Transferring heart services into the community

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13 / 12 / 2012

University Hospitals Birmingham NHS Foundation Trust (UBH) has transferred their heart assessment services into a number of one-stop community clinics to reduce re-admissions and provide services closer to the patient's home. 

 

Background

University Hospitals Birmingham NHS Foundation Trust treats many patients living with long-term heart conditions. The trust identified a need to transfer their heart assessment services into the community combined with a drive to reduce hospital re-admissions. A decision was made to provide preventative heart assessment services within community settings in south Birmingham.

What we did and why?

Commissioners approached the trust and asked them to develop and deliver a one-stop consultant-led heart assessment community clinic. The aim of the service, as outlined in the national service framework was to:

  • help people with heart failure to live longer and achieve a better quality of life
  • help people with unresponsive heart failure and other malignant presentations of clinical heart disease to receive appropriate palliative care and support.

How we did it

In response to being approached by commissioners, the first heart assessment service community clinic was developed with Sparkbrook GP Practice. This clinic has four clinical rooms and runs a clinic one afternoon each week. The trust uses their own equipment, transporting it using community transport for insurance purposes.

The heart assessment service consists of consultant-led outpatient clinics, with access to nurse and technician-led clinics. To qualify for the service, patients must have a confirmed diagnosis of a heart condition or have clinical suspicion of heart failure. Patients that require intervention or surgery are admitted to the Queen Elizabeth Hospital Birmingham.

At each open-access clinic, staff from the hospital including the consultant cardiologist, specialist registrar or general practitioner with specialist interest within the practice sees patients for assessment and diagnosis by echocardiography.

The clinic is supported by a current hospital-based Band 7 healthcare scientist in cardiology and healthcare science assistant/associate. Patients use the Choose and Book service to book their appointments which provides them with greater flexibility and choice.

The patient is seen, informed of their diagnosis and treatment options are discussed. The patient's GP is also informed of the diagnosis and recommendations for treatment are faxed to the patients GP practice. Patients are then offered a follow up appointment with heart failure specialist nurses for education around their condition and the commencement of new or increased dosage of medicine.

Echocardiograms and ECG’s are carried out at the clinic. Patients who require a 24 hour tape can also have one fitted. It takes only a few minutes to put a 24 hour tape on a patient and by providing this service close to a patient's home, unnecessary journeys, travel and patient transport are avoided.

The heart assessment service is also supported by a general practitioner with specialist interest in cardiology who provides three outpatient clinics a week, with a healthcare science associate technician working in parallel with the established nurse-led clinics.

Results and next steps

Similar heart assessment service clinics are also now run at other sites.

Feedback from GPs has been very positive. They like the comprehensive treatment plans, informative letters and short patient waiting times which are usually within two weeks.

Next steps are to improve patient services including collaborative working with lung function/respiratory to help deliver a joint breathlessness service. There are also plans to expand diagnosis to patients in the community who are living with heart conditions but who remain undiagnosed.

Tips for other trusts

Ensure you have a robust business case to secure recurrent funding should you wish to expand services further.

Work closely with health informatics to ensure patient information is recorded accurately. Accurate recording is helpful when demonstrating to the board services need to be expanded and funds are required.

The organisation

University Hospitals Birmingham NHS Foundation Trust (UHB) is the leading university teaching hospital in the West Midlands. The Trust employs around 6,900 staff and provides adult services to more than half a million patients each year, from single outpatient appointments to heart transplants.

Contact and further information

Lyn Newton, Head of Technical Cardiology Lyn.Newton@uhb.nhs.uk.  

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