title: Development of a cardiologist delivered service leads to improved outcomes following admission with acute coronary syndromes in a large district general hospital.
abstract: BACKGROUND
  East Lancashire Hospitals NHS Trust reorganized its services in October 2007 with acute admissions sent to one site which allowed the development of a 24/7 Consultant delivered cardiology service.
  
  
  METHODS
  A retrospective analysis of all patients admitted with an acute coronary syndrome between two periods: Group 1: October 2006 to September 2007 and Group 2: October 2007 and September 2008. We looked at the following end points-length of stay, in-hospital and 30 day all cause mortality.
  
  
  RESULTS
  633 patients in group 1 and 748 patients in group 2. There was significant reduction in length of stay from a median (IQ range) 7 (5-11) days to 5 (3-9) days; P<0.0001. The in-hospital mortality reduced from 15.8% (n=100) to 7.6% (n=56); P<0.0001. The mortality at 30 days reduced from 15.2% (n=96) to 8.3% (n=62); P<0.0001. These reductions remained significant after adjustment for demographic and risk factor variables.
  
  
  CONCLUSIONS
  A 24/7 Consultant Cardiologist delivered cardiac care is associated with marked reductions in all cause mortality following admission with acute coronary syndromes. This improvement occurred with a significant reduction in hospital length of stay.
authors.affiliation: East Lancashire Hospitals NHS Trust, Blackburn, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ng Kam Chuen
authors.forename: R
authors.initials: R
authors.lastname: Schofield
authors.forename: R
authors.initials: R
authors.lastname: Sankaranarayanan
authors.forename: C
authors.initials: C
authors.lastname: Crowe
authors.forename: K
authors.initials: K
authors.lastname: Helm
authors.forename: D
authors.initials: D
authors.lastname: Lane
authors.forename: R K
authors.initials: RK
authors.lastname: Singh
authors.forename: J
authors.initials: J
authors.lastname: Mcdonald
authors.forename: K P
authors.initials: KP
authors.lastname: Balachandran
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D016507:Cardiology Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013222:State Medicine; D006113:United Kingdom