15 Service improvement project evaluating the effectiveness of a pathway change for myocardial infarction (MI)/percutaneous coronary intervention (PCI) patients referred to a UK Cardiac rehabilitation (CR) service
The National Certification Programme for Cardiac Rehabilitation (NCP_CR) is a joint initiative between the British Association for Cardiovascular Prevention and Rehabilitation (BACPR), the British Heart Foundation (BHF) and the National Audit for Cardiac Rehabilitation (NACR) that reports on the quality of Cardiac Rehabilitation (CR) in the UK. Data is used to benchmark, and quality assure services. CR programmes are accredited by achieving all 7 Key performance indicators (KPIs): NACR NCP CR Outcomes Report 2021/22 state that our local service was meeting sufficient standards to be classified as: Amber – meaning 4 – 6 of the 7 minimum standards were met. One standard KPI identified requiring attention was: - Standard 6: National average for wait time MI/PCI (days): 48.5 local value (target is ≤median of 33 days in England). It has been shown that the earlier patients are seen and started on their CR programme, the more likely they are to engage with the process and have better outcomes (BACPR 2023).
Aim
To implement a pathway change to reduce waiting times for MI/PCI patients (discharge to 1st assessment); in order meet KPI NACR standard 6.
Method
A service improvement project was undertaken to implement and review current waiting times. The clinical team highlighted barriers and established a coordinated response to the new pathway. The CR team transitioned from the old pathway (post discharge call (1-5 days) and 1st assessment 2-3 weeks later), to completing the 1st assessment (1-5 days post discharge) and being invited to complete their functional capacity test at an additional date (two part assessment). New pathway was implemented 1st April 2023.
Results
Data analysed 1-month prior and 3-month post pathway implementation March –June 2023, for comparison the same time frame for the previous year was analysed (Figure 1). A total of 437 patients were analysed in these time periods. A reduction of median 20 days post pathway implementation was achieved.
Conclusion
Service evaluation has allowed us to implement and measure the impact of a pathway change for the assessment wait time for patient's post-MI/PCI. The new pathway has been effective and impacted wait times for patients receiving 1st assessment at CR at UHL, aligning with BACPR core standards 2023 stating; upon receipt of referral those eligible shall be contacted within 5 working days, also facilitating NACR accreditation.
