Statement of Service

The Rapid Access Chest Pain Clinic (RACPC) is a cross county service providing a cardiological assessment for patients who present to there GP with recent or new onset symptoms of chest pain which are suspicious of angina. The clinic will facilitate clinical review, non-invasive investigation (including ECG and exercise tolerance testing - ETT) and coronary vascular disease risk stratification. Where possible a diagnosis will be confirmed and management plans will be communicated back to the GP within 24 hours.

 

Aims of Service

• Review of all patients within two weeks of referral
• To make accurate diagnosis of exertional angina
• To eliminate cardiac cause from those who have non cardiac pain promptly
• To perform risk stratification
• To instigate appropriate / stop inappropriate treatments promptly
• Referral for onward cardiac investigation as appropriate

 

 Referral Criteria

• Typical cardiac chest pain (i.e. exertional symptoms easing with rest)
• Of recent onset or recurrence (i.e. within three months or so)
• Patient suitable to perform Exercise Tolerance Test (ETT)
• Patients with a pre existing diagnosis of IHD/ CAD, who have recurrence of chest pain

 

Patients Who Should Not Be Referred to RACPC

• Any patient suspected as having an Acute Coronary Syndrome (i.e. unstable angina or an acute myocardial infarction) should be referred as an emergency to the EMERGENCY DEPARTMENT by Emergency Ambulance
• Any patient with a previous history of Coronary Artery Disease or Ischaemic Heart Disease (excluding Hypertension) who is under ongoing review within cardiology
• Women under 40 years of age and men under 30 years will only be seen in exceptional circumstances as the likelihood of  significant underlying CAD in these age groups will be low

 

Patients Who Will be Excluded from Performing ETT

• Uncontrolled Hypertension (BP>180/110mmHg)
• Significant Valvular Heart Disease
• Morbidly Obese Patients
• Physical incapacity i.e. respiratory, musculoskeletal, general frailty
• LBBB on a resting ECG

 

 Clinic Availability

There are currently seven clinic sessions in operation, these are as follows;

Day	Time	Venue & Supervisor
Monday	9am	Cheltenham General                     Supervised by Dr. Challenor
Tuesday	2pm	Gloucestershire Royal                   Supervised by Dr. Lindsay &  Dr. Saha
Wednesday	2pm	Cheltenham General                     Supervised By Dr. Chamberlain-Webber
Wednesday	2pm	Gloucestershire Royal                   Supervised By Dr. Saha / Dr. Lindsay
Thursday	2pm	Cheltenham General                     Supervised By Dr. Chamberlain-Webber
Thursday	2pm	Gloucestershire Royal                   Supervised by Dr. Siedlecka
Friday	9am	Gloucestershire Royal                   Supervised by Dr. Vaidya

Patients will be offered the next available appointment, be it at Cheltenham General or Gloucestershire Royal (patient preference will be accommodated for date / time / venue as far as is possible and as long as this does not exceed the two week wait)

 

Clinic Access  & Referral Process

Via CHOOSE  & BOOK, alternatively

Complete and return the referral pro-forma and fax to the dedicated number – 08454 225994

The patient will be contacted direct by phone – confirmation of clinic date / time / venue will be sent in writing to the patient and by fax to the GP surgery.

• Please complete a Rapid Access Chest Pain Clinic (RACPC) referral form. This form requires minimal information for speed of referral, an accompanying letter is not required. The referral should be faxed to 08454 225994 (this is the dedicated number for the booking office). A contact telephone / Mobile number for the patient must be given so that confirmation of time & date of the appointment can be given within the next 24 hours.
• General Practitioners should, where possible arrange for up to date routine blood investigations (FBC, U&E, GLUCOSE, LIPIDS, TFT) to be performed prior to the clinic visit. The results from these investigations will then be obtained by RACPC staff before the clinic appointment
• If there is a recent copy of an ECG, please send this through with the referral

 

 RACPC Referral form

 Patient Information - Cheltenham General Hospital

 Patient Information - Gloucestershire Royal Hospital

  

WHAT YOU SHOULD EXPECT FROM THE RACPC SERVICE

• The clinics are staffed by one clinician (Nurse Specialist or Cardiology Specialty Doctor ) and a Cardiac Physiologist . Each clinic is supervised by one of the Consultant Cardiologists
• It is intended that all patients will be seen at the RACPC within a maximum of two weeks from the date of their referral, and it is hoped that the median time will be considerably shorter.
• Clinics will be held at both Cheltenham General & Gloucestershire Royal Hospitals and patients may be required to attend either based on appointment availability.
• Following clinical assessment the patient may undertake an exercise tolerance test (ETT) if appropriate
• A summary, diagnosis & management plan for the patient will be faxed back to the GP surgery within 24 hours of their RACPC appointment – Please be sure to add a fax number to the referral

It is anticipated that some patients may require urgent admission from the RACPC and this will be arranged, although it is to be stressed that the RACPC is not suitable for patients suspected of having acute coronary syndromes.

 

If you have any questions, please contact the Nurse Specialist – either Sandra Wheeler (Service Lead) or Alison Halliday on 08454 228281

(SW/AH November 2011)