Six key steps to implementing a single point of access for aortic stenosis patients outlined in new GIRFT guidance

Specialists from heart centres across England and Wales have worked with the Getting It Right First Time (GIRFT) team to develop new guidance for implementing a Single Point of Access (SPA) for patients with aortic stenosis, with a view to ensuring patients are seen more quickly.

The new resource addresses the challenges of SPA implementation and outlines a six-step approach to ensuring an efficient and successful SPA process. It also includes good practice examples from centres who are demonstrating success.

Aortic stenosis (AS) is one of the most common causes of heart disease, with around 300,000 adults aged 55 years or older estimated to have severe AS in the UK. If untreated, these patients have a poor prognosis; the five-year mortality rate of severe symptomatic AS has been estimated at 88%, worse than for many cancers.

GIRFT data shows that many patients are experiencing delays in the referral and treatment pathways, and therefore not receiving the timely treatment which can improve their chances of survival and their quality of life.

Establishing a SPA – ensuring cardiology teams can arrange the right care for urgent and non-urgent referrals – is widely acknowledged as a key step to improving treatment pathways. However, while some UK heart centres have implemented a SPA, the degree of success has varied, and many centres have yet to adopt the approach.

Specialists from heart centres across England and Wales came together to agree good practices, and identified six key steps to SPA implementation:

  • Establishing a clinical pathway team
  • Setting up a single email address for referrals
  • Appointing an AS co-ordinator
  • Agreeing triage protocols
  • Communicating to all stakeholders
  • Auditing outcomes


The new GIRFT guide is aimed at clinicians and heart centres working to optimise referral and treatment pathways for patients with severe AS. It is designed to be complementary to the British Heart Valve Society’s work and joint professional society guidance for cardiac multidisciplinary meetings, as well as GIRFT’s own best practice pathway for the management of aortic stenosis.

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