Developing and Implementing the Rapid Access to Valve Assessment (RAVA) Pathway for the Greater Manchester Region

Regular contact, trust that work was being undertaken during the non-contact time. Value for money. As a clinician having someone who could continue with the processes required in planning a new service was essential, this allowed me to concentrate on clinical workload whilst TU delivered on the development of the new pathway.

Consultant Cardiac Physiologist, Project Lead, MFT.

26th June 2025

Heart ultrasound examination on patient by cardiologist.

We provided programme leadership to support the development and successful implementation of the Rapid Access to Valve Assessment (RAVA) pathway for patients from across the Greater Manchester (GM) region enabling them to receive more timely access to care and treatment for left sided valve heart disease.

Manchester University NHS Foundation Trust (MFT) commissioned our support to improve the pathway for patients with severe valve heart disease (SVHD) across the Greater Manchester region.

The Challenge

Severe symptomatic valve disease poses a significant threat to patient health as untreated cases often result in considerable morbidity and mortality.

Services in GM were experiencing significant challenges with the average referral-to-treatment time (RTT) across GM exceeding 52 weeks, and were keen to immediately address these waiting times throughout the region. Current services were also fragmented with patients having to navigate disjointed pathways with involvement from multiple providers.

Our client requested our skills to support streamlining the pathway and to apply our programme leadership expertise to enable timely access to treatment for patients with severe valve heart disease. Local clinical teams required our support to develop, test and implement a new RAVA pathway.

Our Approach

We worked closely with clinical colleagues at MFT to manage the project lifecycle to:

Map the existing pathway and involve clinicians and stakeholders in designing the new pathway
Develop the plan for implementing and testing the new pathway
Engage with and involve a range of stakeholders, including patient groups, referring parties such as primary care, independent sector providers and clinicians delivering services
Establish the baseline data and agree metrics and data collection process for the pilot testing.

The Outcome

We successfully implemented the new RAVA pathway with a significant improvement in performance including:

Average time taken from first echocardiogram diagnosis to a clinical decision reduced by 133 days (from 150 days down to 17 days)
Average time taken to refer for surgical treatment reduced by 281 days (from 410 days down to 129 days)
Average time taken from echocardiogram to treatment with Transcatheter Aortic Valve Implantation (TAVI) reduced by 286 days (from 410 days down to 124 days)
Average number of appointments between the decision to refer from primary care to treatment in secondary care reduced by 6 appointments (from 9 appointments down to 3 appointments).

These outcomes demonstrate a meaningful impact to patient care, significantly accelerating the treatment pathway, reducing the burden on healthcare services, and enabling earlier intervention for improved patient outcomes. Patient feedback indicated that all patients on the new RAVA pathway were positive about their RAVA clinic experience.