Expanding the Inpatient Heart Failure CNS Service: A Value-Based Healthcare Approach
Cardiff and Vale’s Heart Failure service at UHW faced a significant challenge: the single inpatient HF Clinical Nurse Specialist (CNS) was unable to meet the increasing demand for care. Considerable pressure on the hospital clinic and the small number of staff led to delays in patient care and poor outcomes. Shaping Change and Value in Health sought out ways to reshape the service in order to deliver value for patients using it’s current resources.
Magda Golebiowska, part of Shaping Change and Value in Health team worked with the Heart Failure service to analyse the current service and patient outcomes, the team identified critical areas for improvement.
They worked together to reshape the service to deliver better value:
Community-based clinics: The shift towards community-based clinics helped alleviate the pressure on hospital clinics, particularly in areas of greatest need, allowing for more efficient patient appointments.
Outpatient and Inpatient Nurses: Nurses were allocated to the team to ensure continuous coverage and improved patient care. This increased the capacity for follow-up appointments and facilitating timely medication adjustments. It also allowed for patients with a new diagnosis to be treated sooner.
The improvement of the HF service led to several positive outcomes:
Increased patient volume due to capacity: The number of inpatients reviewed and followed up increased significantly from 35 in 2023 to 112 in 2024, due to increased capacity.
Reduced waiting times: Follow-up appointments were accelerated, with waiting times reduced from 8 to 2 weeks for patients discharged under acute medicine.
Improved medication optimisation: Timely follow-up appointments allowed for more effective medication adjustments and optimisation, and the optimisation time being shortened from an average of 6 months to about 3 months.
Enhanced patient education: The increased number of HF CNS staff enabled more comprehensive patient education, empowering individuals to manage their condition effectively.
To assess the impact of these changes on patient outcomes, the service is implementing various measures, including:
PROMs: Patient-reported outcome measures will be used to evaluate quality of life.
Data collection: Data will be collected to track time from diagnosis to treatment completion.
Patient satisfaction surveys: Feedback from patients will help identify areas for improvement.
Ultimately, the aim is to have improved patient outcomes including:
Lower mortality from HF within 1-year post-discharge
Reduced length of stay for patients admitted for HF
Decreased re-hospitalisation rates
Improved patient quality of life
Ann Parkes, CNS Cardiothoracics at UHW said ‘It has been valuable to work with Magda, Value in Health Improvement Manager, part of Shaping Change. She has facilitated regular meetings and made new contacts that have been really beneficial in developing the Heart Failure service. The input we have had from the Value team has been instrumental to expand the service and alleviate pressure both from the inpatient and community setting.’
Future plans include developing a heart failure cardiac rehabilitation service and continuing to collaborate with the ViH team to measure outcomes and refine the service.
By adopting a value-based healthcare approach, both the outpatient and the inpatient Heart Failure CNS service at UHW and UHL has taken significant steps to improve patient care and outcomes. The reshaping of the service, coupled with a focus on patient-centered care and data-driven decision-making, is set to make a lasting impact on the lives of patients.