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Heart failure day treatment centre (HFDTC), a novel service design

Session Moderated Poster Session - Acute heart failure

Speaker Teresa Castiello

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure: Multidisciplinary Interventions
  • Session type : Moderated Posters

Authors : T Castiello (London,GB), G Williams (London,GB), A Krakowiak (London,GB)

T Castiello1 , G Williams2 , A Krakowiak2 , 1Croydon Health Services NHS Trust and Kings College Hospital - London - United Kingdom of Great Britain & Northern Ireland , 2Croydon Health Services NHS Trust, Cardiology - London - United Kingdom of Great Britain & Northern Ireland ,


BACKGROUND:  Heart Failure (HF) is one of the most common causes of acute hospital admissions and bed occupancies.  A local Audit was carried out to analyse the HF population in a London borough and to investigate the causes of non-elective HF admission, in order to prevent them and to promote a more effective management. The Audit identified a fragile population, insufficiently referred to HF specialists (51%), with poor compliance (21%) and in sub-optimal therapy (27%) suggesting a large number of preventable admissions. The majority of non-elective admission had sub-acute presentation with relatively mild symptoms or signs of failure. The key objective of the Audit was to guide a novel service design. The Heart Failure Day Treatment Centre (HFDTC) was suggested.
AIM AND HYPOTHESIS: The aim was to design a service to improve quality and reduce admission rate and costs. We hypothesised that the HFDTC would reduce non-elective admission by 10% and readmission rate within 30 days by 30%, increasing patients access to specialised care, with significant reduction of in-patient bed demand.
SERVICE DESIGN: The HFDTC has been established by the multi-disciplinary HF team to operate as a HF specialist nurse (HFSN) run and HF-consultant led facility. The HFDTC aims to provide timely access to specialist care and better patient experience, in line with national and international benchmark.
Inclusion and exclusion criteria identify a sub-acute group of HF population (main inclusion: patients in threatening admission mode, already under HF Team). Patients who meet criteria receive a 'business card' with contact details and opening times; patients are enabled to self-refer to the service or be referred by general practitioner or hospital clinician. The first point of contact with the patient is the HFSN, who can escalate to the HF physician. The HFDTC offers a full range of hospital treatment, such as imaging, bloods and medical therapy.  Patients can have single or multiple accesses to the HFDTC until they are ready to be discharged back to community. 
CHALLENGE:  Service design implies a delicate balance between quality and cost-effectiveness. Funding limitation, agreement among 'Providers' and 'Commissioners', estimation of demand and capacity and coordination with the co-existing teams are the most relevant challenges.
SERVICE EVALUATION:  Economic evaluation, key performance indicators, data monitoring and quality data will be collected and analysed with a specifically designed Audit Tool and through patient questionnaires.
CONCLUSION:  The HFDTC is the first of its kind in the UK and acts effectively as day hospital for patients with established diagnosis of HF. It guarantees prompt assessment and treatment by the HF Team with the aim to reduce acute HF admissions which will result in a decrease in costs and improvement in patients quality of life. The cost-effectiveness of this model will be analysed with the support of a designed Audit Tool.

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