Alan Bethell BHF Adopted Nurse Clinical Nurse Manager Heart Failure

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Alan Bethell BHF (Adopted) NurseClinical Nurse
Manager Heart Failure Cardiac Rehabilitation
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Background
Deprivation Map
CHD Mortality
475,000 population 22nd most deprived local
authority out of 354 Life expectancy is 2 ½ years
lower than the average for England
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Background

• 4 Primary Care Trusts (soon to be 2)
• 1 Acute Hospital

All in financial difficulty !
ALL SERVICES BEING REVIEWED INCLUDING HEART
FAILURE
Specific paper proposing a 2 WTE reduction
in Heart Failure / Cardiac Rehabilitation
Nurses Cost Saving 80k
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Action Plan

• Provide evidence to support service
• Present the solutions to problems
• Current success
• Data presentation
• Base service on invest to save initiative

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Hospital data
Overall admissions are reducing
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However..
Number of patients discharged with a coding of
heart failure
What does this data represent?
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What does this mean?

• Confusion !

• Heart failure admissions are constant
• May indicate we are not having an impact

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Analysis

• ICD data assessed monthly by Heart Failure Team
  for accuracy of diagnosis
• Cross referenced against Heart Failure Team
  admission data
• Gaps identified

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Results
50 excluded from service
50 not suitable due to HEFN or Valvular HF
25 of patients admitted are potentially
suitable 15 patients per month
Missing a high of the patients admitted
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Echo ordered but not obtained before discharge or
not reviewed
Acute hospital portfolio 2005/06
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Average total length of stay (all patients)
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Referrals to service
06/07 targets estimated by HF team
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Referral Source
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Acute Readmissions05-06 Known to HF Service
417 patients reviewed during 05/06
All cause readmissions 18 of case load Heart
Failure Specific Readmissions 6 of total
active case load AVERAGE LENGTH OF STAY 6 DAYS
Excludes end of life care
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End of Life Care
End of life care average LOS at University
Hospital of North Staffordshire NHS Trust 25
days per patient Average Cost to PCT 6818 pp
based on 05/06 costs for a general medical bed
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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

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First of all
Lets be realistic!
We need to be cost effective
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Savings

• Reduction of bed stay from average 14 days to 6
  days 8 days _at_ 272 per day Total Saving Per Pt
  2176
• X 572 patients (admissions with HF 4/2005-4/2006)
  591,872

Based on inpatient activity and does not include
those on QOF register
based on 05/06 costs for a general medical bed
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Whose responsibility?

• Is it time consuming ?
• Is it our responsibility ?
• Is it part of our role ?

YES
To ensure service provision is maintained and
developed for patients with Heart Failure
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Data Sources

• Local data audit teams
• PCT / Acute Trusts
• National audit
• Healthcare Commission
• Benchmarking against other Trusts data
• Athena
• Identifies how local teams are performing

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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!)

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Questions?