Evaluation of workforce and organizational issues in establishing primary angioplasty in England.
OBJECTIVE
To assess workforce and organizational issues in establishing a primary angioplasty service in England.


METHODS
Staff associated with the heart attack pathway at seven acute hospitals participating in the National Infarct Angioplasty Project (NIAP) completed a questionnaire, participated in focus groups and interviews, and observations were undertaken in catheter laboratories.


RESULTS
All seven hospitals implemented primary angioplasty though not all provided a 24-hour service. Hospitals varied in size, number of staff involved in the delivery of angioplasty and the volume of cases. Hospitals that developed the service by incremental expansion encountered more problems than hospitals that planned for a full service at the outset. Simple, direct access to a catheter laboratory reduced delays and could be facilitated by an angioplasty gatekeeper. Little attention was paid to later cardiac rehabilitation. Multiskilling and the ability to work across traditional professional boundaries appeared to provide substantial advantages. Building relationships with key staff and auditing the heart attack pathway were critical to successful service development. Differences in remuneration and rest for staff undertaking out-of-hours working threatened sustainability.


CONCLUSIONS
Primary angioplasty was feasible in varied settings and generally supported by staff. However, the participating hospitals were selected enthusiasts, only some implemented a 24-hour service and activity levels were relatively low. Organizational and workforce issues need to be addressed to achieve an efficient and sustainable service.
Carter
Angela
A
Institute of Work Psychology (IWP), University of Sheffield, Sheffield, UK. a.carter@sheffield.ac.uk
Wood
Stephen
S
Goodacre
Steve
S
Sampson
Fiona
F
Stables
Rod
R
D039602:After-Hours Care / Q000458:organization & administration*; D017130:Angioplasty; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D004739:England; D005260:Female; D017144:Focus Groups; D006739:Hospital Administration; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D008485:Medical Audit; D009203:Myocardial Infarction / Q000601:surgery; D019370:Observation; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D016730:Program Development; D036301:Qualitative Research; D013222:State Medicine; D011795:Surveys and Questionnaires; D000078329:Workforce