Document resource
Background Early invasive management for NSTEMI, defined as coronary angiography within 72 hours of admission, is mandated by Quality Statement 3 of NICE Quality Standard 68 (QS68) [1].However national performance data from the Myocardial Ischaemia National Audit Project (MINAP) Annual Summary report for 2025 reveals that only 55 % of eligible NSTEMI patients received coronary angiography within the 72-hour target [2].The North Cumbria Integrated Care Network (NCIC) operates a County wide cardiology service in a hub and spoke model. The main interventional centre with 24/7 primary percutaneous coronary intervention (PPCI) capability lies at The Cumberland Infirmary (CMI), Carlisle and a non-interventional site having on site CCU is based at The West Cumberland Hospital (WCH), Whitehaven.Here we evaluate impact of a new operating model which was introduced at NCIC in 2024 to improve interventional service delivery.Methods The new network-wide operating model included establishment of The Heart centre which contains 11 ring-fenced acute coronary syndrome beds and 5 chaired radial lounge. Two new cardiac catheterisation laboratories were opened at CIC as part of this development and cardiology workforce was expanded by appointing advanced clinical practitioner at non-interventional site. The impact of this development was evaluated by auditing the service for first quarter (Q1) of 2024 (before opening of THC) and first quarter of 2025 (after opening of THC) . The parameters for service evaluation used were: time intervals from admission to angiography referral (in days),time interval from referral to procedure (in days) and number of patients receiving angiogram within 72 hours.Results At WCH, the percentage of patients receiving coronary angiography within 72 hours improved to 76.90% from 56.25%, with average admission-to-referral time decreasing to 1.1 days and referral to-angiogram time decreasing to 1.3 days. At CMI , the percentage of angiograms done within 72 hours improved to 64.80% from 61.50%,admission to angiogram referral time increased to 1.7 days and referral to angiogram time decreased to 1.4. ( table 1)Overall time to coronary angiography improved across the network in 2025 with implementation of new network model.Conclusion These findings demonstrate that expanding catheter laboratory capacity and ring-fenced inpatient pathways can offset upstream referral delays and improve delivery of guideline-mandated invasive management for NSTEMI in geographically dispersed networks. Deterioration in time from admission to angiography referral at CMI is likely explained by discontinuation on enhanced in-reach to AMU/ED Ongoing workforce resilience, and closer integration of interventional and inpatient cardiology services will be critical to sustaining improvement.Abstract 506 Table 1Collaborative table showing data for Q1 2024 vs Q1 2020 showing number of patients, Average and median days from admission to Angiography