Project Name: Service improvement for the detection and treatment of Heart Failure (“HF”) in secondary care (“Integrated Nurse Programme”)
Project Summary:
The principal aim of this joint working project is to improve awareness, identification, management of, and outcomes for, patients with HF in secondary care.
This will be achieved through improvement of the current hospital-based specialist HF service through the deployment of an “in-reach” nurse specialist with the purpose of;
- Identifying and triaging HF patients (both at acute medical receiving units and non-Cardiology departments) so the patients can be appropriately referred to the relevant Cardiology service and receive specialist HF input and
- Subsequently coordinating the discharge of patients and liaising with community teams, including primary care, to ensure continuous appropriate care for HF patients after their discharge from hospital.
Planned Milestones:
| Milestone and Date for Completion | Activity |
|---|---|
| Milestone 1: 1 month from signature of Joint Working Agreement (“JWA”) | The Trust shall confirm the appointment of 1 WTE specialist HF nurse to the JWP Complete collection of baseline comparator data for the Project outcomes. |
| Milestone 2: months from signature of JWA | The Trust shall develop and complete service strategies/protocols and implementation procedures governing the clinical operations of the HF Service. |
| Milestone 3: 3 months from milestone 2 | The Trust shall carry out clinical operations according to the developed strategies/protocols and implementation procedures designed during milestone 2. |
| Milestone 4: 3 months from milestone 3 | The Trust shall continue clinical operations according to the developed strategies/protocols and implementation procedures designed during milestone 2. |
| Milestone 5: 3 months from milestone 4 | The Trust shall continue clinical operations according to the developed strategies/protocols and implementation procedures designed during milestone 2. |
| Milestone 6: 1 month from milestone 5 | The Trust shall analyse the data it has collected in relation to the JWP and prepare a business case for continuing the Project. |
| Milestone 7: 1 month from milestone 6 | The Trust shall submit its business case to relevant body. |
| Milestone 8: 15 months from milestone 7 | The Trust shall submit a final JWP Report to Novartis. |
Expected Benefits:
Anticipated benefits for Patients
- Improved access to diagnosis and treatment;
- More equitable and consistent care and access to care; and
- Enhanced experience for patients and their carers who live with HF.
Anticipated Benefits for Newcastle upon Tyne NHS Trust
- Increase the overall quality of care and improve equity of access to specialist care for patients with HF;
- Improve patient flow and increase levels of accurate diagnosis on non-cardiology wards;
- Increase proportion of patients with HF being managed in accordance with the NICE chronic heart failure 2018 guidelines ; and
- Insight into benefits of increased inpatient long-term therapy initiation/optimisation which may inform ongoing redesign and workforce planning
Anticipated Benefits for Novartis
- Further opportunities for the appropriate use of heart failure licensed medicines in line with NICE guidelines, including Novartis’ medicine;
- Improved reputation; and\
- Improved professional and transparent relationship and trust between Novartis and the NHS.
Start Date & Duration: April 2021 for 26 months
UK2301251919
Project Name: Service improvement for the detection and treatment of Heart Failure (“HF”) in secondary care (“Integrated Nurse Programme”)
Completion Date: June 2023
Outcome Summary:
The provision in Specialist In Reach Heart Failure nurses has improved patient care during acute heart failure admissions.
There are significant improvements in diagnosis and early specialist treatment, and appropriate supported discharge to reduce readmsissions and improve quality of life. There has been reductions in length of hospital stay for heart failure, reductions in in-hospital mortality, improvements in follow-up and rehabilitation. Patient experiences are positive with improved patient journeys through the heart failure service.
Ongoing funding for continued provision of this service has been secured.
Key Project Outcomes Data:
Inpatient Heart Failure Nurses now are seeing ~300 patients per year
There has been a 25% increase in referral to community services following acute admission
There has been a 40% increase in referrals to Cardiac Rehab for Heart Failure patients
Observed mortality for heart failure in the Trust is 7.7% vs National average 9%*
There has been a reduction in patient length of stay from 13.8 to 10.5 days
Outcomes:
A reduction in hospital mortality (in keeping with the National heart failure audit showing a significantly lower inpatient mortality in patients seen by a specialist)
Only 15% of patients seen by HF nurses readmitted in a 90-day period.
Specialist nurses can also help to plan re admission in a timelier manner, if required, thereby in turn also reducing length of stay.
A prediction of continued increase of heart failure patients, over the forthcoming years, which is evident in an increase in patient numbers as identified above.
Conclusion:
The project has proven benefit from inpatient heart failure nurses in improving patient care and outcomes, it has improved patient journey and experience and shown reductions in hospital readmissions and mortality
Temporary funding has successfully been converted into a substantive long-term post with ongoing funding from the Trust
Currently, the Trust is looking to expand service further to provide more comprehensive cover across Newcastle.
References:
National Heart Failure Audit data (NICOR) NICOR | Heart Failure (Heart Failure audit) (Accessed Jul-2023)
UK2308168062