Using QI Methodology to reduce delays in the non-ST Elevation Acute Coronary Syndrome (NSTEACS) Pathway
Jonathan Goodfellow, National Clinical Lead Wales Cardiovascular Network, NHS Wales Executive
Introduction
The primary drivers for change aimed to improve compliance with National Institution for Clinical Excellence (NICE) Quality Standard, enhance clinical outcomes, reduce hospital stays, and lower costs per case. NICE guidelines recommend coronary angiography within 72 hours for high-risk NSTEACS patients, but Welsh hospitals had only 18% compliance.
Baseline data indicated poor compliance and unwarranted variations, leading to longer hospital stays and higher costs, with worse outcomes for delayed angiography patients. The goal was to reduce the time from admission to angiography by 50%, addressing safety, timeliness, effectiveness, efficiency, and equity in care.
Methods
- Engaged stakeholders and subject matter experts.
- Used QI methodology for a limited-scope project in two hospitals.
- Ensured sustainability of staff wellbeing, patient outcomes, economic factors, and project continuation.
- Secured accurate dynamic data, measuring time from admission to angiography.
- Formed multidisciplinary teams from both hospitals, including diverse healthcare professionals and support staff.
- Engagement meetings included baseline data presentations, process mapping, brainstorming, and prioritising improvement ideas.
- Utilised Pareto analyses to identify primary causes.
- Subject matter experts' informed ideas were tested through PDSA cycles and adjusted based on continuous data analysis.
Outcomes
- Combined PDSAs reduced average time from admission to angiography by 45%, achieving 94.72 hours vs. the 72-hour standard.
- Staff engagement improved significantly.
- Enhanced understanding of system-wide changes required for a clinical pathway across two hospitals.
- Front-line teams learned problem-solving using Pareto analyses, excluding biases and anecdotes.
- Initially sceptical teams achieved improvements without extra resources, appreciating QI methodology.
- Costing of pathways before and after improvements facilitated resource reallocation for sustainable clinical pathways.
- Demonstrated Value-based healthcare with potential benefits beyond cardiology patients.
Learnings
- Importance of switching from static to dynamic data
- Recognition of frontline teams' lack of access to continuous data over time.
- Leadership-level difficulties in obtaining necessary data.
- How to ensure a continuous data feed going forward to inform further change. Recognised constraints: time pressures, suboptimal staffing, bed and angiography lab capacity, and competing patient demands.
What next?
Improve data collection: ACS App is due to go live across health boards
Opportunity to Spread & Scale to other hospitals and tertiary cardiac centres across Wales.
