Dr. Patrick Owens:

As a clinician and an interventional cardiologist I will talk about the single point of failure that was mentioned. The catheterisation laboratory is, by definition, a single point of failure. There is only one table and only one patient comes into the room at any single time. If a patient is on the catheterisation laboratory table and is having an angiogram or a stent inserted, the duration of a procedure can be very long. Somebody could be on the table for a couple of hours or more during complex procedures. Once one starts the procedure one cannot stop, or at least not safely stop. If somebody is brought in as an emergency to the emergency department or, indeed, is blue lighted in as a code STEMI - ST-elevation myocardial infarction - which is the phraseology for coming in with an acute heart attack, that patient must be accommodated as quickly as possible but if somebody is on the table that cannot happen. It is not just acute heart attacks. It might be somebody with a life threatening rhythm disturbance or with what is called a tamponade, which is where there is a fluid collection around the heart, and these all must be addressed. If there is only a single unit they must wait or one must stop one's procedure, wheel the patient out and take the acute emergency in. That has happened. Having two catheterisation laboratories greatly diminishes the chances of that eventuality.

Then there is the more obvious sense of single point of failure, which is that if the catheterisation laboratory breaks down everything grinds to a halt. If the laboratory is closed for maintenance, for example, which it was on Monday two weeks ago, the service stops. It does not stop just for emergencies but also for inpatients who are admitted with acute problems, need their procedure carried out but who must wait another day in their hospital bed. All of that has repercussions and knock-on effects on bed occupancy. Single point of failure is a major issue. The reason that ours remains the only unit in the country with a single catheterisation laboratory is that all the other laboratories and units realise that this is an issue.