Document resource
Introduction Getting It Right First-Time guidance recommends treatment for severe aortic stenosis within 8 weeks of referral, yet delays remain common. A 2024 audit of the South Yorkshire transcatheter aortic valve implantation (TAVI) pathway identified prolonged waits from diagnostic echocardiography to valve team assessment. We developed an automated ‘Red Alert’ process to identify severe aortic stenosis at the time of echocardiography and trigger rapid specialist screening.Methods We undertook a service evaluation with retrospective analysis of all patients who underwent TAVI in 2024. Time intervals were measured from diagnostic echocardiography to first valve specialist assessment and to CT-TAVI. An electronic search tool was implemented to automatically flag patients aged >70 years with peak aortic valve velocity (Vmax) ≥4.0 m/s. Flagged cases were sent to a dedicated inbox and reviewed the next working day to confirm eligibility (no prior management decision, not already under valve clinic surveillance, and no contraindication to intervention). Eligible patients underwent telephone triage within 1 week of echocardiography and investigations were requested. Waiting times in the prospective pilot (Oct 2020 - Jan 2026) were compared with the 2024 baseline.Results In 2024, 270 patients underwent TAVI. Of these, 67 were outpatients not under aortic valve team surveillance and with Sheffield as the local provider. Median time from diagnostic echocardiography to first specialist assessment was 105 days, and median time from echocardiography to CT-TAVI was 156 days ( figure 1).During the pilot, 83 patients met automated trigger criteria; 32/83 (39%) were eligible for rapid screening. Eight were subsequently redirected to advanced care planning (n=4) or excluded for clinical reasons (n=4), leaving 20 who proceeded to investigation. Median time from diagnostic echocardiography to screening clinic was 6 days, and median time from echocardiography to CT-TAVI was 74 days (figure 2).Conclusions An automated, echo-triggered pathway substantially reduced time to first specialist assessment (by 99 days) and to CT-TAVI (by 82 days) compared with baseline, without requiring manual referral at the point of echocardiography. This scalable model could support other trusts to reduce delays. Further work will focus on reducing downstream waits, including CT-TAVI scheduling.Abstract 433 Figure 12024 TAVI referral pathwayAbstract 433 Figure 2Red alert pathway