King's College London NHS Foundation Trust

Project Name: Heart Failure In-reach Nurse, Kings College London

Project Summary: 

The main objective of the Collaborative Working Project (CWP) is to improve the quality of care delivered to Heart Failure (HF) patients at Kings College Hospital NHS Foundation trust (the Trust) in line with  National Institute for Clinical Excellence (NICE)) and international European Society of Cardiology (ESC) guidelines. This CWP will improve the current hospital-based specialist HF service at The trust  by deploying an  “in-reach” nurse specialist to the acute ambulatory unit (ACU) and the Emergency Department (ED). Additionally, the CWP will establish inform a business case for future funding of this extension to the HF service by the NHS.  

 The CWP will measure percentage improvements in the following key performance indicators (KPIs) (against the baseline values) at the trust for all patients presenting/referred to the Ambulatory Care Unit with suspected and known heart failure, culminating in KPI rates for this cohort comparable to inpatients entered into the National Heart Failure Audit from The National Institute for Cardiovascular Outcomes Research (NICOR) (2019/2020) :-

• input from specialist 
• specialist follow-up with a HF Consultant  
• specialist follow-up with a HF Nurse 
• implement the measurement of Patient Reported Outcome Measures (PROMs) 

Expected Patient Benefits:

Improved access to diagnosis and treatment;  

More equitable and consistent access to care;  

Enhanced experience for patients and their carers;

Increased education on Heart Failure

An individualised HF care plan for all appropriate patients presenting to ED/ACU

Start Date & Duration: September 2022 for 18 months

UK | September 2022 | 518414

Project Name: The development of an Acute Heart Failure Nurse In-Reach Service at Kings College Hospital

Partner Organisation(s): King’s College Hospital NHS Trust

Completion Date: July 2024

Outcomes Summary:

Despite several challenges, the implementation of an acute heart failure nursing in-reach service has demonstrated significant short-term benefits to patients and the HF Unit at King’s College Hospital.

Key Project Outcomes Data:

The table below summarises the changes in the KPI from baseline (2020/2021). The 2023-2024 data is based on local NICOR submission data and has not yet been verified by NICOR at the time of writing this report. We do not expect, however, any significant changes to the results.

Outcomes:

Primarily, the introduction of this service has improved access to specialist HF care. This has been particularly impressive in those patients presenting with newly suspected heart failure, who would otherwise have been discharged without the benefit of appropriate investigations and HF therapies. This cohort comprised approximately 50% of the referrals reviewed, with 41% subsequently being diagnosed with HF. Moreover, 9% were able to be reassured that they did not have heart failure and appropriate alternative diagnoses/investigations were able to be prioritised.

The vast majority of patients reviewed whether newly diagnosed or known, were HFrEF patients. This is of particular importance given the evidence for the benefit of the ‘four pillars’ in these patients. As one of the biggest challenges in such patients is ensuring the initiation and optimisation of such therapies, any service where this can be expedited with appropriate referrals to a HF nursing service is likely to have longer term benefits.

Quote from Partner:

"This partnership between King’s and Novartis has successfully enhanced services for heart failure patients, exemplifying the value of collaboration in healthcare. By combining the clinical expertise of heart failure healthcare professionals with project support from the pharmaceutical sector, we've been able to implement strategies that effectively improved the delivery of heart failure care at King’s College Hospital. Furthermore, this collaboration has facilitated safe, early discharges, ensuring that patients receive the right care at the right time, reducing hospital stays while maintaining high standards of treatment and “recovery”. Susan Piper

Conclusion:

Whilst KCH  await the outcome of the submitted business case, KCH plan to integrate the InReach service into the wider HF nursing team working pattern. This should not only provide a more consistent service with respect to periods of annual leave etc but will extend the experience gained to all members of the HF nursing service at KCH. In addition, KCH hope to collect some longer-term data from the patient cohort, specifically looking at medical therapy, admissions/readmissions and, given time, mortality. Integrating the InReach work with what KCH  hope to be a substantiated HF ambulatory care unit is the ultimate aim, with rapid optimisation of suitable patients. 

From an education perspective, KCH  hope to implement regular teaching sessions, particularly at staff induction, with the acute services to both maintain awareness of the service and to emphasise the importance of early diagnosis/management in HF patientsThese sessions will take place independent of Novartis Support. 

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