Interventional cardiology services have undergone an enormous transformation in the last 20 years. The numbers of PCI procedures per year has increased substantially and the typical case mix has changed from a mostly elective service to the current day situation where most procedures are performed on patients presenting with acute coronary syndromes. Patients are now typically older and sicker with PPCI, cardiogenic shock, out of hospital cardiac arrest, surgical turn downs, left mainstem and CTO procedures being common clinical situations. This increased risk profile has coincided with an era of greater scrutiny of doctors.
We are all expected to provide data on our individual clinical service for appraisal purposes. In addition, we may be required to discuss difficult cases with patients and their relatives, local serious incident enquiries, the Care Quality Commission, Coroners courts, the General Medical Council and even the police. When dealing with these challenging situations it may be very helpful for clinicians to have up to date information describing an overview of their practice as a whole in order to put an individual case in context.
The NICOR database of PCI procedures is one of the best of its kind and provides an excellent overview of procedures in the UK. Patients who do not have procedures performed do not appear on this database but local departments are still accountable for these cases. The purpose of this current document is to describe a local governance framework which can used by PCI centres on a voluntary basis. This is based on the system currently in use at the Essex Cardiothoracic Centre which works well and is popular with clinicians.
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