bhf arrhythmia nurses carolyn shepherd clare parker/sarah chalkley arrhythmia nurse service...
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BHF Arrhythmia Nurses
Carolyn Shepherd Clare Parker/Sarah Chalkley
Arrhythmia Nurse Service
2008/2011
History of Arrhythmia Nurse Role
Pressure groups – Arrhythmia Alliance.
National Drivers (Chapter 8 NSF & NICE)
Equity of care for patients in South West
Collaborative business case
British Heart Foundation Funding for 3 years
Steering group established
(includes NBT, AGWS cardiac network, PCT)
BHI Arrhythmia Nurses
2008
Cardiology Backgrounds.
BHF funding for development
Working towards MSc in Advanced Practice
2011
MSc module in Arrhythmia Management
Physical Examination and Assessment module.
Independent Nurse Prescribing module.
Applying for BHF funded MSc genetics modules
Targets of Arrhythmia Nurse Role
Develop links with primary care to promote awareness of up-
to-date diagnosis, management and treatments for arrhythmias
Establish telephone advice and guidance helpline for patients/
carers/primary care staff
Address long clinic waiting list
Reduce length of stay and prevent unnecessary admissions
Establish robust pre-operative assessment
Develop service for survivors of sudden cardiac death and
their families
Pre-operative Assessment
Pre-operative Assessment
Pre-assessment – 2008
Pre-operative assessment undertaken by ward staff and junior doctors on day of procedure
Consent on day of procedure
No central point of case management
No written information or point of contact provided
No MRSA Screening
Patient satisfaction running at 60%
Pre-assessment today
• Three one -stop clinics per week• Over 1,000 patients expertly pre-assessed and case
managed• Gold standard nurse-led consent- (Standard set for whole
Trust)• Pre-written consent forms - (Adopted & adapted nationally)• Processes agreed for infection control and anticoagulation
management• Overall patient satisfaction rose from 60% in 2009 to 96% in
2011.
Patient comments. Satisfaction Survey - 2011
I was very well treated by the young lady. I was given the opportunity to ask any questions – did not
feel rushed. Good thorough pre-op assessment. I had serious atrial fibrillation lasting days after the
ablation, but a phone call to the arrhythmia nurses allayed fears and the atrial fibrillation was sorted by increasing medication.
The arrhythmia nurses took a great deal of trouble and time to explain the procedure. It was extremely helpful and reassuring. 10/10 Thank you.
Impact of KEY CHANGES to Pre-assessment
Pre and post
pre-assessment
service cancellation rate.
Increased day case
procedures.
PRE - 17%PRE - 17%
POST - POST - ↓↓ 2.5% 2.5%
PRE - 37%
POST - ↑ 71%
Telephone advice/support Line
Telephone Advice and Guidance 2008
Calls dealt with by;
Medical secretaries
Waiting List Office staff
Medical staff
Cardiology ward staff
CCU staff
Catheter lab staff
Any available person!
Telephone Advice and Guidance 2011
Telephone line open to;
Patients
Carers
Relatives
Health care Professionals
General Practitioners throughout Bristol
Q1 2009-10 Q2 2009-10 Q3 2009-10 Q4 2009-10 Q1 2010-11 Q2 2010-11 Q3 2010-11 Q4 2010-11 Q1 2011-12 Q2 2011-120
50
100
150
200
250
300
350
Total number of phone callsApril 2009 - Sept 2011
Telephone Advice and Guidance2009 - 2011
Q1 2009-10 Q2 2009-10 Q3 2009-10 Q4 2009-10 Q1 2010-11 Q2 2010-11 Q3 2010-11 Q4 2010-11 Q1 2011-12 Q2 2011-120
50
100
150
200
250
300
350
Phone call catergories (April 2009 - Sept 2011)Misc OHP (primary care) OHP (in hospital) Medications Physcological supp Post proc queries Pre proc queries
Category of telephone calls
GP/Out-Patient Appointments Avoided
175 appointments avoided in 1 year through:
Advice given
Reassurance given
Medication changes made
Post op queries answered
Pre-op queries answered
GP Telephone Calls
No Tariff
Expert Advice
Medications/pre-post op queries/investigations
Consultant input
Urgent ECG advice
Reduce Clinic Waiting Times
Nurse-led follow-up clinics
One clinic per week.
Six patient slots of 30 mins each.
Annual Total – 312 patients seen
Cost of Nurse-led appointment £111.01p
Saving on Consultant appointment of;
£120.71pTotal Saving = £37,661p per annum
Nurse-led Cardioversion follow-up
Nurse-led cardioversion follow-up.
Clinical expertise to review and plan patient pathway
Reduces need for GP re – referral for review
Assess and offer
ablation treatment if appropriate
Assess and discharge to
Primary care with care plan
Nurse-led follow-up clinics
Reduces waiting time for patient
Isn’t this repeating what you’ve already said?
Reduces Consultant clinic waiting time
Unplanned Admissions Averted
Unnecessary Admissions Averted
Cost of admission to A&E:
Mid tariff; £110 – plus tests. CXR/ECG/Bloods etc
Number of potential admissions averted.
Last full year = 49
Saving. £5,390 plus
Unplanned Admissions avoided
Q3 2010-11 Q4 2010-11 Q1 2011-12 Q2 2011-120
2
4
6
8
10
12
14
16
18
20
Admissions avoidedOctober 2010 - Sept 2011
Wound Review Service/rescue
Example of rescue work to reduce admissions•Free service•On demand•Early treatment if required•Rescue before major problem occurs•Reassurance
Reduction in Length of Stay
Reduced Length of StayElective Patients
Nurse-led discharge
• Reduction of discharge time from 13.00 to 10.30am
• Improved patient throughput leading to reduced
cancellations• Improved patient information pre-discharge
reduces readmission
Length of StayPatient pathway pre ANs
Patient admitted to A&E or MAU
Medical Clerking/basic tests
ADMIT to CARDIOLOGY. Await specialist EP review - 1 – 2 nights
Review by EP – treat/discharge
Wait for OPA, 2 - 3 months
Attends OPA/listed for procedure/waits
Procedure
Pre-operative assessment
Reduced length of stayIn-patient pathway 2011
Patient admitted to A&E/MAU
Medical Clerking/Basic tests
Picked up by Specialist Nurse on post-take ward round
Referred to Arrhythmia Nurse/Treatment plan recommended
Patient information given/Listed for procedure / tests
Discharge same day with treatment plan
Pre-operative assessment
Procedure
Tests reviewed by AN
Overview 2008 - 2011
5,130 Patient contacts
1,165 Telephone calls
84 Wound Reviews/Rescue
312 Outpatient Appointments
The Future - EP expansion
Cannot have this as the focus for primary care!Appointment of new EP Consultant.Initial aim to reduce waiting listGenerate increased pre-assessment work?Need for further follow-up clinic?Increased number of in-patients to review?
Commitment to South Bristol Hospital clinicsArrhythmia clinic/pre-op clinic.
Summary
Cost of two band 7 nurses with add-on costs
£85,318 per annum
Savings
Clinics £111.01p x 312 = £34,635.12p p/a
Unplanned admissions A&E £5,390
Two day admission = ?
No charge for telephone advice
Retreat is not an option!
No service!No pre-assessment–(no capacity in general pre-op)
No case management
--- phone calls redirected/not taken
312 follow-up clinic slots to find
No expert nurse-led discharge from wards (↑cancellations)
No reduction in length of stay for unplanned admissions (↑ cost)
None/limited provocation studies (↓ income/service)
No arrhythmia nurse-led clinics at South Bristol Hospital. (↓ income)
Reduced quality (↑complaints)
All in context of expanding service.