ICU/HDU and Cardiology Clinical Stream Meeting Thursday 12th June 2008 Attendees: Professor Fletcher, Martin Rowley, Chris Trethewy, Bruce Bastian, Jane Kerr and Karen Chronister Item Discussion Scope of Streams Cardiology Stream: Focus outside big hospitals, including CCU as well as broader range of cardiology issues. ICU Stream: Represents ICU/HDU and Retrieval for all HNE ICU’s. Cardiac Retrieval Patients often fall into category B (this means they have potential for deterioration rather than actually being critically ill). Managing transport for this group requires further discussion. There are a broad range of treatment options for cardiac conditions. There is a need to increase standardisation of care to improve consistency. State wide guidelines will soon become available. Intra aortic balloon pump certification for helicopter transport is not completed but is in progress The cardiology transport nurse system has proven very effective in the metropolitan area. Strategies for increasing its range were discussed (eg use of cardiology transport nurse on the helicopter for category B transfers). Retrieval/transport Cardiology referral boundaries HNEAHS boundaries and cardiology service boundaries are not identical, particularly with respect to pacing services on the Mid Action/Decision Chris Trethewy Item Discussion Interventional/cardiac support in Tamworth Action/Decision North Coast. Agreed to keep this item under review. Cardiology services have been increased in Tamworth. Funding for pacemaker services has been submitted for consideration Interventional Cardiology services have increased despite finite CCU beds in the unit. This increases CCU pts into HDU beds and compromises critical services Discussed option to increase monitored beds into ward 3- stroke. Vascular unit. Issues around role delineation surrounding those beds and burden on ICU MOs. Independent unit is a good initiative but need VMO as director, and clearly defined responsibilities regarding alarms and who is responsible for patients. Advanced cardiology trainee for Tamworth roll out not defined with role delineation and job description. Processes currently underway to clearly define roles and responsibilities of advanced trainee – different to JHH. Need standardisation post stent management and to streamline admission and discharge process Failed lysis Role of angioplasty at Tamworth: Current evidence for rescue .angioplasty unclear and response regarding transfer of such patients is not uniform. An agreed guideline would be useful. Time critical transfers Process of transfer of category B patients is complex. Retrieval medical consultation is sometimes required to smooth the process. Bruce Bastian to follow up Prof Fletcher to revisit issues with committee/stakeholder group. Looking at redesign strategies and 23hr beds etc Prof Fletcher will undertake to get agreement from colleagues. Item Discussion Agreed that Retrieval staff have expertise regarding timing and vehicle selection. Next meeting It was agreed that there would be a further meeting later in the year. Action/Decision