S92
EuroPRevent Congress Abstracts May 2015
Poster Session III Friday, 15 May 2015, 08:30–12:30 P452 Improved efficiencies in cardiac rehabilitation through service redesign 1
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A Maiorana , J Julie Smith , J Garton-Smith , J Redfern , A Bremner , D Hendrie , J Rankin1, L Dimer6, T Briffa4 Royal Perth Hospital, Cardiology, Perth, Australia, 2Royal Perth Hospital, Perth, Australia, 3The George Institute for Global Health, Sydney, Australia, 4The University of Western Australia, Perth, Australia, 5Curtin University, Perth, Australia, 6Heart Foundation, Perth, Australia
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Topic: Cardiac rehabilitation Purpose: Cardiac rehabilitation (CR) is widely recommended following acute coronary syndrome (ACS) but is both underutilised and under-resourced. An alternative model of CR for cost effective secondary prevention (ACCES) was implemented and evaluated at a West Australian tertiary hospital. The project aimed to increase the proportion of patients receiving four guideline-advocated CR components: an initial assessment, individualised plan, education and follow-up, through service redesign in an environment of unchanged staff resources. Methods: Patients discharged from cardiology wards with a primary diagnosis of ACS 1/4/ 2013-31/3/2014 (ACCES group) were compared to patients discharged 1/4/2011-31/3/2012 (controls). Patients transferred directly to another hospital for continuing cardiology care, aged >80 years, or deceased within four weeks of discharge were excluded. A quality improvement framework involving key stakeholders (74 patients, 52 hospital staff, 18 General Practitioners) was undertaken to inform processes to support change. Ward nurses assumed a more active role in inpatient CR, supported by a new CR needs assessment tool. This enabled CR specialist nurses to focus on post discharge service provision. An automated referral process was established that generated a daily list of eligible patients for follow-up by CR staff post discharge. Results: The ACCES model was associated with a significant increase in the provision of each one of the four CR components (Table 1) and resulted in a near doubling in the proportion of patients who received all four components, culminating in follow-up. This equates to an increase of 264 patients per 1000 admissions. Conclusion: Clinical service redesign was associated with efficiencies in CR, doubling patient numbers serviced for no additional staffing. This finding has important implications for the many CR programs that have limited staff resources or relatively low levels of uptake. Improved access to CR is associated with changing the clinical course post ACS. Table 1: Uptake of core CR components
Component Initial assessment Individualised CR plan Education Follow up
Controls (n=999) 723 (72.4) 544 (54.5) 504 (50.5) 291 (29.1)
ACCES (n=862) 835 (96.9) 648 (75.2) 638 (74.0) 478 (55.5)
P-value
EuroPRevent Congress Abstracts May 2015
Poster Session III Friday, 15 May 2015, 08:30–12:30 P452 Improved efficiencies in cardiac rehabilitation through service redesign 1
1
2
3
4
5
A Maiorana , J Julie Smith , J Garton-Smith , J Redfern , A Bremner , D Hendrie , J Rankin1, L Dimer6, T Briffa4 Royal Perth Hospital, Cardiology, Perth, Australia, 2Royal Perth Hospital, Perth, Australia, 3The George Institute for Global Health, Sydney, Australia, 4The University of Western Australia, Perth, Australia, 5Curtin University, Perth, Australia, 6Heart Foundation, Perth, Australia
1
Topic: Cardiac rehabilitation Purpose: Cardiac rehabilitation (CR) is widely recommended following acute coronary syndrome (ACS) but is both underutilised and under-resourced. An alternative model of CR for cost effective secondary prevention (ACCES) was implemented and evaluated at a West Australian tertiary hospital. The project aimed to increase the proportion of patients receiving four guideline-advocated CR components: an initial assessment, individualised plan, education and follow-up, through service redesign in an environment of unchanged staff resources. Methods: Patients discharged from cardiology wards with a primary diagnosis of ACS 1/4/ 2013-31/3/2014 (ACCES group) were compared to patients discharged 1/4/2011-31/3/2012 (controls). Patients transferred directly to another hospital for continuing cardiology care, aged >80 years, or deceased within four weeks of discharge were excluded. A quality improvement framework involving key stakeholders (74 patients, 52 hospital staff, 18 General Practitioners) was undertaken to inform processes to support change. Ward nurses assumed a more active role in inpatient CR, supported by a new CR needs assessment tool. This enabled CR specialist nurses to focus on post discharge service provision. An automated referral process was established that generated a daily list of eligible patients for follow-up by CR staff post discharge. Results: The ACCES model was associated with a significant increase in the provision of each one of the four CR components (Table 1) and resulted in a near doubling in the proportion of patients who received all four components, culminating in follow-up. This equates to an increase of 264 patients per 1000 admissions. Conclusion: Clinical service redesign was associated with efficiencies in CR, doubling patient numbers serviced for no additional staffing. This finding has important implications for the many CR programs that have limited staff resources or relatively low levels of uptake. Improved access to CR is associated with changing the clinical course post ACS. Table 1: Uptake of core CR components
Component Initial assessment Individualised CR plan Education Follow up
Controls (n=999) 723 (72.4) 544 (54.5) 504 (50.5) 291 (29.1)
ACCES (n=862) 835 (96.9) 648 (75.2) 638 (74.0) 478 (55.5)
P-value
