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The new Sheffield clinical pathway for heart failure and the GP open access echo service

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The new Sheffield clinical pathway for heart failure and the GP open access echo ... Algorithm summarising recommendations for the diagnosis of heart failure ... – PowerPoint PPT presentation

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Title: The new Sheffield clinical pathway for heart failure and the GP open access echo service


1
The new Sheffield clinical pathway for heart
failure and the GP open access echo service
  • Laurence OToole
  • Consultant Cardiologist

2
Sheffield PCTs and associated Secondary Care
Trusts
Service review heart failure The performance of
this organisation does not meet minimum
requirements or the reasonable expectations of
patients and the public.
3
Assessment The PCT and its associated secondary
care trust(s) ensures good outcomes for patients
by effectively and swiftly diagnosing
patients with heart failure, providing them with
evidence based treatment and monitoring patients
effectively to optimise treatment, detect
deterioration and minimise admissions to
hospital having effective and adequate
multidisciplinary services and care processes
providing patients and their carers with
education and support so that they can play an
active role in the management of their care
4
Source Data used for Healthcare Commission Heart
Failure Improvement Review
Results of Acute Hospital Portfolio Sept 2005 100
Patients (50 per site) diagnosed with Heart
Failure
HF REVIEW RESULTS Results FEB 07
(provisional) JULY 07 (published)
BESPOKE QUESTIONNAIRE (MAY/JUNE 06) 7
CATEGORIES (Categorical continuous data items)
CENTRAL RETURNS (QOF, diagnostic returns,
hospital episode statistics)
PLAN IMPROVEMENT PHASE
5
Where Sheffield scored poorly
  • No dedicated HF clinic
  • Long waiting times for echo
  • Prescribing consistent with NICE guidance
  • Referral to specialist services
  • Audit
  • Overall mortality and admission rates

6
Prescribing consistent with NICE guidance
  • patients with proven LVSD prescribed ACEi/ARBs
  • national average 85.2 2.7
  • PCT source data
  • North 79.9
  • West 80.8
  • SW 80.9
  • SE 77.2

7
The diagnosis of heart failure
8
NICE Guideline Algorithm summarising
recommendations for the diagnosis of heart
failure
9
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10
Outcomes from Current Open Access Echo Service
L OToole RHH data
11
Outcomes from Current Open Access Echo Service
L OToole RHH data
12
Problems with the Diagnosis of HF in General
Practice
  • Symptoms non-specific
  • Broad differential diagnosis
  • Requires access to specialist investigation
  • Difficult to address with time constraints
  • Inertia because of complexity of treatment
  • Patient reluctance to consider investigations

Barriers to accurate diagnosis and effective
management of heart failure in primary care BMJ
2003326196
13
Problems with Echocardiography for GPs
  • Uncertainty about interpretation of technical
    reports
  • Perception of long waiting times
  • Concerns about overloading the service
  • Inconvenience for patients

14
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15
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16
LVSD
Single New Patient Appointment in Consultant
Cardiology Heart Failure Clinic
Reports reviewed and commented on by Consultant
Cardiologist
No major finding or non-LVSD major finding
Back to GP Care
17
LVSD
Single New Patient Appointment in Consultant
Cardiology Heart Failure Clinic
Nurse-led drug titration clinic
Back to GP Care
18
The new Sheffield in-patient pathway for heart
failure
Hospital admission screening for HF patients by
HF nurses
Preferential admission to HF ward areas
Interested Physician follow up
Better discharge information
Nurse-led post-discharge HF clinic
19
The new Sheffield clinical diagnostic pathway for
heart failure
LVSD
Single New Patient Appointment in Consultant
Cardiology Heart Failure Clinic
Reports reviewed and commented on by Consultant
Cardiologist
No major finding or non-LVSD major finding
Back to GP Care
20
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21
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