Alan Bethell BHF Adopted Nurse Clinical Nurse Manager Heart Failure Cardiac Rehabilitation

1. Alan Bethell BHF (Adopted) NurseClinical Nurse Manager Heart Failure & Cardiac Rehabilitation

2. CHD Mortality Rates in People Aged 35-74 by PCT (1999-2003) CHD Mortality Rates in People Aged 35-74 by PCT (1999-2003)

3. Background Specific paper attached to reduce the team by 2.0 WTESpecific paper attached to reduce the team by 2.0 WTE

4. Action Plan Provide evidence to support service Present the solutions to problems Current success Data presentation Base service on invest to save initiative Present the Solutions to Problems Diagnosis in UHNS inaccurate (and in general practice) Delay in obtaining echocardiogram. In-patient duration prolonged. Readmissions high. Current Success� Reduction in Bed Days Reduced Admissions Cost comparison Invest to save initiative Invest capital monies to develop service and achieve same results in a larger population Present the Solutions to Problems Diagnosis in UHNS inaccurate (and in general practice) Delay in obtaining echocardiogram. In-patient duration prolonged. Readmissions high. Current Success� Reduction in Bed Days Reduced Admissions Cost comparison Invest to save initiative Invest capital monies to develop service and achieve same results in a larger population

5. Hospital data

6. However�..  Suggests that we are not impacting on admissions Suggests that we are not impacting on admissions

7. What does this mean? Confusion ! Causing conflicting data in terms of hospital avoidance and admission Average 60-65 patients per month discharged with a primary coding of heart failure- Suggests that this actual numbers could be higher if taking into account co morbidities Causing conflicting data in terms of hospital avoidance and admission Average 60-65 patients per month discharged with a primary coding of heart failure- Suggests that this actual numbers could be higher if taking into account co morbidities

8. Analysis ICD data assessed monthly by Heart Failure Team for accuracy of diagnosis Cross referenced against Heart Failure Team admission data Gaps identified How many have had an echo +/- coronary angiography How many are suitable for service International Classification of Disease coding (ICD) How many have had an echo +/- coronary angiography How many are suitable for service International Classification of Disease coding (ICD)

9. Results

10. Echo ordered but not obtained before discharge or not reviewed

11. Average total length of stay (all patients)

12. Referrals to service

13. Referral Source >200 GP�s 30 referrals! >200 GP�s 30 referrals!

14. Acute Readmissions05-06 Known to HF Service 417 patients reviewed in 05/06 leading to readmissions as charted 417 patients reviewed in 05/06 leading to readmissions as charted

15. End of Life Care Medical Bed day cost = �272.72 pp per day Cardiology Beds= �543.61 pp per day No of patients deceased = Medical Bed day cost = �272.72 pp per day Cardiology Beds= �543.61 pp per day No of patients deceased =

16. Some Solutions ? Improve accuracy of diagnosis Introduce BNP Reduce waiting for echocardiogram Targeted nurse led portable echocardiography (bedside) Increase referrals Validation of GP QOF registers Reduce in-patient stay Rapid access to HF service iv therapy as an outpatient Prevention of readmissions HF nurse follow-up / access to iv therapy QOF Data � 7 patients identifies as suitable but not referred = across N Staffs +++++ referralsQOF Data � 7 patients identifies as suitable but not referred = across N Staffs +++++ referrals

17. First of all��

18. Savings Reduction of bed stay from average 14 days to 6 days = 8 days @ *�272 per day Total Saving Per Pt = �2176 X 572 patients (admissions with HF 4/2005-4/2006) = �591,872

19. Is it time consuming ? Is it our responsibility ? Is it part of our role ? Whose responsibility? Debated with own team. Debated with own team.

20. Data Sources Local data audit teams PCT / Acute Trusts National audit Healthcare Commission Benchmarking against other Trust�s data Athena Identifies how local teams are performing

21. What has this achieved Consultation paper being withdrawn for Heart Failure Team Business planning for capital investment in primary and secondary care Sustainability of care package to local population (at present!)

22. Questions?