Ayrshire and Arran

Ayrshire and Arran region

Service commenced in May 2004.

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Patients per year

482

from 348 in 2012.

Urban / rural split

78%

from 78% in 2012.

Total region population

370,410

from 366,860 in 2012.

Specialist HF nurse WTE posts

5 WTE (4 staff)

from 4 WTE, from 7 staff in 2012.

Service provision

2012 2018
HFrEF HFrEF
HFpEF HFpEF
HF post MI HF post MI
Valvular HF Valvular HF (only with LVSD)
Congenital HF Congenital HF
Palliative Care General palliative care with pathway to specialist services
Cardiac Rehabilitation for HF
Screening for psychological distress- direct referrals to psychology

Service model

2012 2018
Home Home
Clinic Clinic
In-pt education In-pt education
In-pt management In-pt management
GP surgery GP surgery (stand alone clinics)
Virtual Virtual

Additional notes

Service achievements since the last review in 2013

  • Implementation of home health monitoring.
  • New database developed for audit and record keeping
  • Development of electronic referral process
  • Use of electronic communications e.g. iPad, staff development programme with Cardiac┬áRehab, out-patient nurse led clinic at both sites.

Service challenges since the last review in 2013

Staffing levels is problematic which reduces the ability of the team to innovate

Future improvements

  • Reintroduction of outpatient Intravenous (IV) diuretics
  • Exploration of rapid response and early supported discharge services
  • Weekly MDT.

REMINDER

The following details are from our 2012 report and may not reflect the current state of the Ayrshire and Arran Health Board.

Further details

(Actual number of staff)2008 * 5 WTE (6 staff)
SIGN Ratio1:91,715 (2008 1:73,290)
Ave. caseload per post125 (community) / 225 (hospital)
Individual patients managed by service (average year)348 patients
Service ProvisionHome visits 80% / Clinic Appointments 20%
Provision for HF-PEFNo
Administration support per week18.75 hours (across service)
Providing education to non-specialist staffYes - informal basis to non-specialist staff
Doctor with specialist interest in Heart Failure1 Consultant Cardiologist (non-specialist)
Cardiac Rehabilitation available/number seenYes - 80 patients in total
Access to psychological support referral pathwayInadequate (currently recruiting to clinical post)

Notes on current service provision

Three full-time posts are based in the community to follow-up patients discharged from secondary care and four advanced specialist nurses are based within the acute setting; their posts also cover Chest Pain Assessment, outpatient Rapid Access Chest Pain clinics and Cardiac Rehabilitation. Most referrals are from secondary care, although 30 were also received direct from GPs.

Funding in comparison to 2008

The service is core funded by the NHS with adequate provision, although the previous BHF Post of Palliative Care Specialist Nurse did not receive ongoing funding. The service is undergoing a process of succession planning for the Specialist Nurse posts.

Challenges

The service is facing rising caseloads and differing methods of management are predicted to be challenges for the future. A replacement lead for the established Clinical Psychology service is awaited.

Development opportunities

A new database was recently implemented within the service and the specialist nurses are leading on the implementation of the HF Bundle across the NHS Board. New projects currently include tele-monitoring and the administration of diuretics (through a BHF funded secondment for 2 years). A new ICD pathway is also in the process of being implemented which will have the potential to impact on patients and the service.