Poor cathlab utilisation for patients with stable angina: is it time to do smart listings than follow guidelines?

Abstract Background/Introduction In contemporary cardiological practice, the optimisation of Cath Lab scheduling represents a pivotal challenge, particularly in the management of stable angina patients slated for diagnostic angiography and potential percutaneous coronary intervention (PCI). Standardised 90-minute bookings frequently result in underutilisation of resources when PCI is deemed unnecessary post-angiography. This not only incurs significant operational inefficiencies but also squanders valuable healthcare resources and patient time. Purpose This study aims to develop and validate a scoring system tailored to optimize Cath Lab scheduling by facilitating risk-based booking times for patients with stable angina undergoing diagnostic angiography and potential PCI. By harnessing a clinically derived scoring system, our objective is to enhance Cath Lab efficiency, reduce unnecessary resource expenditure, and improve patient throughput without compromising the quality of care. This innovative approach endeavors to establish the practicality and efficacy of precision scheduling in cardiac care, ensuring that resource allocation is meticulously aligned with the individualised procedural needs of patients. Method This prospective study analyzed 103 stable angina patients who were booked into the Cath Lab in 2023. Each patient's past medical history was analysed to identify clinical predictors indicative of the necessity for PCI. Based on these predictors, we aimed to develop a scoring system to stratify patients into risk categories and to guide the allocation of Cath Lab booking durations. Results In this cohort of 103 patients scheduled for angiography and PCI, only 43 (41.75%) underwent PCI. Utilising our "Neelam Score", which rates patients from 1 to 6 based on factors like diabetes, hypertension, chronic kidney disease, previous myocardial infarction, previous PCI, and CABG, we correlated higher scores with an increased likelihood of undergoing PCI. Specifically, 100% of patients with a score of 5 required PCI, followed by 75% with a score of 4, 69.23% with a score of 3, 36.82% with a score of 2, 33.33% with a score of 1, and 16.67% with a score of 0, indicating a clear trend where higher scores predict a greater necessity for PCI. Furthermore, analysis of Cath Lab bookings revealed 1346 minutes of time were unnecessarily allocated, averaging 51.77 minutes wasted per day. Conclusion The implementation of the Neelam Score could significantly enhance operational efficiency by aligning patient risk with resource allocation. The correlation between the Neelam Score and the actual need for PCI suggests that a risk-based scheduling model could reduce wastage, increase the number of patients seen, and optimise the utilisation of healthcare resources. Our findings advocate for a transition from standardised time allocations to a risk-based approach, potentially transforming Cath Lab operational dynamics and improving patient outcomes.