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Transforming the care of patients with heart failure

A pioneering nurse-led service in Sheffield is speeding up the discharge process and keeping seriously ill patients with heart failure out of hospital.

A pioneering nurse-led service in Sheffield is speeding up the discharge process and keeping seriously ill patients with heart failure out of hospital. 

heart
Members of the nurse-led ambulatory unit in the heart failure team at Sheffield's
Northern General Hospital (from left):
Andrew Birchall, matron Ann Matto, Kerry Morton and Meg Warriner. 
 

A nurse-led service run by the heart failure team at the Northern General Hospital in Sheffield is breaking new ground. 

Seriously ill patients with heart failure, who would previously have had to stay in hospital, can now go home and receive day care in the ambulatory intravenous diuretic therapy unit for heart failure (AID-HF). 

Heart failure specialist nurse Kerry Morton says the ambulatory unit was the idea of one of the cardiology consultants, and the heart failure specialist nurses helped to develop it. 

The pilot started in June 2014 and the service was up and running by September that year.

Big difference

‘There are some community services giving intravenous furosemide to patients, but the big difference with our unit is that we have direct contact with the consultants and other services,’ says Ms Morton. ‘The unit is absolutely superb and works really well.’ 

Ms Morton applied for her current post three years ago, having previously worked in cardiac intensive care. ‘I was looking for promotion in an area where I could use my skills, and this job came up,’ she says. 

‘It’s self-directed and quite autonomous. We assess and treat patients ourselves and go to the consultants for further advice. Seeing patients benefiting from our treatment is immensely satisfying.’ 

Ms Morton works alongside four other heart failure specialist nurses and four cardiology consultants. She also works closely with staff in the cardiology day unit and the community heart failure nurses, who refer patients to the service. 

‘If we didn’t provide this service they would still be in hospital, so we’re speeding up their discharge’

Those who are ready to go home but still need intravenous diuretics for fluid overload are invited to attend the AID-HF unit. ‘Once they have been discharged, they come in daily for their treatment while having their weight, blood pressure and renal function monitored,’ says Ms Morton. 

‘If we didn’t provide this service they would still be in hospital, so we’re speeding up their discharge. Patients in the community who need intravenous furosemide due to not responding to an increase in their oral diuretics are referred to the AID-HF unit, preventing them from being admitted to hospital.’ 

Ms Morton says ambulatory intravenous diuretic therapy is feasible in advanced heart failure, even in high-risk patients. ‘Our patients have ischaemic heart disease, cardiomyopathies and valve problems, or their heart has become stiff with comorbidities,’ she says. 

Think quickly

‘Patients may have come in with chronic obstructive pulmonary disease and then developed heart failure. We allocated six beds for these patients initially but other patients, such as medical outliers, could occupy their space so the matron allocated a day room with comfortable chairs that are protected for them.’

The patients see a consultant cardiologist once a week but the rest of the time they are cared for entirely by the ward and specialist nurses. ‘We are dealing with very sick patients and administering very large doses of furosemide,’ says Ms Morton. 

‘We have direct access to the ECG department for pacemaker checks, and do ECGs and chest X-rays, check bloods and take samples. You’re on the spot and have to think quickly about how you’re going to treat a patient, but it’s very invigorating,’ she adds. 

‘People don’t think they’re going to die from heart failure because they can’t feel that their heart is failing’

The team collects data on the patient’s background, days of attendance – as a marker of hospital days saved – and re-admission to hospital. They have also produced a standard operating procedure and track what happens from the patient’s first day right through to discharge. 

Palliative care can be a particular challenge. ‘Now that we’re more involved, we have to do quite a lot of the talking and also provide support,’ says Ms Morton. 

‘People don’t think they’re going to die from heart failure because they can’t feel that their heart is failing. When they need recurrent admissions to AID-HF, we consider discussions about end of life at the heart failure multidisciplinary meeting. It’s good that people are able to end their days at home but it can be stressful, especially when you’re dealing with young people.’ 

Improving lives

Patients understand they can contact the heart failure specialist nurse should a problem arise, and a recent patient survey was very positive. ‘There were some grumbles at first when we took them to the day room, but we haven’t had a single official complaint. It’s remarkable how happy the patients are,’ says Ms Morton. 

The unit has improved the lives of many heart failure patients but she recalls one in particular. ‘We had a man in his fifties who had been having chemotherapy. He was admitted to the day ward at first but he couldn’t stay as he wasn’t able to walk.  

‘He told us he was worried that if he stayed in the hospital he would never come out again, so I did everything in my power to get him in on a daily basis. The ward staff were fantastic, allocating him a bed each day. When he was able to go home, he was so thankful for what we had done.’


Alison Whyte is a freelance health journalist

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