Cardiac assessment nurses: reducing pressure on stretched A&E services

Meet the senior cardiac nurses who’ve spearheaded a rapid cardiology assessment service in their local A&E department

23 Feb 2018, by Siobhan Chan

Team of the Year accept their award in 2017

The Team of the Year at the BHF Alliance Awards ceremony in 2017

A team of senior cardiac nurses alleviating pressure on their local A&E department by assessing patients with potential heart problems are now developing an assessment and management system that could be implemented in any UK hospital.

The innovative work by the Cardiac Assessment team from Royal Stoke University Hospital earned them the Team of the Year Award at the BHF Alliance Awards in June 2017.

The team provides 24-hour cardiac support to the hospital’s A&E department, providing a cardiology opinion to around 500 patients a month, the majority of which are seen within 30 minutes of referral, and giving telephone support to 200 ambulance crews and other colleagues.

“We deliver a prompt and intelligent decision-making service for the A&E department and other emergency portals,” says Dot Morgan-Smith, Advanced Nurse Practitioner at the hospital.

Avoiding unnecessary admissions

In the past, patients attending A&E with suspected cardiac problems used to remain in hospital and wait to be seen by a specialist, via admission to the medical assessment unit or referred to a rapid access clinic if further investigation was required.

“Some patients were being admitted unnecessarily,” Dot says. “Our area has high deprivation and complex health needs, and there are consequent pressures on our A&E department and colleagues.”

Patient pathways are now more streamlined. Because patients no longer have to wait to access specialist opinion, the team estimates this saves the equivalent of six bed days every day for the Trust.

Now, patients presenting with a cardiac problem are assessed by the Cardiac Assessment team, who can admit patients directly to the bed base where appropriate. They can talk to patients who aren’t admitted about their symptoms, offer reassurance, discuss lifestyle advice where necessary, refer patients for outpatient tests, arrange follow up and inform their GP of the plan directly via letter.

“It’s reassuring for patients,” says Dot. “It’s concerning to be told, ‘we think it’s your heart’ – it makes people anxious, and they put their life on hold until their next hospital appointment.”

The team’s medical knowledge, clinical experience and knowledge of the pathways, facilities and contacts within the hospital have been crucial to their success, Dot believes.

“Our senior cardiac nurses have an average of 15 years’ experience,” Dot says. “To prepare for this role we also trained for a total of three years, including general health assessments, independent prescribing, and studying for a postgraduate diploma in cardiology.”

Persistence and resilience

The team now runs seven chest pain clinics per week, carries out their own investigations, treats patients and stages lifestyle interventions. They also work with the junior medical staff to facilitate inpatient diagnostics and discharge.

They are now developing a ‘Trigger System’ – a scoring tool that can be used by triage nurses at A&E departments that should mean heart patients are seen even more quickly.

“Our system should cover patients who attend A&E with typical symptoms that signal a possible heart problem, such as chest pains, blackouts or loss of consciousness,” Dot explains. “So if a patient’s score indicates that they clearly have a cardiac problem, we can see them right at the beginning.”

‘Fantastic’ achievement

The BHF Alliance Team of the Year award was handed to senior cardiac nurses Michelle Beeston, Sarah Chell, James Cripps, Sonia Curry, Bob Gunter, Angela Jones, Dot Morgan-Smith, Diana Thomas, and Consultant Dr Rhys Beynon. Since the award, the team has grown in size – as has the scope of their work.

Dot says it was ‘fantastic’ to win the award. “It’s validation for all our hard work,” she says. “It’s taken months of training – a lot of which we did in our own time. I can’t put into words how much it’s meant to us.”

The Cardiac Assessment Team also scooped the BMJ Cardiology Team of the Year award [PDF] and is in talks with other CCGs who are hoping to use their model.

Has your team transformed cardiovascular care in your area? Your work could win a BHF Alliance Award. The deadline for nominations has been extended to Sunday 4 March 2018.

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