Heart Failure Input to the Hot Floor

What problem are you setting out to solve?

Patients with primary or secondary diagnosis of Heart Failure, Chest Pain or Atrial Fibrillation have a 70% conversion rate to admission.

How do you intend to solve this?

Run a three month pilot to assess the impact of increasing specialist nurse resource in this area.

What are you doing to improve this and how are you tracking progress? 

  • Addressing how patients are identified to HF service (tracking the number of patients seen – currently 12 per month)
  • Making dedicated diagnostic slots available (to see if this, combined with HF intervention impacts the conversion rate – 70%)
  • Track length of stay amongst those who have been admitted following intervention with pathway (currently 5.18 days on average)

What difference has this made to patients? Please describe in relation to a patient journey

Patients have quicker access to specialist care and diagnostics in Emergency Department/ AAU (meaning they don’t need to wait to be admitted to MAU before they get diagnostics).

Earlier intervention from specialist has potential to avoid the need for admission as they can be assigned a package of care to return home, but can also shorten length of stay if an admission is necessary.

One patient, admitted to MAU overnight, was assessed by a Heart Failure Nurse the next morning and discharged with AAU follow up.

What difference has this made to staff?

Decision making process is expedited by dedicated diagnostic slots; this allows scans to take place without admitting to MAU. Specialists can then make a decision on care plans.  This can avoid admissions in many cases, but can also allow direct admission to a cardiology ward (bypassing MAU), in either scenario there are benefits in terms of patient flow.

Who is involved in your improvement team? 

Becky Horne, Rosemary Gilbert – Heart Failure Nurse Specialists

Crystal Dickson – Cardiology Nurse

Helen Churchward, Chiméne Morgan – Medicine Care Group Improvement Support


Project Update: 26 March 2019

What is the current state? 

Data from Heart Failure Pilot


Has there been any recent changes to the data, or significant steps taken to improve on the current process? 

Lower admission conversion rate of 9.4% for patients presenting with these conditions seen by the Heart Failure Specialist Nurses.

What stage of the improvement cycle are you / the team currently in?

Embedding changes on the back of pilot, further improvement cycles could be undertaken to test the impact of direct Cardiology admission for any patients seen through this process

What are your learning points?

  • Increased provision of diagnostic support at front door was valuable to decision making
  • Having advance nurse clerking allowed direct admission, therefore avoiding MAU

What are your next steps?

Consider backfilling HF service to continue this work in the immediate term, until a long-term recruitment plan can be formulated




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