NORTH OF SCOTLAND PLANNING GROUP

CARDIAC PLANNING EVENT24th February 2010

Aberdeen

Cardiac Activity NOS

• Start 1975• Last 15 years Range = 540-675• Average : 600 cases/Year• All types of Adult Cardiac Surgery, except

cardiac transplantation• All types of Adult Thoracic Surgery , except

transplantation

For every 1 million population 400-500 CABGs are required...NOS 1.2 million = Approx. 500-600 CABGs

CABG and the Age TrendsOver the last 4 years 1791 cabg cases were performed in NOS:

• Grampian= 1009• Highlands = 323• Tayside = 352 • Orkney = 41• Shetland = 28• Fife = 23• England =7 • Western Isles = 4• Wales / Forth Valley =1

> 70 Year old = 39 % > 80 Year old = 5 %

Can we deny treatment on basis of age?

North of Scotland CT Surgery Unit

• 2 Dedicated Operating Theatres• 6 Bed Cardiac ITU (5 Staffed beds 24x7) (CITU)• 6 Bed High Dependency Unit (W51) • 32 Bed WARD (W50)

NOS –CTH Surgery Unit Staffing

• 5 CONSULTANTS SURGEONS• 5 WTE CONSULTANTS ANAESTHETISTS• 2 SPECIALITY DOCTOR (STAFF GRADE)• 7 SpR/ CLINICAL FELLOW/ STA• 3 FY2• 5 MEDICAL SUPPORT NURSES• 3 SURGICAL SUPPORT PRACTITIONER (TRAINEE)• 4 PERFUSIONISTS/ +1 TRAINEE

The Scottish Coronary Revascularization Register 2008-2009

ERI GJNH NOS Scotland %

CABG 587 725 365 1677 55.6%

C+V 133 183 94 410 13.6%

Valve 258 311 122 691 22.9

C+V+O 10 11 2 23 0.8%

C+O 5 11 5 21 0.7%

Other 22 65 15 102 3.4%

TOTAL 1050 1351 613 3014

The Scottish Coronary Revascularization Register 2008-2009

Observed and predicted in-hospital mortality (CABG)

Mortality ERI GJNH NOS Scotland

Alive 572 (98.3%) 691(96.6%) 358(98.9%) 1621(97.7%)

Died 10 (1.7%) 24(3.4%) 4 (1.1%) 38 (2.3)

EuroSCORE Additive –Mean (SD)

3.6(2.9) 3.5(2.6) 4.1(3.1) 3.6(2.8)

EuroSCORE Logistic –Mean(SD)

4.1(7.3) 3.7(5.2) 4.9(7.7) 4.1(6.6)

The Scottish Coronary Revascularization Register 2008-2009

Observed and predicted in-hospital mortality (CABG) (Elective)ERI GJNH NOS Scotland

Alive 427 (98.6%) 574(98.0%) 239(99.2%) 1240(98.8%)

Died 6(1.4%) 12(2.0%) 2(0.8%) 20(1.6%)

The Scottish Coronary Revascularization Register 2008-2009Observed and predicted in-hospital mortality (CABG) (Urgent)

ERI GJNH NOS Scotland

Alive 129(97.7) 113(90.4%) 113(99.1%) 355(95.7%)

Died 3(2.3%) 12(9.6%) 1(0.9%) 16(4.3%)

Keeping up with New Techniques

• As a whole: Sensible open-minded approach to new techniques and treatments

- Off-pump Revascularization -AF Ablation -Minimally Invasive MV Surgery (2 patients

from Highlands and Tayside) -Antegrade Cerebral Perfusion for aortic

surgery

ECMO AND VAD

• Only Scottish Centre which has experience in Extra Corporeal Membrane Oxygenator in Adults

• Ahead in experience with Ventricular Assist Devices

• Most of the complex aortic surgery including aortic arch are performed in Aberdeen

Full compliance with WTG

Recruitment Pressures

• Medical Middle Grade Staff : Training/Non training (SpR –STA-Core Trainee- Clinical Fellow –Research Fellow –Trust Doctors).. EWHD –Immigration restrictions.. Image of bleak future.

• Anaesthetic Medical Staffing... Improvement• Nursing.. Specialist training, turn over, retention

etc.

Most of the above are problems at NATIONAL LEVEL

Solutions

• Non training :Speciality Doctors “Staff Grade/Associate Specialist” (2WT)

• MMC: Medical Support Nurses (5 WT) along with 3 FYD2 (FY2 cover only 30% of rota requirements)

• Surgical Practitioners (3 Trainees) graduating Aug 2011

Sustainability

• Expanding the non-training grade (SpD)• Replacement of some medical middle-grade

posts with Surgical Practitioners posts.• Redesign rota structures and roles taking into

accounts the limitations imposed by CC - AFC-EWHD- Professional bodies –Unions...etc

A transitional period of higher PayRoll during training and replacement ( About 3 Years)

Plans/Future

• Using telemedicine (PACS already)- SCI.. Extending clinical database to region

• MD Meeting revival with Raigmore and Ninewells using technology

• Promotion of managerial and administrative collaboration to achieve clinical effectiveness.

This event today is another step in the efforts to support regional integration... Best wishes!