New Site Guidance
In 2001 an ad hoc Advisory Group of the Coronary Heart Disease Taskforce of the Department of Health, chaired by the National Director for Heart Disease, reported on the development of percutaneous coronary intervention (PCI) services.1 The Group concluded that:
- the development of new PCI services should be planned within Networks of Cardiac Care and agreed between all relevant parties
- facilities for PCI in tertiary centres should be fully utilized
- all PCI services should adhere to agreed technical, professional and practical standards
- all sites considering setting up a PCI service should undergo BCIS peer review prior to starting such a service.
Since then the number of hospitals carrying out percutaneous coronary intervention procedures has increased rapidly, and there has been a commensurate increase in the total number of PCI procedures done in the United Kingdom. There has, however, been concern that the development of new PCI services has not always been compliant with the 2001 Advisory Group recommendations. At the Angioplasty Consensus Meeting, hosted by the National Heart Improvement Programme in September 2008, the importance of British Cardiovascular Intervention Society (BCIS) Peer Review for new PCI Services was emphasized and there was broad agreement that this process should be re-invigorated.
Technical, professional, and practical standards for PCI services are currently defined in several documents. 1-5 All PCI services in the United Kingdom are expected to comply with these standards, which are intended to support provision of high quality patient-centred care. BCIS will review the full PCI Guidance documents during 2010, but in the interim this document summarizes and updates BCIS recommendations on the development of new PCI services. The guidance in this document is also relevant to all PCI services in the United Kingdom.
New Site Guidance
P-PCI STEMI Guidlines
NHS England announced the creation of 23 Urgent and Emergency Care Networks in the Spring of 2016. As part of the NHS Planning Guidance, Commissioners and Providers are required to compose ‘Sustainability and Transformation plans’ to describe how patients will access emergency specialist services. Emergency care for STEMI heart attack and quality standards for 7 day services concerning Consultant input and access to diagnostics are prioritised. Simultaneously the British Cardiovascular Society is preparing a report on Out of Hours Cardiovascular Care for Hospital In-patients. This document is a statement prepared by Officers of the British Cardiovascular Intervention Society (BCIS) to inform these discussions. It has been approved by BCIS Council on July 7th 2016.
The Heart Team
Structure and functioning of a Multidisciplinary “Heart Team” in patients with coronary artery disease
Rationale and Recommendations from a Joint BCS/BCIS/SCTS Working Group
1.1 International Guidelines from both the Cardiology and Cardiac Surgery Societies have recommended the utilisation of a Multidisciplinary Team (MDT) approach to assist in guiding the management of patients with coronary artery disease (CAD). Whilst such a process is well recognised as beneficial in other areas of medicine, and also incorporated into some elements of current cardiological practice, its routine use in the context of CAD is less established. The functioning of such a “Heart Team” varies across the UK as does its composition, frequency and the type of cases discussed.
1.2 It is the intention of this document to provide guidance as to the essential components of a Heart Team in terms of how it should be structured and how it should function. This includes its attendance, scheduling and frequency as well as the type of cases to be discussed and the minimum data to be presented. Importantly, it also addresses the required managerial, administrative and technological support, systems of documentation, feedback and audit, and the degree and timing of patient/carer involvement.
1.3 It is acknowledged that working environments will differ; surgical as opposed to non-surgical cardiology centres is one such example. It is envisaged therefore that the fundamental components of this document will form a foundation upon which MDT policy for individual units may then be developed. Similarly it is anticipated that it can be used in order to identify any shortfalls in current practices, prompt those initiatives that will deliver improvement and assist to secure the necessary resources that will then allow a robust MDT process to be established.
These guidelines have been developed by an intercollegiate working party of health professionals from The Renal Association, The Royal College of Radiologists and The British Cardiovascular Intervention Society to outline what is considered best practice for the administration of intravascular iodinated contrast agents to adults. We would like to thank the authors, Dr Andrew Lewington, Dr Robert MacTier, Dr Richard Hoefield, Dr Mark Downes, Dr Andrew Sutton and Dr David Smith.
These joint guidelines have been developed with direct input from The Royal College of Radiologists to ensure compliance with the RCR Standards for intravascular contrast agent administration to adult patients, Second edition.
Please note at the time of publication, NICE (The National Institute for Health and Clinical Excellence) are in the process of developing national clinical guidelines on acute kidney injury at present, which are due for publication in August 2013.
Prevention of Contrast Induced Acute Kidney Injury (CI-AKI) In Adult Patients