Nurse led rapid access community arrhythmia clinics

15 Pages·2010·0.81 MB·English

South Tees Hospitals
NHS Foundation Trust
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i Nurse led rapid access community
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arrhythmia clinics: Improving access
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and delivery of patient care
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i J Mudd, S Hackett, Angela Hall, AJ Turley, SA James
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& NJ Linker
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The James Cook University Hospital, Middlesbrough,
United Kingdom
Introduction & Background
• A nurse led rapid access community arrhythmia service
was developed in 2007
• The aim was to relieve pressure on tertiary-centre
cardiology appointments and to meet national guidance
on arrhythmia management
• We report our experience and outcomes after 27
months
South Tees Community
Arrhythmia Service
• Community service covers
Middlesbrough, Redcar
and Cleveland
• Population of
approximately 300,000
• 50 GP Practices
The CRM Team Structure
EP
Consultants
Health Arrhythmia
Care Care
Assistants Coordinator
Patient
Specialist
Arrhythmia
Secretaries
Nurses
CRM
Physiologists
CRM: Cardiac Rhythm Management
Why a community clinic?
• Key Drivers
– Provide services in
patients own locality
– 18 week programme
– NICE Guidance
– Limited fast access to
diagnostics for
patients with
suspected arrhythmias
– Demand and Capacity
Methods
• Nurses completed competency based training
programmes. Appropriate experience and qualifications
are essential
• Primary care referrals are triaged by arrhythmia nurses
and directed to community or tertiary care services. Traffic
light system for clinical triage
Triage: Diagnosis of
Cardiac Arrhythmia
Atrial Bradycardia
Fibrilation AtrialFlutter Heart Block
AVNRT
AtrialFlutter
AVRT
AVNRT WPW (with AF)
Atrial Tachycardia
AVRT VT
RVOT
AtrialTachycardia
ILVOT
RVOT
ILVOT
Symptoms not interfering with
daily activities
Potentially Life Potentially Life
Non-Life Non-Life Non-Life
Threatening Threatening
Threatening Threatening Threatening
• Assessment • Assessment
• Assessment • Immediate referral to
• Management (as per • Discuss treatment options
• Discuss treatment options Consultant
protocols) • Management (as per
• Management (as per Electrophysiologist
• Reassurance protocols)
protocols) • Further investigation
• Refer back to GP or • Refer back to GP or review
• Refer to Electrophysiologist required
Review in 12 weeks in 12 weeks
• Management (as per
protocols)
Catheter Ablation will be offered to this group of patients in line with the agreed
protocols
Methods
•The community clinics offer a ‘one-stop-shop’ with all patients undergoing
clinical evaluation, 12-lead ECG and echocardiography at their first appointment.
–Ambulatory monitoring/patient activated recorders are fitted as required
•Clinical supervision and review of patient treatment plans is provided by a team
of electrophysiologists and decisions made for ongoing treatment as necessary
•Stroke risk stratification for all patients with atrial fibrillation/flutter
•Medication is prescribed and titrated by the arrhythmia nurses
•A patient telephone help line is also provided
Results
October 2007 – January 2010 • 87% of patients managed
solely within the community
• 1459 Referrals made
clinics
• 1386 New patients seen
– 4% referred on for specialist
– 7 Referrals re directed
opinion
– 66 waiting to be seen
– 9% listed for procedures
• 2116 Review patients seen
• Patients fast tracked
minimising waiting times
• Average waiting time for
appointment is 5.2 weeks
• Reduction in waiting times for
tertiary centre outpatient
appointments
Results: Invasive procedures
126/1386 (9.1%)
Invasive Procedures
were
listed for invasive
procedures
LHC
6% Ablations
21%
DCCV
25%
PPM
27%
ILR
21%