The Issue
Chronic heart failure (CHF) is an increasingly prevalent condition which is characterised by periods of decompensation, many of which lead to unplanned hospital admission. Across the East Midlands, the median length of hospital stay (LOS) for a CHF patient is 11 days, compared to a national median of nine days. Hospital readmission rates are 11-12% at <29 days compared to a national average of 10%. The majority of hospitalised patients with CHF are not managed by physicians with specific interest in CHF, or even by a cardiologist. Evidence for the heart failure specialist nurse services (HFNS) services is around management of patients at high-risk of hospitalisation, that is, patients who have been recently discharged from hospital admission with CHF. Primary care trusts in the East Midlands have access to HFNS; However, these work in a variety of ways, with no standardised referral or discharge criteria.
What we're doing about it
There are a number of strands of work being progressed at a regional level in the East Midlands to address these issues:
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An agreed and implemented high quality care pathway across primary and secondary care, that is underpinned by clear clinical roles and responsibilities and tracked through an audit
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A heart failure diagnosis project to ensure all individuals suspected of heart failure have access to evidence based diagnostics and that registers are validated with an echocardiogram
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Agreed referral and discharge criteria for HFNS services; agreed referral criteria for patients suitable for specialist intervention (invasive procedures)
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Agreed provision of specialist in-patient management for patients with CHF
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Personalised care plans and a patient self-management programme to enable people to access anticipatory care when required.
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Assurance of integration of community and hospital heart failure teams.
