Background/Introduction Patients with stable angina are listed for diagnostic angiography and potential percutaneous coronary intervention (PCI) on the same setting also known as 'query proceed' based on latest NICE guidelines. We offer standardised 90-minute bookings for these patients however, not all patients have a PCI and procedures often finish earlier than scheduled. This negatively impacts on staffing resources and cost effectiveness of running day case cathlab facilities. This study aims to assess cathlab utilisation based on standard scheduling and to develop a scoring system to optimise cathlab scheduling for patients with stable angina. Methods We conducted a prospective study on 103 consecutive 'query proceed' patients from the first 6 months of 2023. We collected data on demographics, risk factors, procedural details and start and finish times for each patient. We analysed those who had undergone PCI or diagnostic studies including pressure wire or intracoronary imaging only. We derived a cathlab listing score with one point for each of the risk factors such as type two diabetes, hypertension, chronic kidney disease (CKD), previous myocardial infarction (MI), previous PCI and coronary artery bypass surgery (CABG). We aimed to assess if our predictive score can be effective in allocating time needed for the cathlab procedure and assess if higher scores can lead to increased likelihood of undergoing PCI. Results Our cohort of 103 patients included 82 men and 21 women with mean age of 70 (42 to 92 years). 37 patients (35.92%) had a history of diabetes, 66 patients (64.08%) had hypertension, 13 patients had CKD, 26 patients had a previous MI, 28 patients (27.18%) had a previous PCI, and 12 patients had a previous CABG. We found that 43 patients (41.75%) underwent PCI, 24 (23.30%) had an angiography with pressure wire, and 35 (33.98%) had only an angiography. Time analysis revealed that the allocated time of 90 minutes per procedure resulted in a total of 1,346 minutes of time remaining unused, averaging 51.77 minutes wasted per day. Based our predictive score, which rates patients from 1 to 6, all 100% who scored a 5 required PCI, followed by 75% who scored a 4, followed by 69% with a score of 3, 37% with a score of 2, 33% with a score of 1, and 17% with a score of 0, indicating a clear trend where higher scores predict a greater necessity for PCI. Those with a score of 3–5 when compared to those 0–2 had a likelihood ratio of 14.3 for PCI, p-value of 0.00015. Conclusion(s) Current cathlab scheduling strictly based on NICE guidelines has resulted in inefficient cathlab utilisation. A smart and simple scheduling using our predictive risk factor based scoring that can be used both by clinicians and booking teams is likely to enhance operational efficiency and resource utilisation. This could optimise the utilisation of healthcare staff and resources which would significantly improve NHS wait times.
Giri et al. (Wed,) studied this question.