Collaboration of district general hospitals with a physician-to-patient approach can deliver a 24-hour primary angioplasty service with favourable door-to-balloon times

摘要

Sandwell General Hospital is an acute district general hospital that provides primary angioplasty service without on-site cardiac surgical facilities. The service was rolled out in stages in July 2005 and achieved 24-hour status by January 2007. Its two distinguishing features are collaboration with its partner hospital of the same National Health Service (NHS) trust for after-hours angioplasties, and mobilisation of interventional cardiologists to whichever one of the two hospitals that patients present to. We aimed to show that 24-hour primary angioplasty service by this collaboration is feasible and can achieve recommended door-to-balloon times. A retrospective audit of the British Cardiovascular Intervention Society database of 381 primary angioplasties over a four-year period from June 2005 to June 2009 was performed. Median door-to-balloon time improved from 80 minutes (interquartile range [IQR] 51 to 107) to 64 minutes (IQR 50 to 85; p<0.007) and the percentage of primary angioplasties achieving recommended door-to-balloon time of <=90 minutes increased from 65% (45/69) to 79% (169/214; p=0.001). In-hospital deaths were 3.0% (10/332) for patients without cardiogenic shock and 6.8% (26/381) for all-comers. We conclude that 24-hour primary angioplasty service in a collaboration of district general hospitals with a physician-to-patient no-transfer approach can achieve favourable door-to-balloon times.