creating new models for cardiac imaging, ensuring timely investigations using the most appropriate modalities for patients.

Nuclear cardiology services, including PET and PET-CT, should be available at a network level. a) GIRFT to work with NHSE/I and cardiac networks on creating new models for cardiac imaging, ensuring timely investigations using the most appropriate modalities for patients.

All networks should ensure that: (a) there are MDMs for HF and device implantation for all relevant patients within the network; b) there are MDMs for review of patients for revascularisation, aortic valve disease, mitral/tricuspid valve disease, endocarditis and EP at network level; and (c) there are pathways to access external MDMs in ICC, ACHD, advanced HF and low volume interventions if these are not provided within the network. a) GIRFT to work with NHSE/I, trusts and cardiac networks to ensure appropriate MDMs in place as per guidance.

All trusts should ensure that audit teams are appropriately resourced to provide weekly uploads of data to the national cardiac registries. a) NHSE/I should work with GIRFT to ensure the financial sustainability of cardiac registries. b) All trusts should assess resource requirements with a view to completing weekly uploads.

Trusts must ensure that there is regular clinical validation of coded data, that all relevant clinical information is captured and readily available to coders and that clinical staff are fully aware of the importance of accurate coding, especially that of co-morbidities. a) Coders have full access to clinical record that is easy to view and interrogate. b) Use EPRs to ensure that all clinical information on a patient is captured. c) The GIRFT clinical coding team to work with trusts to make sure staff are trained to capture all relevant information.

Care pathway redesign using digital tools needs to be clinically led and patient centred. Examples of good practice can be found in the NHSX Cardiology Digital Playbook and appropriate governance standards should be adhered to. a) GIRFT will support ongoing work of NHS Digital and NHSX in (including NHS Digital Playbook) the digital transformation of cardiology services.

All networks should implement robust evidence-based prescribing guidelines which are regularly reviewed and cover both primary and secondary care, ensuring optimal outcomes for patients across the clinical interface. a) GIRFT to support trusts and networks to implement prescribing guidelines.

NHSX and the Department of Health and Social Care should work to ensure that there is clinical engagement with the procurement of cardiac devices and that all devices are subject to systematic surveillance to ensure their safety and efficacy. a) Improve awareness of costs and product utilisation across the NHS by providing cardiology supply chain analytics. b) Work with NHSE/I to prioritise and review the safety, efficacy and relative risk of all cardiology Class III and Class IIb devices in the NHS supply chain. c) Work with NHSX and NHS trusts to support the implementation of Scan4Safety and POCT in cath labs as well as to submit data to the NHS Digital Medical Device Information System (MDIS). d) Work with the HCTED programme on device assessment and supply chain surveillance data to support implementation. e) Work with NHS Supply Chain and the cardiology devices industry to improve supply chain value and resilience in cardiology device supply chains. f) Work with NHSX, NHS Digital, HQIP, NICOR and the cardiology devices industry to review existing registry and audit activities as well as to define a roadmap for a cardiology device level outcome registry and to realise the value of NHS data for development and innovation.

Trusts should work to reduce litigation costs by adopting the GIRFT 5-point plan. a) Clinicians and trust management to assess their benchmarked position compared with the national average when reviewing estimated litigation cost per activity. Trusts would have received this information in the GIRFT Litigation data pack. b) Clinicians and trust management to discuss with the legal department or claims handler claims submitted to NHS Resolution included in the data set to confirm correct coding to that department. Inform NHS Resolution of any claims which are not coded correctly to the appropriate specialty via CNST.Helpline@resolution.nhs.uk c) Claims should be triangulated with learning themes from complaints, inquests and patient safety incidents. d) Where trusts are outside the top quartile of trusts for litigation costs per activity GIRFT will be asking national clinical leads and regional hubs to follow up and support trusts in the steps taken to learn from claims. GIRFT will share examples of good practice with trusts where it would be of benefit.