The new Sheffield clinical pathway for heart failure and the GP open access echo service Laurence O’Toole Consultant Cardi...
Service review heart failure The performance of this organisation does not meet minimum requirements or the reasonable exp...
Assessment The PCT and its associated secondary care trust(s) ensures good outcomes for patients by: •  effectively and sw...
Source Data used for Healthcare Commission Heart Failure Improvement Review Results of Acute Hospital Portfolio Sept 2005 ...
Where Sheffield scored poorly <ul><li>No dedicated HF clinic </li></ul><ul><li>Long waiting times for echo </li></ul><ul><...
Prescribing consistent with NICE guidance <ul><li>% patients with proven LVSD prescribed ACEi/ARBs </li></ul><ul><li>natio...
The diagnosis of heart failure
NICE Guideline Algorithm summarising recommendations for the diagnosis of heart failure
 
Outcomes from Current Open Access Echo Service L O’Toole RHH data 35% 312 (45%) Murmur ?cause pathway 37% 382 (55%) ?HF pa...
Outcomes from Current Open Access Echo Service L O’Toole RHH data 5% 16% 35% No Major Finding N=239 10% 28% 57% Major Echo...
Problems with the Diagnosis of HF in General Practice <ul><li>Symptoms non-specific </li></ul><ul><li>Broad differential d...
Problems with Echocardiography for GPs <ul><li>Uncertainty about interpretation of technical reports </li></ul><ul><li>Per...
 
 
Single New Patient Appointment in Consultant Cardiology Heart Failure Clinic Back to GP Care  Reports reviewed and comment...
Single New Patient Appointment in Consultant Cardiology Heart Failure Clinic Back to GP Care  LVSD Nurse-led drug titratio...
Preferential admission to HF ward areas ‘Interested Physician’ follow up Hospital admission screening for HF patients by H...
Single  New Patient Appointment in Consultant Cardiology Heart Failure Clinic Back to GP Care  Reports reviewed and commen...
 
 
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The new Sheffield clinical pathway for heart failure and the ...

  1. 1. The new Sheffield clinical pathway for heart failure and the GP open access echo service Laurence O’Toole Consultant Cardiologist
  2. 2. Service review heart failure The performance of this organisation does not meet minimum requirements or the reasonable expectations of patients and the public. Sheffield PCTs and associated Secondary Care Trusts
  3. 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. 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 BESPOKE QUESTIONNAIRE (MAY/JUNE 06) 7 CATEGORIES (Categorical & continuous data items) HF REVIEW RESULTS Results FEB 07 (provisional) JULY 07 (published) CENTRAL RETURNS (QOF, diagnostic returns, hospital episode statistics) PLAN IMPROVEMENT PHASE
  5. 5. Where Sheffield scored poorly <ul><li>No dedicated HF clinic </li></ul><ul><li>Long waiting times for echo </li></ul><ul><li>Prescribing consistent with NICE guidance </li></ul><ul><li>Referral to specialist services </li></ul><ul><li>Audit </li></ul><ul><li>Overall mortality and admission rates </li></ul>
  6. 6. Prescribing consistent with NICE guidance <ul><li>% patients with proven LVSD prescribed ACEi/ARBs </li></ul><ul><li>national average 85.2% ± 2.7% </li></ul><ul><li>PCT source data </li></ul><ul><ul><ul><li>North 79.9% </li></ul></ul></ul><ul><ul><ul><li>West 80.8% </li></ul></ul></ul><ul><ul><ul><li>SW 80.9% </li></ul></ul></ul><ul><ul><ul><li>SE 77.2% </li></ul></ul></ul>
  7. 7. The diagnosis of heart failure
  8. 8. NICE Guideline Algorithm summarising recommendations for the diagnosis of heart failure
  9. 10. Outcomes from Current Open Access Echo Service L O’Toole RHH data 35% 312 (45%) Murmur ?cause pathway 37% 382 (55%) ?HF pathway Major Echo Finding (%) Number of people scanned (% total)
  10. 11. Outcomes from Current Open Access Echo Service L O’Toole RHH data 5% 16% 35% No Major Finding N=239 10% 28% 57% Major Echo Finding N=143 DIED in next year (%) ADMITTED STH Gen Med/Cardio in next year (%) REFERRED STH Gen Med/Cardio in next year (%) ?HF pathway N=382
  11. 12. Problems with the Diagnosis of HF in General Practice <ul><li>Symptoms non-specific </li></ul><ul><li>Broad differential diagnosis </li></ul><ul><li>Requires access to specialist investigation </li></ul><ul><li>Difficult to address with time constraints </li></ul><ul><li>Inertia because of complexity of treatment </li></ul><ul><li>Patient reluctance to consider investigations </li></ul>Barriers to accurate diagnosis and effective management of heart failure in primary care BMJ 2003:326;196
  12. 13. Problems with Echocardiography for GPs <ul><li>Uncertainty about interpretation of technical reports </li></ul><ul><li>Perception of long waiting times </li></ul><ul><li>Concerns about overloading the service </li></ul><ul><li>Inconvenience for patients </li></ul>
  13. 16. Single New Patient Appointment in Consultant Cardiology Heart Failure Clinic Back to GP Care Reports reviewed and commented on by Consultant Cardiologist LVSD No major finding or non-LVSD major finding
  14. 17. Single New Patient Appointment in Consultant Cardiology Heart Failure Clinic Back to GP Care LVSD Nurse-led drug titration clinic
  15. 18. Preferential admission to HF ward areas ‘Interested Physician’ follow up Hospital admission screening for HF patients by HF nurses Nurse-led post-discharge HF clinic Better discharge information The new Sheffield in-patient pathway for heart failure
  16. 19. Single New Patient Appointment in Consultant Cardiology Heart Failure Clinic Back to GP Care Reports reviewed and commented on by Consultant Cardiologist LVSD No major finding or non-LVSD major finding The new Sheffield clinical diagnostic pathway for heart failure

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