WINNER - Community cardiology diagnostic vehicle. An innovative response to C19 and the future for cardiac diagnostics
Betsi Cadwaladr University Health Board
When the first lock-down of the COVID-19 pandemic took place, the community heart failure diagnostic service run by Betsi Cadwaladr UHB was unable to continue in its current format. The community hospitals closed their doors in order to provide bed space for COVID positive patients, affecting a choice between putting the clinics on hold and watching waiting lists grow, or adapting service delivery to continue to support a vulnerable patient group.
Initially, it was decided that patients needed to be clinically assessed in the safety of their own homes. In view of this, the community echo-diagnostic clinics adapted their service to provide home visits from April 2020 – Sept 2020, with visits carried out with existing clinical equipment, including a portable Echo machine, to assess, diagnose and manage patients with suspected heart failure. These home visits, although completely necessary, were ergonomically very difficult to sustain. A long-term sustainable solution was needed that provided a safe and controlled environment which could be taken to the patient, leading to the idea of a cardiology diagnostic vehicle.
The vehicle enabled the team to expand clinics dynamically, depending on length of waiting time. It allowed double clinics (one in the clinic room, the other in the community hospital car park) and also provided the ability to carry out home visits to patients who are unable to access transport but who are at high risk of admission, ensuring that the patients receive a prompt diagnosis and subsequent treatment of heart failure, helping to avoid hospital admission.
A review of the patients visited in the 5-month lock-down and the interventions that were urgently required due to the likely deterioration of some of these patients, indicated that at least 10 hospital admissions for decompensation of heart failure were avoided (13% of all patients visited).
Liliana Shirley
liana.shirley@wales.nhs.uk
