Case Studies
Recognising Royal Stoke for Their Commitment During COVID
HeartFlow would like to take a moment to recognise sites that are going above and beyond to deliver an outstanding CT service to patients, especially during this COVID pandemic.
We are excited and proud to recognise Royal Stoke University Hospital for their Outstanding CT Service!
Overview of Royal Stoke University Hospital’s Cardiac CT Service
- Extensive high-volume cardiac CT service, performing around 3,000 cardiac CT scans in 2019. This number dropped to just under 2,000 CT scans in 2020 due to reduced external referrals and reduced number of some clinics.
- The service has undergone significant expansion over the last few years by taking on external referrals, most recently from Burton on Trent.
- The trust caters to a population of 3 million within Staffordshire. As one of the top three busiest Regional Trauma centres and one of the five biggest cardiothoracic surgery centres in the UK, generates a sizeable amount of cardiac and thoracic imaging work.
Changes to CT service due to COVID-19
Royal Stoke’s cardiac team began the coronavirus pandemic without any CT scanning backlog. However, with the outbreak of the virus, scanning was suspended and the team ended the first wave with a waiting list of 518 patients.
While services such as cancer treatment and 2WW imaging continued during the first wave, Cardiac CT was not initially considered urgent. The cardiothoracic radiologists supported by the imaging management team highlighted the significance of the backlog and risk of potential adverse cardiac events to patients awaiting cardiac CT given the higher mortality for such an event compared to early cancer.
Scanning every Saturday and Sunday for two months
- The team was able to start scanning again in September 2020 and to deal with the backlog, the hospital’s team of four cardiothoracic radiologists started undertaking weekend lists every weekend (both Saturday and Sunday) from 13th of September. This schedule remained in place for eight straight weeks, in addition to maximising weekday lists, resulting in a drop of waiting list size to 44 patients by 11th of November. Weekend Saturday-only lists were continued thereafter till 28th of November.
- The team has continued to scan inpatient cardiac CT throughout the pandemic including TAVI work and commenced routine week day outpatient lists in September. All cardiac CTs are performed with onsite cardiothoracic radiologist coverage.
- To ensure that significant ramp up in scanning did not create a reporting backlog, the team sought to minimise the hands-on supervision of lists. This was achieved via the tactical use of systolic phase imaging when heart rate was slightly higher than optimal rather than beta block these patients.
- To ensure heavier reliance on systolic phase imaging did not affect image quality the team used the HeartFlow Analysis as a tool to benchmark image quality. They recognized that a decrease in the image acceptance rate for the HeartFlow Analysis would equate to suboptimal image quality. The HeartFlow acceptance rates during the COVID recovery remained comparable to pre-pandemic numbers which concurred with the subjective option of reporting radiologists.
- Before the second coronavirus wave hit, the team had worked their scanning backlog down to 44 patients. There was no resultant reporting back log with rapid turnaround of reporting facilitated by reducing hands on supervision by radiologists. The cardiac radiographers themselves selected the scanning protocol dependent on patient heart rate and variability via pre scan check on table with minimal need of beta blocking. This was particularly useful given that all four radiology consultants involved are dual thoracic and cardiac radiologists and the need for thoracic imaging expertise during COVID has understandably seen a significant rise in demand.
HeartFlow’s impact
One of the key benefits that Royal Stoke University Hospital has seen from the HeartFlow Analysis has been the ability to minimise time spent in hospitals. This has been invaluable throughout the pandemic, when patients have been apprehensive about attending hospital due to infection risk. With the HeartFlow Analysis, patients have often been able to get a diagnosis in a single visit.
The clarity brought by HeartFlow’s technology has also allowed the Stoke team to take a direct to intervention approach rather than bring patients back for a diagnostic angiogram, with a significant reduction in diagnostic angiograms for moderate coronary artery stenosis reported on CT coronary angiogram.
Royal Stoke University Hospital has gone to great efforts to ensure that patients have been able to receive continued access to the best of cardiac care throughout the COVID pandemic. We, at HeartFlow, are proud to be working with them to enhance heart care for their patients.
Dr. Samavia Raza, Consultant Cardiothoracic Radiologist at University Hospitals of North Midlands NHS Trust, said:
“Chest imaging has been the front line of Radiology during COVID and our CT radiographers deserve particular commendation for the work they have done not only for COVID inpatients during the first and second waves, but for simultaneously helping us ramp up to address massive backlogs such as Cardiac CT post the first wave. We have continued to keep the waiting list below 40 since mid-November with all external referrals now open.
With the HeartFlow Analysis, we can often avoid patients undergoing an additional hospital visit and unnecessary invasive procedures to determine a treatment plan. Given the current concerns with social distancing, minimising unnecessary hospitals visits is now more important than ever before. As we restore our diagnostic services to pre-COVID levels and recover from long waiting lists, the HeartFlow Analysis has shown to be a very useful tool in reducing the number of diagnostic tests a patient needs, which in turn improves patient flow through the diagnostic pathways.”
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