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Nurse-led A&E pilot ‘improving cardiac care and cutting admissions’

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Early evidence suggests a nurse-led scheme to assess and support people with heart conditions while in accident and emergency is helping slash A&E admissions.

The project at Derriford Hospital – run by University Hospitals Plymouth NHS Trust – has seen heart failure nurses review patients soon after they come into the emergency department.

“Early intervention from a specialist nurse is really beneficial to patients”

Becky Horne

As a result of their specialist advice and expertise, many people have been able to return home safely without being admitted.

The nature of cardiac conditions means the vast majority of patients who arrive at A&E generally end up being admitted and then referred to a heart failure nurse, noted the trust.

The three-month pilot, devised by the hospital’s heart failure nursing team, set out to examine the impact of earlier input from specialist nurses for those with a primary or secondary diagnosis of heart failure, atrial fibrillation or irregular heartbeat, and other cardiac conditions.

“Early intervention from a specialist nurse is really beneficial to patients, as in many cases they can be sent home with a package of care and can avoid having to stay in hospital. In terms of patient experience, this is the best possible outcome,” said lead heart failure specialist nurse, Becky Horne.

During the first two weeks of the pilot, which got under way in March, heart failure nurses assessed more than 30 patients in the emergency department.

They were able to provide the majority – 91% – with advice or care packages allowing them to return home. The admission rate during this time plummeted from 70% to just 9%.

“In the reducing number of instances where admission is necessary, we are able to directly admit patients to the most appropriate specialist ward,” said Ms Horne.

University Hospitals Plymouth NHS Trust

Rosemarie Gilbert and Becky Horne

Plymouth specialist heart failure nurses Rosemarie Gilbert and Becky Horne

“This is better for patients as it speeds up their onward journey, bypassing a transitional stay in an assessment unit and putting them straight into the care of our specialist team,” she added.

The team is also looking at the impact of early intervention from specialist nurses on outcomes for patients admitted directly to cardiology wards.

This will involve monitoring length of stay among this patient group, which was just over five days on average before the pilot got under way.

The project, which is part of trust’s People First improvement programme, is inspired by “lean” methodology devised by car giant Toyota and now increasingly used in health services.

Last year, the trust became one of the first seven in England to be selected to take part in NHS Improvement’s “lean” programme aimed at improving safety and patient care, eliminating delays and reducing length of stay.

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Readers' comments (1)

  • This looks very good. We see a lot of really good evaluations of nurse led services and yet their value is still doubted.

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