Fifth report on the provision of services for patients with heart disease - best electric toothbrush on the market

In the UK, Executive summary services for patients with heart disease are poor.
The Ministry of Health (especially in the UK) has recently recognized the issue and has done a lot to correct it.
Nevertheless, there is still much work to be done.
In order to ensure that our patients deserve cardiovascular services, the key areas that need to be addressed are as follows: implementation of the National Service Framework: situations not included in the NSF should receive the same level of attention as coronary heart disease.
The NSF should be implemented consistently throughout the UK.
Patient participation: few patients have been involved in the planning of cardiovascular services in the past.
Patients need to be more involved in the process so that the service is truly patient-centered.
Staffing: all types of trained healthcare professionals and support personnel required to provide modern and effective cardiovascular services are severely short.
Unless the appropriate number of staff is recruited and retained, the level of care required for heart patients is still not available.
It is essential to address as soon as possible all the factors that lead to the current shortage of staff.
Information technology (IT): IT is complex to provide modern care to cardiologists, and if IT is to ensure the safety of care, IT is necessary to improve the current level of care.
This is essential for education, training, medical records, telemedicine and data collection.
In addition, effective auditing and reliable clinical governance require it.
Reorganization of work practices: this has taken place, especially by reviewing and modifying the roles of employees, with great opportunities to use them more effectively.
This will improve the service to patients.
Maintain standards and quality: quality will only be maintained if all employees have a high level of training and continuous professional development and have effective clinical governance.
Time and resources must be allocated for this aspect of the service, rather than compressing it into existing services. oas_tag.
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The format of the executive summary report This report is designed to be able to read and refer to separate sections with minimal cross-readingreferencing.
This inevitably leads to repetition.
Many of the issues discussed in the report are common to all medical fields.
In all medical areas of the National Health Service (NHS), infrastructure, including IT and personnel, needs to be significantly improved to a similar extent.
This report focuses on the infrastructure needs of heart patient care in order to develop a comprehensive plan for the provision of this service.
In this summary, summarize the general questions together.
It first describes the purpose of the report and the important content of the services needed to treat cardiovascular diseases in 2002.
It then outlines the significant progress made so far, summarizes the remaining problems, and proposes what is needed to raise the level of cardiovascular care in England and Wales to an acceptable standard.
This report is co-sponsored by many groups and patients involved in the care of heart patients (see the box on this page ).
Each section contains a patient and non-professional point of view, and each section has a non-professional summary prepared by non-professional contributors.
There is also a lay version of this executive summary.
Royal College of Physics, (Secretary) Royal College of Physics John Kham, Howard Swanton, British Heart Society Gray, Jane Flint, British Heart Society, james Munro of the British Heart Society, the Royal College of Surgeons of the United Kingdom and the British Association of Thoracic Surgeons and irellandbruce Keogh, the Royal College of Surgeons of the United Kingdom and irellandfrank Dunn, royal College of Surgeons in Edinburgh and Glasgow (lawyer), non-professional member and legal adviser Knight, patient representative, British Association of patients with heart disease, jill Riley, john Gibbs, British Heart Care Association, catriona MacGregor, British pediatric heart association, Simpson, British Heart Society, Mark Davis, Alan Ma Yang Davis, primary care Cardiovascular Society, community Epidemiology and care British heart society Keith Dawkins, Graham Litch, British Heart Society, Kevin Jennings, British Heart Society Tom Quinn, heart Care by the British Heart Foundation Charles George Sir, raffi Kaprielian, registered director of the cardiologist, Lay SummariesMajor administrative and technical support Elizabeth beremi, the purpose of preparing the report technical support report seeks to identify the status of cardiovascular services provided in all areas of the health care system.
This is also a description of the requirement that writing is considered to be to provide the services that our patients need and deserve.
This information should be useful for those involved in advancing services at all levels.
Summarizing the current situation helps to identify areas where real progress has been made in the past few years and areas that will be needed in the future.
Once these areas in need of help are known, use the broad expertise of donors to propose solutions to problems.
The report is not a comprehensive criticism of the current situation.
This approach is inappropriate and will backfire, and will not recognize the very important progress made in the past few years in cardiovascular care organizations and financing in the UK.
What should be the service target for heart disease treatment in 2002?
Services must meet the needs of patients
Is to be patient-centered service.
This requires greater involvement of patients in planning for cardiovascular care.
The service needs to be as close as possible to where the patient resides and to have equal access to all geographical, social and ethnic groups.
This service must respond to changes in practice and cover the whole cardiology, rather than focusing solely on areas highlighted by the national framework for services for coronary heart disease (CHD.
Delays and Pat issues across the country in service delivery need to be addressed.
Care should be safe and appropriate.
This requires a team of appropriately trained and committed experts, with a sufficient number of people and the right resources in terms of equipment, beds, information technology and support personnel.
The NSF and NICE programs are designed to improve care equity.
At present, many patients with severe heart disease are not seen by experts who specialize in training the care of patients with heart disease.
It is essential that a major review of the process of providing heart care in primary, secondary and tertiary care be undertaken.
There are great opportunities to improve the way healthcare professionals work together, the way their tasks are organized and the role they play.
What has been done?
Very significant steps have been taken in many different areas.
In recent years, the Ministry of Health has recognized the importance of coronary heart disease as a very major health problem in the UK, which has driven this.
Through the NSF of coronary heart disease, this awareness has become a reality for patients.
The NSF sets very precise figures for the treatment of coronary heart disease.
These objectives then provide a framework for the redesign of services and ensure that the important standards of care contained in this document are delivered to patients.
In fact, the NSF has been transformed into a significant increase in the number of ongoing coronary vascular reconstruction in England.
The NSF must be updated on a regular basis as care for heart patients is rapidly evolving and the original NSF is now inevitably out of date.
The new local care network is growing rapidly and will provide ways to do so.
This should be the first step in restructuring the approach to providing a large number of cardiovascular care and will lead to integration of level 1, Level 2 and Level 3 care.
With rapid access to chest pain clinics, opportunities to improve access to the system for patients have begun, mainly in the UK.
These measures allow patients who have new chest pain but do not need emergency treatment to see a doctor at the least waiting specialist clinic.
These clinics were established in conjunction with the NSF and are now available in most parts of the UK.
Other aspects of outpatient care are out of date and need to be thoroughly rethought.
Some progress has been made in improving information technology and establishing electronic medical records;
Achieving this goal will be an important step in achieving the integration of care.
The nhs it strategy and the information strategy for coronary heart disease were recently released.
As medicine becomes more patient-centered, it is also important to hear the patient's voice.
The new NHS collaborator is a major step in the right direction.
The national health insurance system is now focused on raising standards.
The emergence of "clinical governance" expands the scope of the audit, covering all aspects that affect the quality and safety of care, a big step forward.
However, it brings with it many real issues that will be discussed below, and in addition, at the moment it is almost only applicable to the health care industry and needs to be extended to all other health care workers.
In this part of this executive summary, the main issues in providing cardiovascular care are highlighted.
Some are already being addressed, at least in part, and many are common in all areas of providing patient care.
Solving these problems requires a combination of new ideas and increased funding.
The cost of the ideal service is unlimited, so the main areas are prioritized in this report.
The needs of patients with heart disease are certainly reflected in all areas of medicine, and there is an urgent need to greatly increase the resources of all types of medical patients, and more people are being sent to hospitals. 1.
The expansion of the NSFThe SF has had a huge impact in the UK.
However, since the health care budget and priorities are the responsibility of the delegated government sector, the NSF has not been implemented in Wales, Scotland or Northern Ireland.
Interest in coronary heart disease programmes equivalent to the NSF in these countries is variable and delayed.
This leads to significant differences in the provision of heart care.
These differences are particularly evident in border areas, especially in areas where cross-border referrals are commonplace.
More homogeneous services must be provided.
CHD is only used for the treatment of coronary heart disease, which is the most important part of Cardiology.
However, there are many other important areas of cardiology and cardiac surgery that also deal with important and life-threatening diseases and have a good evidence base to support effective treatment.
These include heart muscle disease in children and adults, complex heart rhythm problems, Valve heart disease, and congenital heart disease.
These areas often create problems that consume a lot of time, expertise and resources.
These situations need to be taken seriously and given the same attention as coronary heart disease.
They also need funds proportional to their demand for the service.
This must be done thoroughly as soon as possible, otherwise there will be a real danger of imbalance in the whole service, as the emphasis on coronary heart disease can harm a large number of other patients.
The main capital plan planned as part of the NSF will address some of these issues. 2.
Patient Involvement in heart care the entire medical industry has become aware of the need to involve patients in care planning.
This is considered a high priority for heart patients, many of whom need to work with doctors and vice versa to get the best care.
This has been tried and, in fact, there is considerable patience and input in this report.
However, there is a better way to do this.
The British Heart Society is leading the development of this consultation and has set up a working group to promote this development with existing patient groups.
This is a collaborative project with the British Heart Foundation, which already has an important place in the community. 3.
Shortage of staff-
Inside the NHS, well-trained staff are everywhere.
They are valuable and scarce resources for the NHS.
This is largely due to the fact that there are enough trained people to fill these positions.
All the staff who treat patients with heart disease are facing this problem.
For example, a cardiologist, a cardiologist, a nurse, a technician, and a support person (such as a secretary and staff member ).
If cardiologists are to provide 24-hour care to all heart patients, plans to double the number of most medical professional advisers over the next decade may prove inadequate.
Current demand estimates suggest that the number of consultants in most medical professions needs to double;
In terms of Cardiology, the number of consultants will increase from the current approximately 630 to 1200 (approximately 1 out of every 50 000 population ).
However, all secondary and tertiary centres require 24 hours of consultant heart care, plus the European Working Hours Directive, which means that each Regional General Hospital is ultimately (at least) five cardiologists and three-level centers are all needed and more will be needed.
The authors of the report believe that by 2010, the goal of 1500 British cardiologists was not excessive.
Similarly, in pediatric cardiology, there are currently 59 consultants in the UK.
This number needs to be increased to the target level of 1 pediatric cardiologist per 500 population, which makes the total number of consultants in the UK about 120.
The reason for the shortage of personnel-
These vary depending on the group of staff considered.
However, it is clear that the future of different groups of employees is closely linked. In some cases—
Such as cardiologists and cardiac surgeons.
The problem lies not in recruitment or retention, but in inadequate provisions for training and hiring the necessary numbers.
In the case of other staff, there are other major issues that hinder recruitment.
These are complex, but the generally low level of pay and ancillary benefits is a very important factor for very responsible and demanding jobs.
Changing roles—
Over the years, the way work and responsibility have been divided in the health care sector has barely changed, but now there are people trying to change, if not break the pattern.
There are several examples that suggest that responsibility traditionally in one group area may be transferred to another --
For example, the creation of a general practitioner (GP) specialist, the expanded role of a nurse to take over many tasks previously performed by a physician, and multiple
The skills of the technician so that they can do the work that used to require the radiologist and the technician.
Unless there is a sufficient number of groups taking on new responsibility, these measures will not alleviate staffing issues, which is clearly not the case at the moment.
There are too few GPs, nurses and technicians, so it's just that moving around to work can't solve anything.
However, a careful re-evaluation of these services should lead to more cost-effective service delivery in the long run.
Lack of long-term manpower
This has been the case for years and has led to overwork and low morale.
This is associated with the increasing expectations of informed patients and is a major factor in medical errors, patient complaints and high levels of discontent.
In a system, human beings, as providers and recipients of care, can never completely eliminate mistakes.
However, it is important to recognize all the factors that lead to the current situation, and we must work together to correct them.
This will require: a careful review of the system behind work practices.
Since errors are often caused by bad systems rather than individual errors, it should be of great help to introduce appropriate, agreed agreements.
Provide the health care team as a whole with appropriate continuous professional development time and adequate staffing to make up for the absence of basic training by other staff.
Sufficient funding and staff time to support the very important tasks of clinical governance.
It is now necessary for senior staff to spend more time on the process and operation of obtaining patient consent.
Provide time and resources for training and coaching other members of the team and the essential elements of running the revalidation plan.
Provide skilled consulting staff in order to provide the additional information needed by the patient appropriately.
Sufficient staff to allow rotas to comply with the European Working Hours Directive.
All of this additional work is usually added to the already comprehensive agenda, and despite the substantial increase in the workload involved, little additional funding or staffing has been received.
This should not continue.
What can be done in terms of staffing?
These staffing issues are critical to providing effective services to patients with heart disease.
With excellent facilities, it doesn't make sense for no one to work inside.
There is a need for proactive action on a professional level to look at the role of all healthcare professionals providing services and to explore new and more effective delivery models.
In the end, this will be synchronized with the staffing reform of the entire NHS.
It is clear that in the short term this is easier to achieve on a professional level, especially since there is general agreement that this needs to be done.
The issues involved in these reforms are enormous, but without them we will continue to be unable to meet the growing needs and expectations of patients.
Ultimately, this approach will only work if there are also centralized-driven reforms in pay and working conditions to attract people so desperately needed by the service sector. 4.
Good information technology is essential to the operation of the entire NHS, and if provided properly, it will make the service more efficient.
This will help alleviate some of the above staffing issues.
It is especially needed when taking care of patients with heart disease, because when the patient's condition suddenly changes and there is a life-threatening problem, it may require fast and accurate information.
Therefore, all healthcare professionals dealing with patients must have access to this data quickly.
Linking primary, secondary and tertiary care and making the new care network effective will be critical.
This is not the case in most regions.
Clinical governance is closely linked to it.
Accurate data needs to be collected and recorded locally in order to accurately know the results of the treatment of heart patients.
The publication of treatment outcomes contributes to this area, but the quality of the data needs to be improved, validated and risk layered.
Each part of this report makes it clear that, despite recent initiatives undertaken by the Ministry of Health, there is a major problem due to the lack of such initiatives.
Despite the complexity of the problem, this requires a very urgent rectification;
This is an area where a significant injection of money will have a huge impact, whether it is the ability to purchase a system or to hire enough paperwork and computing staff to make the system work.
The British Heart Association intends to develop a comprehensive set of data on heart disease and its treatment.
This will be an effort to work with the Ministry of Health.
Electronic Medical Records
The development of electronic medical records will be immediately available to health care professionals throughout the system and provide appropriate security of secrecy.
This will improve the coordination of care and communication as the cornerstone of medicine. Telemedicine—
Developing computerized links in the distance may allow complex follow-up procedures in the distance, such as checking pacemakers and implantable vibrators, which can be much more convenient for patients. 5.
The reorganization work practice fast track chest pain clinic is a relatively new concept, and its success shows the opportunity to restructure services for the benefit of all.
In the past two years, 30 cooperative networks of coronary heart disease have been established.
Their goal is to redesign the service in order to improve the patient experience throughout the patient journey.
Outpatient clinics are very time consuming and have been doing the same for decades.
The needs of many visits must be checked very carefully and better ways to take care of these patients are found.
This will require the cooperation implicit in the establishment of a local care network.
In addition to the role changes of various staffing groups, it is necessary to carefully study the organization of each group.
In the medical staff, there is a non-
Level of consultant and staff, especially in outpatient heart disease, rehabilitation, quick visit clinics and surveys.
In the United States, there has been an increase in auxiliary staff called surgeons and physician assistants.
They work closely with doctors on the task.
They assist in the operation, obtain and organize the test results, etc.
This saves medical time and costs far less per hour than the cost of a doctor performing these tasks.
Patterns of in-hospital treatment can also be modified, but limitations often come from outside of direct health care systems
For example, the community provides care for patients who need not medical care but society.
There is already a strong interface with social services, which should be improved.
The expansion of the internet will have a significant impact on this area in the future, but we do not have any real feeling about this development method at present.
This will be the primary educational resource for healthcare professionals and patients.
It is used to help the interaction between patients and healthcare professionals, which is very exciting, but is currently developing slowly. 6.
Maintain proper staffing with standards and quality assurance
The standard of care depends on the employment of high-quality employees who do not overwork.
Issues related to adequate staffing were discussed above (Section III. Training—
It is only when the initial recruitment attracts the right people and then the training is of high quality that a high-quality staffing is achieved.
It depends on the availability of appropriate training courses and assessments.
Courses and training methods must be updated on a regular basis.
This is happening in some areas, and courses trained by cardiologists are a good example.
This was produced under the auspices of the Royal College of Physicians and has recently been completely rewritten.
Clinical governance-
In the process of seeking to maintain the standards and quality of care, clinical governance in all aspects is essential.
Continuous Professional Development (CPD )-
This is critical to maintaining standards, and the right number and type of CPD is at the heart of this desire.
This will only be achieved if time permits and there is enough cover to allow people to attend the training, and there is time to organize and provide the training.
This must be included in the staffing level and corresponding funding is required.
The status of research in service is often ignored and takes a short-term utilitarian attitude, so research is seen as a luxury and has no major role in standard training or maintenance.
This is far from the facts.
Research in all areas of the ongoing treatment of patients with heart disease generates a questioning attitude and allows for careful and rigorous interpretation of new data.
It also makes the team working on research proud, which has a positive impact on the quality of the clinical work they do.
At present, the cardiology training course is recommended for one year of study time.
This is not enough to develop independent academic skills.
There is a great need for strengthening academic cardiology in British Cardiology.
This requires more creative and innovative training programs for clinicians and scholars who have been studying longer than they currently do.
Lay summary: fifth report on providing services to patients with heart disease this report is the guide needed to raise the care of patients with heart disease in the UK to a good overall standard.
It aims to help build new services to treat heart disease and improve existing services.
The word heart or cardiovascular care covers all aspects of diagnosis and treatment in patients with heart disease.
This report is written by a team of doctors, nurses, other health care professionals, as well as patients and non-professionals from the public.
Inevitably, there will be rapid progress in any area as complex as providing heart care, which can be difficult to keep up.
In addition, it is expensive to keep up with the progress.
As the new method replaces the old method, the treatment method has changed and is expected to be improved.
The role of the staff providing care and the hospital will also change.
Two good examples are the transformation of many forms of heart care, previously limited to specialist centres, and a very important extension of the role of local hospitals and nurses in providing general and specialist health care.
In many other areas, similar important changes in improving patient care are changing.
It is important that the way in which care is provided is centered on the individual needs of the patient.
Contrary to the belief of some, this is not a new ambition for healthcare professionals who care for heart patients.
In the past, however, it was not as developed, prominent, or universal as it should be.
The patient's point of view needs to be considered more carefully and incorporated into the planning of the way cardiovascular services are provided.
This report is intended to reflect this goal and lead to patient-centered services.
Another key to providing modern and effective services suitable for patients is to carry out multi-disciplinary work at all levels.
All health care professionals, including doctors, nurses, technicians, ambulances, social service personnel and administrators, have a strong will to achieve this goal.
The new local care network currently under development will provide the basis for this.
The Nursing Network is a formal structure that allows close cooperation between primary care (GP clinic or local clinic), secondary care (Local Hospital) and tertiary care (Specialist Heart Center, give the patient good and proper treatment.
Over the past decade, great progress has been made in the diagnosis and treatment of heart disease.
Providing care to patients with heart disease in the UK does not keep up with the growing demand that these advances bring, because these advances are health care that occurs in the context of limited spending in all areas.
As a result, modern care in the UK is not delivered as fast as it should, and now it is bad compared to modern care in many other countries in the developed world.
However, there are now very encouraging signs that the situation is being corrected.
The introduction of the national framework for coronary heart disease services (CHD) is a big step forward, followed by a significant increase in the allocation of funds to achieve the goals of the NSF.
The NSF is a series of care standards carefully developed for patients with coronary heart disease, and if they are met, it will greatly improve the level of care for patients with heart disease nationwide.
They are based on scientific evidence and it is necessary to conduct an examination to assess whether they are being achieved.
The NSF has resulted in a significant increase in the number of heart bypass surgery.
Despite these improvements, there is still a significant shortfall in the care provided to heart patients.
The NSF is being implemented in England, but decentralized government departments in Scotland, Wales and Northern Ireland have not shown the same interest in the initiative.
Although the NSF of coronary heart disease is a welcome step forward, it only deals with part of the problem.
The NSF does not cover many other types of important heart disease
Heart failure, heart rhythm problems, and heart valve disease, for example.
These need to be the same level of concern as the outcome of CHD for CHD.
Such shortcomings can inevitably only be corrected if sufficient resources are available, but resources must be used appropriately to solve the problem.
This report explains in detail what is needed to provide the services that our patients need.
Trained staff lack all types of healthcare professionals needed to fully provide modern and effective heart care.
This includes from a general practitioner shortage to a cardiac surgeon shortage, which is particularly serious in terms of nurses and heart technicians (now referred to as CCSOs.
The shortage of nurses is very serious in very professional areas such as intensive care units, and at the same time, the role of nurses is also expanding.
This extended role of the nurse is extremely important in providing heart care.
Nurses are creating new roles and, to some extent, they are taking over the many jobs that have been reserved for doctors in the past.
Obviously, while there is a lack of nurses available for traditional roles, there is also a major difficulty as more nurses are needed to fill new positions in the extended role.
The same problem occurs throughout the service, but another major problem is providing heart technicians.
Heart technicians who perform the tests required by many heart patients did not have a proper occupational structure in the past, although a very late occupational structure is now being developed.
The main personnel problems faced by the National Health Service (NHS) can only be overcome when the use of staff and the thorough review of recruitment, training, retention, and the remuneration of all health care professionals.
It is true that if there is no properly trained staff to manage, it makes no sense to build and equip new facilities in primary, secondary or tertiary care.
Good communication in information technology (IT) has always been the cornerstone of good clinical care.
This can only be done if it is done well
Is computer.
This is available and it allows all healthcare professionals who deal with individual patients to share information, whether they are treated in the healthcare system.
At the heart of this desire is the creation and introduction of electronic medical records, which are accessible to all healthcare workers.
This is under development, but not yet.
Progress has been made in the development of the National Central Heart Audit Database (CCAD.
At present, this only involves children with heart disease, coronary vascular molding, and national audits of heart attacks, but it should be extended to all areas of heart care.
Nationwide, there is also an urgent need to accurately record surveys, treatments and outcomes in order to monitor the quality of care provided to all patients and improve the quality of care if necessary.
It is time consuming to gather information for this basic task.
Well-trained clerical staff must do so in order to reduce the pressure on technicians, nurses and doctors who are already in short supply.
Sufficient computer hardware and software must be provided.
A good IT system is critical for the entire NHS, but it is especially important in the technically complex field of heart care.
In order to provide adequate standards to support modern and effective heart care, a significant amount of new financial investment and restructuring is required.
Chapter 1: Introduction The synopsithe report is a template for service provision. It is a multi-disciplinary report of coronary heart disease in a multi-disciplinary profession that is still the biggest killer in the UK's patient perspective, and when needed, it must enable patients to have access to this reporting care, without serious care inequality, economic, geographic, race-based or gender-based issues, national framework for coronary heart disease services (CHD) needs to be urgently addressed) labor recruitment and retention is an urgent issue in the new National Health Service (NHS), especially in the context of continuous professional development of clinical activities in the heart information technology (IT) (CPD) all areas of critical importance must have more people to complete clinical work and allow time for effective clinical governance, CPDResearch is an important part of strong clinical services, but Summary of funding and lack of time: Brief Introduction This report is the guide needed to elevate the care of heart patients in the UK to a good overall standard.
It aims to help build new services to treat heart disease and improve existing services.
The word heart or cardiovascular care covers all aspects of diagnosis and treatment in patients with heart disease.
This report is written by a team of doctors, nurses, other health care professionals, as well as patients and non-professionals from the public.
Inevitably, there will be rapid progress in any area as complex as providing heart care, which can be difficult to keep up.
In addition, it is expensive to keep up with the progress.
As the new method replaces the old one, the treatment will change and hopefully improve.
The role of the staff providing care and the hospital will also change.
Two good examples are the transformation of many forms of heart care, previously limited to specialist centres, and a very important extension of the role of local hospitals and nurses in providing general and specialist health care.
Long-term lack of resources has seriously hindered the provision of care for patients with heart disease.
The most important shortage of resources is the trained staff of all health care professionals involved in providing care to heart patients.
In addition to this, the care of patients with heart disease requires the support of modern information technology, which will contribute to communication between health care professionals, in addition to the appropriate selection of information about the type of disease being treated, and results.
In addition, information technology will allow the integration of primary, secondary and tertiary care, which is critical to providing first-class services to patients.
The implementation of the National Service Framework is a big step forward in the care of patients with heart disease, appointing a national director of heart disease, who is an experienced cardiologist working in the Ministry of Health, this has greatly improved the national plan for heart disease treatment and the implementation of these plans. 1.
1 This report is intended to: describe the current situation and serve as a benchmark for measuring progress, as a template for new service development, identify areas of demand, and give priority to suggested ways in which deficiencies and problems can be overcome, so that it can be retained and expanded after the recent successful introduction of the NSF. 1.
Coronary heart disease is still the most common cause of death in the UK;
1998 in a total of 137 153 people in British of coronary heart disease, full for mortality of 626 151.
Thus, the death toll from coronary heart disease accounts for 22% of all deaths in the UK.
Therefore, coronary heart disease has recently been declared a major priority for the Ministry of Health.
The European Union recently issued a statement aimed at reducing the risk factors for coronary heart disease.
These are popular developments, so there have been many improvements in the resources and organization of heart care over the past two years. 1.
Nevertheless, there are still many shortcomings in the service, and this report attempts to analyze the situation in a realistic and constructive manner.
It is clear that the service does not have sufficient resources to implement best practices recommended by, for example, the National Institute of Clinical Excellence (NICE.
NICE has released guidelines for the use of stent, GP IIb/IIIa inhibitors and implantable vibrators s1, which have significant financial implications without increasing funds and resources
This also applies to recent UK and European guidelines for the treatment of acute coronary syndrome in 2, 3, which require more interventional treatment for this very common disease and therefore are more costly. 1.
This is the fifth in a series of reports.
The fourth report, which was prepared nine years ago, proved to be an important document providing a template for the design of cardiovascular services, it is also highly accurate to predict the development that may affect cardiovascular services to provide care to patients with heart disease. 1.
The report hopes to emulate these achievements, but while cardiologists and cardiac surgeons have written the previous report for their own consumption, the report has a multi-disciplinary origins.
It was written by a variety of healthcare professionals, as well as patients and non-professionals in collaboration.
This is not an empty gesture of political correctness;
It is truly recognized that complex heart care for adults and children requires the joint efforts of health care workers, which need to be patient-centered. 1.
6 patients with heart care and their relatives, usually in an important position, can comment on what care is needed from this location and suggest ways to improve this care. 1.
We believe that the information contained in this report must be open to the public.
Therefore, it is attached with a comprehensive non-professional summary that will also be published separately.
The relevant part of the layout summary is also before each part.
The complete document and layout summary is on the Internet (the website address is printed later) for easy access, and the illustrations will be downloadable so that others who wish to present the data can use it. 1.
The purpose of this report is to present the points as clearly as possible and, where appropriate, to guide readers to find sources where they may find more detailed information.
Appendix 4 and a comprehensive list of relevant websites in Appendix 3 and Appendix 5. 1.
9 all authors of the report believe that the profession has a strong intention in the broadest sense to improve the quantity and quality of care available to cardiologists, and reduce the burden on patients to prevent heart disease through Level 1 and Level 2. 1.
For many years, the country has been providing inadequate care for patients with heart disease.
This was acknowledged in the National Science Foundation chd4 three years ago, which outlines a major improvement program offered by heart care and is currently being implemented as soon as possible.
The first result of this implementation has proven to be excellent. 1.
The Ministry of Health recently reconsidered its intention to fund the NSF
Got the approval of the NHS administrator.
After the National Science Foundation in England, Wales and Scotland, it has been slow to develop personal policies similar to the National Science Foundation but possibly very different.
These latter initiatives are under development and are therefore not considered in detail in this report.
This commitment from the Ministry of Health has been further demonstrated by the appointment of an experienced, well-appointed cardiologist (National Director of Cardiology) to develop heart services and oversee the implementation of the NSF. 1.
12 although the benchmark for measuring the activity of the tertiary Heart Center is traditionally the number of times coronary artery bypass surgery has been performed, very significant changes have taken place in practice, in many centers, the number of vascular reconstruction operations performed through coronary intervention (PCI) has exceeded those performed
The latest advances in PCI technology may increase the trend in its direction.
The modern benchmark highly recommended is the overall burden of vascular reconstruction (RfA and PCI), rather than the incidence of surgery for coronary artery bypass grafting. 1.
13 This report has also been prepared in the context of other significant recent changes in the field of health care;
These include the national health insurance plan and the Human Rights Act. 1.
It is clear that there is a huge regional inequality in the field of care in the UK that needs to be addressed.
7. 8 it is important to eliminate any discrimination that may be based on region, race, age or gender in providing heart care. 1.
15 a fundamental area of agreement between all authors of this report is that this situation must develop as soon as possible so that cardiologists can assess that it is certainly one thing, not good luck, for patients with suspected heart disease. 1.
The model of care and the need for resources outlined in this document are at the lowest level, which will give the British people access to the standards of care they need and deserve.
These goals will inevitably change over the next few years, and new progress will affect the delivery of care. 1.
17 unless innovative approaches are found to improve recruitment, training and retention of the necessary labor force, these objectives cannot be achieved.
This is probably the biggest problem facing the NHS and applies to all areas of endeavor. 1.
This is particularly serious for nurses, perfusionist, and technicians (now known as cardiac clinical science officials.
Expanding and changing the boundaries of responsibility between different groups of workers is essential, and the expanded role of nurses is an example (see Chapter 12 ). 1.
Insufficient number of technicians.
Over the years, health care workers in this group have been neglected and paid too low, although they are essential if modern cardiovascular care is to be provided.
The Labor Development Federation must work with the local heart network to develop training programmes to encourage recruitment for such work. 1.
CCSOs lack proper career structure and lack of study leave.
This must be corrected urgently. 1.
21 only when significant investments in information technology (IT) are made at all levels can patients' expectations for efficient, accessible and high-quality care be met.
This is critical so that information about patients is readily available so that healthcare professionals who manage their care have immediate access to agreements, guidelines and advice. 1.
22 full provision of information is also critical to: Audit of the clinical government's ongoing professional development (CPD) collection of reliable results data. These data are key areas of modern medical practice. 1.
23 This document is intended to provide a template for the provision of services at all levels.
It cannot be forgotten that this cannot be achieved without a well-trained, motivated workforce.
Such a workforce can only be achieved through excellent training and extensive, high-quality CPD.
This must be linked to a realistic mechanism to revalidate professional competence. 1.
24 the improvement of CPD and clinical governance level, the main methods currently used cannot be achieved --
That is to say, extend existing resources and people to the tipping point and assume that important developments may be "cost neutral ". 1.
25 plans to improve care for heart patients and calculate the necessary manpower must take into account the fact that there has been a significant change in the needs of doctors and other health departments in the care team.
These are discussed in detail in the report, but include some of the above factors, such as revalidation, an increase in the number of CPD and a decrease in the participation of junior staff in clinical care, provide a broader training programme for junior staff and expand the role of clinicians in management.
All of these factors mean that a very popular, proposed and projected increase in manpower and resources is only the beginning and will not fully address the problems that exist. 1.
26 in the pragmatic atmosphere needed to move heart care forward quickly, research cannot be forgotten.
Without research at all levels of the profession, progress will soon slow down and stop, and the much-needed development of services will be hampered. 1.
In the past, 27 researchers in the UK have made a very important contribution to our understanding and treatment of heart disease --
For example, most of the basis for the use of thrombolysis for myocardial infarction comes from the ISIS group in Oxford, and there are many other examples. 1.
Currently, the UK has contributed 10% of research publications in the Global Heart Disease field.
It is very important that this contribution continues and increases as it inspires an important atmosphere of thirst for knowledge, which is needed to develop and provide health care progressively and effectively. 1.
It is essential that all members of the 29 multi-disciplinary group be interested and participate in the research.
The day-to-day audit activities themselves are critical to quality care and cannot replace Research. 1.
30 the difficulties faced by heart services in recent years, on the one hand, the knowledge base and workload are exponentially expanded, and on the other hand, they are almost fixed resources, resulting in research being partially shelved in attempts to provide basic care. 1.
Although a lot of work has been done, there is still a lot of work to be done.
It must be borne in mind that there is no big and important area of heart disease included in the cardiology, and in the context of coronary heart disease, the NSF itself is out of date.
Table 1 lists some of the essential elements of the service. 1.
View this table: View the inline View pop-up table 1.
1 Some essential elements of the service provider 2: Patient Perspective care professionals need to show openness, honesty, the need to fully explain personal health care issues to patients, whenever appropriate health care professionals who treat heart disease should be trained in special care, patients are entitled to expert cardiac advice and must be as easily accessible as possible with a possible waiting list if emergency rehabilitation is required, it must be immediately reduced to an acceptable level and should be available to all who need itLay Summary: patient perspective heart patients have the right to receive expert opinion time within the appropriate time.
This should not be delayed at all if things are urgent.
Once this opinion is obtained, doctors or other relevant health care professionals must deal with the patient's heart problems in an open and honest manner.
The details must be fully explained to the patient so that the patient is aware of the diagnosis, the impact of the diagnosis on his or her future, and the treatment required.
Enough time must be set aside to do so.
It is important that face-to-face discussions be supported by appropriate literature, which should be a language other than English if needed.
In addition, patients should be able to obtain the latest results of their type of treatment from the institutions in which they are treated and should be told how these results compare with those of other units. 2.
1 patients ask all healthcare professionals who treat them due to heart disease to show: Open
2 patients with heart disease are entitled to expert advice when appropriate.
This opinion should come from a cardiologist or other healthcare professional trained by a cardiologist.
Doctors who have no interest in cardiologists are not appropriate to care for patients with heart disease without the help of expert input. 2.
Cardiologists have seen more trends in patients with heart disease.
In fact, the Ministry of Health has announced that they expect no cardiologist to work until 2004 without a consultant colleague.
It is crucial to reach the number of Cardiologists needed to provide a comprehensive national service as soon as possible.
At present, the annual growth rate is more than 10%, and the number of consultant cardiologists will increase to about 1000 by 2008.
This will improve the current situation, but this figure needs to be revised significantly up due to significant changes in recent work practices (see 6 ). 16 to 6. 26). 2.
4 need to train doctors and other healthcare professionals on how to interact effectively and with patients and their caregivers and explain their illness and their treatment to their patients.
This has become a bigger part of undergraduate medical training, but training is also needed already in practice.
There is a need for appropriate training in the art of consultation for all health professionals.
This is particularly important in the context of heart disease, as diagnosis is often both scary and threatening for patients.
Proper treatment at an early stage will gain patient confidence and their cooperation in future care.
If this is not done from the beginning, then fear and resentment may become deeply rooted and may not change in the future. 2.
5 Information needs to be provided to patients in an understandable format.
It is important that it is not taught in scientific terms, but translated into ordinary everyday languages without losing accuracy.
This can be difficult and it is often very helpful to provide written materials as much as possible.
Each heart unit needs to be able to provide a comprehensive set of written and visual materials for their patients and their relatives and carers.
Therefore, this service needs to be provided to all ethnic groups as much as possible. 2.
Every effort should be made to improve communication between medical staff and patients.
Nurses and trained consultants have a great potential role in advising patients on the best way to understand and adapt to the disease.
It is important to build structures in order to provide such comprehensive advice and advice when needed, especially when delivering important messages. 2.
7 communication issues are also closely related to the process of obtaining appropriate consent.
The British Heart Society produced a consent information leaflet, and the General Medical Council and the Ministry of Health also submitted several important documents on the subject.
9,10 procedural consent forms need to be standardized and patients must have sufficient time to consider the impact of the relevant procedures, ask questions about this and obtain written information for further guidance.
If the procedure is urgent, the time may be shortened as necessary.
It's a time-consuming process to get it done correctly, and there's no resources currently needed to support the right system. 2.
Every effort must be made to make heart care accessible to specialists.
The use of fast track clinics and sometimes patient-friendly ones will help to achieve this goal.
Rapid visits to clinics for chest pain patients are becoming widely available, and this trend of "quick visits" may extend to patients with heart symptoms in addition to chest pain. 2.
Better communication between all healthcare professionals and institutions will improve patient care.
Communication between primary, secondary and tertiary care must be promoted.
Electronic medical records need to be implemented as soon as possible, as this will greatly speed up the process. 2.
10. patients require that the waiting list should be much shorter than it is currently, and that when their doctors assess that they are at risk without emergency treatment, treatment can be provided without delay.
Continental Europe's experience is that in countries with similar economic conditions to ours, there is little waiting time for outpatient heart disease or vascular reconstruction. 2.
Rehabilitation services must be available to 11 patients when needed
For example, heart surgery and intervention after a heart attack. 2.
12 in the presence of an appropriate support group, patients should be provided with information that will enable them to assess the potential usefulness of the group and to make contact if they wish.
Systems need to be set up to help patients see their heart problems in their daily lives so that they can adapt to their problems and thus continue to live a satisfactory life. 2.
These services aimed at raising patients' awareness of the disease are not
Currently exists or only partially available.
The education and resources needed to establish services that are more patient-compliant, including additional personnel, will require funds that are not currently normally identified or included in the budget. 2.
The patient interface is very important, so it is necessary to take joint initiatives on behalf of patients and institutions of healthcare professionals to develop ways to improve two-way communication.
The British Heart Association, which has recognized this need, is advancing plans to bring together all types of medical workers and patient delegates in the heart field to identify problems and ways to solve them.
This is seen as the first step in enhancing patients' rights and empowerment.
This is a joint initiative with the British Heart Foundation. 2.
This is a very important area that is currently neglected and under-resourced.
It should have a stronger foundation across the country and sufficient funding.
Time scales are required and must be observed.
It is proposed that by the end of 2003, National applicable systems will be developed through the British Heart Society initiative.
Chapter III: reliable data are required for audit, clinical governance and ongoing professional development, which depends on the coordination of data sets owned by the appropriate information technology (IT) professional associations. The central Heart Audit Database (CCAD) has proven to be feasible and must now be implemented on a broad scale. It is necessary to analyze local practice patterns, audit these patterns are very important public domain for using local data as the basis for the service to provide data, but must be reliable, and it has been verified that sustained professional development (CPD) is critical to maintain a high quality careLay Summary: Audit, clinical governance and sustained professional development are critical for high quality cardiovascular care.
The only way to keep this up is that all healthcare professionals who provide care have a high level of careto-
Medical Education.
This can only be achieved if everyone receives continuing education.
This is what is called continuous professional development (CPD ).
Also, in the near future, doctors in the UK may have to go through a process of "re-treating"accreditation”.
This is to ensure that their professional standards remain high enough so that they can continue to practice as doctors.
For other healthcare professionals, the same process will inevitably be followed.
Only by accurately collecting information about the outcome of the treatment can the overall quality of the treatment be assessed.
These figures need to be analyzed locally and compared with national figures.
This examination of the quality of care is a major part of the so-called "clinical governance.
The term "clinical governance" covers the entire complex process of monitoring all aspects of patient care and ensuring its high quality.
This is an important but time consuming process.
It requires input from the secretary and paperwork, as well as extra time from doctors who are already busy.
If it is to succeed, it must be properly funded.
In the future, it is hoped that the central heart database will monitor the quality of treatment nationwide.
A prototype is currently being developed.
This is called the central heart Audit Database (CCAD) and information is currently being collected on all children with heart disease.
It is also auditing all cases of heart attack (myocardial infarction) in the UK.
This is called the National Audit Program for myocardial infarction ". 3.
1 Audit, clinical governance and CPD have been readily accepted by Cardiology and Cardiac Surgery as formal forms and advances in the process of improving the quality of care. 3.
Some notable issues, such as the Bristol survey related to professional standards, have prompted attention to the quality issues outlined in the new NHS related to process and outcome measurement.
Modern and reliable in December 1997, first-class service in 1998. 11,123.
3 This leads to 1999 of the Health Services Act, which provides that the chief executive and board members of the trust and health authority have a statutory obligation for clinical quality.
The bill emphasizes the importance of the process of ensuring the quality of care rather than focusing solely on standards. 3.
The structures and processes required for effective clinical governance need to be based on solid data.
In the field of cardiac surgery and cardiology, considerable progress has been made through expert associations, which have collected "program-specific results" data prior to the emergence of clinical governance. 3.
However, the data are not standardized for disease processes and risks, the definitions are variable, and the existing registers are not validated.
In addition, there are very few registers with long-term outcome data. 3.
6 in 1995, the Ministry of Health invited the Association of experts (for example, the British Heart Society and the Association of Thoracic Surgeons) to coordinate their data sets in order to coordinate and collect centralized data for all patients undergoing cardiac surgery.
This initiative was initiated through the central heart Audit Database Project.
The project then demonstrated the feasibility of collecting confidential data online using standardized encryption and transmission protocols.
The system is being further developed under the protection of the NHS Information Administration. 3.
The CCAD database will be linked to the National Bureau of Statistics, whose structure will allow tracking of patients from intervention to death, and will therefore help to understand the disease process and national practice.
Perhaps most importantly, these types of data will enable us to understand who will benefit the most from which interventions. 3.
A major initiative led by the Royal College of Physicians with CCAD is the national (England and Wales) Myocardial Infarction Audit.
This is the national audit programme (MINAP ).
Data is available in almost all suitable hospitals (201/216), mainly online. 3.
CCAD is planned to be extended to coronary intervention (PCI) and cardiac surgery by 2002. 3.
In any audit process, patient secrecy is an important issue that must be respected.
The recent Health and Social Care Act allows for the aggregation of clinical outcome data as long as it is in the interests of the individual and the public of the patient.
These regulations allow CCAD to do such a summary. 3.
Real valuable clinical data obtained locally should be used to promote local clinical governance and planning. 3.
12 The Quality Concept of cardiology and cardiac surgery must cover the entire clinical pathway from the first time a patient has sought medical advice to discharge. 3.
13. individual procedural outcome measures are only a small part of this process, although important because there are many non-
The effect of treatment on outcomes. 3.
These effects may include the severity of the disease, the prevalence of co-illness, the awareness and willingness of patients to seek medical advice, and the threshold for moving from a general practitioner to a cardiologist and from a cardiologist to a surgeon.
Threshold accepted by intervenors or surgeons, standards for care, anesthesia, surgery and intensive care, adequacy of staffing levels, attitudes towards training, interpersonal relationships between employees, even the physical design of the unit plays an important role. 3.
Any of these factors may affect the quality of patient care and its outcome.
In the search for measurable quality, obvious changes in easily measurable outcomes should be seen as a barometer of the success or failure of complex care pathways, rather than a barometer of a single event --
Operation or intervention, for example. 3.
An important aspect of quality control is the audit of the Heart Department.
The British Heart society is developing its own peer review system.
This will provide regular external audits and, therefore, significant changes in practice, poor organization of clinical care, and poor outcomes should be identified and corrected early.
Although the process is currently voluntary, it may become a regular activity for all units and can also respond when specific problems occur. 3.
Out of respect for our patients, any data released to the public domain must be validated, properly analyzed and presented in a format that is easy to understand and understand.
This is a complex area, but in the Nuffield Trust publication, eager to know: publicly publishing information about medical quality, the general question is briefly summarized.
This report concludes with a number of policy proposals based on a review of the experience of public disclosure in the United States.
On July 1999, they were introduced to the then minister of health, Mr. Frank Dobson, and distributed to key decision makers and health advisers in the UK.
They are outlined in Table 3. 1.
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1. publicly disclose potentially sensitive materials related to patients.