Publication
Improved access to care for Heart Failure patients in Midlands Regional Hospital Portlaoise
From Department of Health
Published on
Last updated on
From Department of Health
Published on
Last updated on
Heart failure affects an estimated 2% of the adult population in developing countries, and over 10% amongst the over 65s. It accounts for 5% of all emergency admissions in Ireland. Identifying, preventing, improving care and reducing hospital stays for those with heart failure is the aim of this new Sláintecare Heart Optimisation project in Midland Regional Hospital Portlaoise. The introduction of an Advanced Nurse Practitioner (ANP) in Cardiology in Midland Regional Hospital Portlaoise is improving patient access and continuity of care.
Karen Kelly, the Candidate Cardiology Advance Nurse Practitioner (cANP) explains how the Heart Optimisation Team in Portlaoise empower patients’ in self-care for their illness, optimising their medication and optimising their quality of life:
“The patient is at the centre of everything we do and all the care is designed individually for each patient. We work with the patient and their families to make sure the patient has all the support they need to manage their condition at home, avoiding hospital admission and readmission”.
This approach has resulted in excellent patient outcomes:
The Sláintecare funded cANP post has contributed greatly to the existing care of Heart failure patients in Portlaoise. It has provided an opportunity to extend the service and implement new care pathways, referral pathways and services for patients with and at risk of heart failure. This has resulted in increased referrals for both inpatient and outpatient service and increased access to services for patients and their carers.
Early identification of patients, and initiating them into a structured disease management programme (education and support on self-care and optimisation of medication), improves patient outcomes, mortality rates and reduces readmission rates.
To facilitate early intervention and diagnosis, the heart optimisation service includes a Rapid Access Risk Assessment Clinic where the ANP in cardiology works with the Consultant Cardiologist in providing urgent outpatient care. The service treats patients with/at risk of developing heart failure. This includes patients presenting to GPs with signs of heart failure. Patients attending the risk assessment clinic have a point of care lung ultrasound (POCUS) by the cANP. This is a relatively new modality providing very accurate assessment of congestion, response to treatment changes and differential diagnosis in dyspnoea.
In collaboration with the local community intervention team, patients can be reviewed and have blood tests by a nurse in their home when required. This facilitates close monitoring, and timely titration of medications of vulnerable patients in the community. This service is really appreciated by patients and their carers, is extremely valuable during the COVID-19 pandemic by reducing patients’ need to attend clinic, and it provides continuous assessment for patients who cannot travel to clinic.
The Heart Optimisation nurses have introduced a new initiative, in collaboration with patientMpower, that allows remote monitoring of patients’ blood pressure, heart rate and weight at home. This has empowered patients in self-management of their health, facilitated early discharge, reduced clinic visits and admission avoidance. Patients are extremely satisfied with the service, and feedback has been very positive:
"I feel more confident going home, knowing I am monitored by the nurses."
"It’s great to see the graphs on my phone, reduce the need to go to clinic and have medications titrated from home."
One patient in particular had an 80 kilometre round trip to attend clinic, and can now have their appointment without leaving their house.
"Means so much to have the girls at the end of the phone. So grateful for them sending a nurse to my home when I was not up to going into the clinic after my recent loss."
"Thank you so much for all your care and kindness for our mother, she was most grateful for all you did, especially facilitating her to stay at home. It meant so much to all of us."
Patients can now see a number of specialities in one visit, without having to come to hospital multiple times for tests and treatments, thanks to the successful engagement the team has carried out across different clinical teams in the hospital.
Karen says:
"We are looking forward to further developing the services as part of the Enhanced Community Care programme, which is reducing our dependence on the current hospital-centric model of care and supporting capacity building in the community, key to realising the vision of Sláintecare”.