A review of whether a second cath lab is required at University Hospital Waterford (UHG) has controversially concluded that there is no need and that it should cease its emergency workload.
Niall Herity, who conducted the independent clinical review, said because the existing lab does not meet the accepted standard of carrying out “an absolute minimum” of 100 primary percutaneous coronary interventions (angioplasties) per year, the hospital should cease this service.
He said instead patients should be sent from the region who suffer heart attacks to Cork University Hospital or St James’s Hospital Dublin.
By shedding its emergency workload, it could concentrate on conducting “a much larger volume” of planned cath lab work and ensure patients booked in for a procedure, many of whom travel long distances, were not cancelled at the last minute to accommodate urgent cases, as currently happens.
Dr Herity, clinical director of cardiology at Belfast HSC Trust, said building a second cath lab was “not justified to accommodate the workload” and that instead, the existing lab should be staffed and funded to work for 12 sessions of four hours each, every week. Currently the lab is open from 9am-5pm.
Dr Herity said the range of planned cath lab work that UHW currently undertakes for its catchment population should continue and that the interventional cardiologists at the hospital should continue to carry out angioplasties by taking part in the 24/7 primary PCI rota centred in CUH.
In addition, cardiology services in the South/South West hospital group should “agree a strategy that makes best use of their combined excellent skills, cath lab facilities and teams, in order to optimise clinical outcomes for all the patients across the hospital group”.
In an approach that is causing controversy, Dr Herity based his conclusions on a catchment population of 286,147 — clinicians in UHW argue the catchment population is c.500,000.
However, Dr Herity argues that he tracked hospital admissions for cardiac catheterisation and angioplasties by county of residence and that residents of Carlow, Kilkenny, and Tipperary North travelled in much greater numbers to Limerick or Dublin hospitals for treatment – hence the reduced catchment population.
Dr Herity said there was “insufficient local population need” to justify an additional 24/7 cath lab in the south east and that there would be a “significant risk that a 24/7 centre at UHW would not be able to guarantee a robust, sustainable rota of consultants and cath lab staff”.
There are currently two interventional consultants at UHW and there should be three.
Dr Herity also spoke to the National Ambulance Service to establish the “actual times of contemporary blue light journeys from UHW to CUH” and found it was approximately 90 minutes.
He said of 80 patients who activated the angioplasty service at UHW last year, 54 were within a 90-minute drive time of either CUH or St James’s.
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