Nurse Intervention Pilot showing signs of improving cardiac care
A nurse-led improvement project in Derriford Hospital’s Emergency Department is changing the way patients with cardiac conditions experience urgent care.
The three-month pilot, devised by the Heart Failure Nursing Team, is examining the impact that earlier intervention from a specialist nurse could have on the outcomes of patients attending the Emergency Department with either heart failure, cardiac conditions or atrial fibrillation (as a primary or secondary diagnosis).
Nobody wants to have to stay in hospital, but the nature of cardiac conditions means that there is a high likelihood a patient will have to be admitted, with 70% of emergency attendances requiring an inpatient admission and a subsequent referral to a Heart Failure Nurse.
The primary focus of the pilot is to assess the impact of quicker access to specialist nurse review and diagnostics, by providing Heart Failure Nurse support within the Emergency Department.
Lead Heart Failure Specialist Nurse, Becky Horne, said: “Early intervention from a specialist nurse is really beneficial to patients, as in many cases they can be sent home with a package of care and can avoid having to stay in hospital. In terms of patient experience, this is the best possible outcome.”
Over the first two-week period of the pilot (from 4 March), the Heart Failure Nurses assessed more than 30 patients in the Emergency Department and were able to provide 91% with advice or care packages allowing them to return home. The admission rate during this time was lowered to 9% (compared to 70% previously).
“In the reducing number of instances where admission is necessary, we are able to directly admit patients to the most appropriate specialist ward.” explains Becky. “This is better for patients as it speeds up their onward journey, bypassing a transitional stay in an assessment unit and putting them straight into the care of our specialist team.”
Having studied the initial impact of the pilot, the next stage is to understand the impact early intervention has on outcomes for patients admitted directly to the Cardiology wards. This will involve monitoring length of stay amongst the patient group (previously 5.18 days on average).
This ‘scientific learning’ approach is based on the Trust’s Improvement Practice work called #PeopleFirst. #PeopleFirst is delivered by the Trust’s Quality Academy and supported as part of NHS Improvement’s national ‘Vital Signs’ initiative with seven organisations across England.
This improvement practice is based across several methodologies including Lean and IHI approaches. The practice aims to ensure patients are at the centre of change, staff are respected and teams are supported to drive improvement. This will improve the quality of patient care, improve safety, eliminate delays and reduce length of stay.
Want to know more? Visit Heart Failure Input on the Hot Floor project for further updates.
Professor Matthew Cramp
Professor Cramp qualified from St Bartholemew's Hospital in 1987. He undertook specialist training in hepatology and liver transplantation at Westminster Hospital, King's College Hospital, London and St Vincents Hospital, Sydney
Areas of expertise:
Professor Cramp has wide experience in all forms of liver disease including liver transplantation.
Professor Cramp's specialist interests include liver transplantation and viral hepatitis. Professor Cramp has has extensive research and clinical trials experience in viral hepatitis.
Qualifications: MD FRCP (UK)
Research interests: The immunology of Hepatitis C
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