Waiting time for heart ultrasounds has been more than halved since April with the introduction of new work practices at Mater Dei Hospital’s cardiology department.

There were 6,000 patients waiting for an appointment for an echocardiogram – ultrasounds that allow doctors to see how the heart beats and identify abnormalities – but by investing double the time, the waiting list has been slashed to 14 months from two years and nine months.

Five months into the hospital’s contentious split of cardiac services, the new cardiology chairman, Robert Xuereb, is keen to highlight the team’s hard work and commitment to drive change.

Prof. Albert Fenech and I both believe in the department and both work hard for the cardiac patient

He is less eager to revive the controversy that erupted when the government announced it would be splitting the department.

The public storm was sparked by his colleague Prof. Albert Fenech, a cardiac specialist and Nationalist MP, who had insisted the split was purely a decision “to give this guy the job”.

Prof. Fenech had even gone as far as filing an injunction to stop the split but the court turned down his request.

The cardiology and cardiac surgery departments were joined 10 years ago with one chairman responsible for the coordination of heart disease.

Prof. Fenech was extremely vocal against the split, describing the move as “ignorant” and a disservice to patients as medical and surgical services would no longer fall under the same department.

Reflecting on his five months since starting the job, Dr Xuereb said he was “very sad” about what had happened.

“I don’t think the matter was politicised as I don’t believe any party was behind it. It was more of a personal agenda and this should never come before our patients’ interests,” he said.

But all this is in the past for Dr Xuereb and there is no hint of animosity. On the contrary, he praises Prof. Fenech and attributes the department’s recent achievements to his predecessor’s groundwork.

“We have very different characters, very different opinions and very different approaches. But we have one thing in common. We both believe in the department and we both work hard for the cardiac patient,” he said.

It is for this very reason that he intends to ask the hospital authorities to make a concession and renew Prof. Fenech’s consultant past retirement age contract so as not to lose his expertise.

Since taking over, Dr Xuereb has been working hard to introduce new work practices to address the problems that have been plaguing the department, such as waiting lists.

The first was to increase working hours by introducing afternoon sessions on weekdays and Saturdays to be able to more than double the number of echocardiograms carried out every month, from 400 to 900.

“This was only possible thanks to the hard work and cooperation of every single member of the team and was not done at the expense of patient safety,” he said.

On the contrary, patient safety, had been improved through the creation of pre-assessment clinics where patients are properly checked and their clinical history is analysed to determine the exact procedure they would undergo, he said.

Before, a patient used to be referred by a physician, not a cardiologist, which meant that they were being assessed by the cardiologist literally minutes before being taken into theatre for an invasive procedure.

This practice has been instrumental in addressing waiting lists – coronary angiogram waiting time has gone from six months to zero – and freeing up the consultants to do more complex procedures.

“This pre-assessment clinic didn’t exist and mix-ups happened as there was no networking,” he said.

Exchanging ideas, peer review and better communication were also paramount for Dr Xuereb and he has introduced journal clubs and meetings for practically every day of the week.

He is also working extremely well with Alex Manche, who has headed the cardiac surgery department since the split. The two have already worked together through the Maltese Cardiac Society where Dr Xuereb is president and Mr Manche vice president.

“We are working in parallel and together – there are no issues between us,” Dr Xuereb said.

More importantly, he said, this has led to a situation where all the decisions were being taken together – from nurses to radiographers, technicians, healthcare workers, specialists and consultants – for the benefit of patients.

From this month, the department will also employ an expert consultant in cardiac imaging so that it can soon start offering MRIs for the heart.

The department is inundated – it gets 100 new referrals at outpatients per week, mostly patients suffering from chest pain, shortness of breath and palpitations – so everyone’s cooperation has been vital to face the constant challenges.