WINNER - Heart Failure Service Redesign, Swansea Bay Heart Function Service – Not Accepting Failure

Swansea Bay University Health Board

Heart failure occurs at the end stage of all cardiovascular disease and affects around 1% to 2% of the population. Heart failure is characterised by periods of chronic symptoms, interspersed by acute decompensations, resulting in progressive fluid retention, acute breathlessness and frequently lead to long hospital admissions. The management of heart failure is believed to account for 2% of the NHS budget and 70% of this is consumed during hospital admissions.

Swansea Bay University Health Board initiated a project aimed to redesign and develop their whole heart failure service and to implement a modern, responsive and fully integrated service. A Clinical Redesign Group was developed, project managed by the Value Based Health Care team, with representation from clinicians, service management and finance teams from Primary, Community and Hospital delivery units.

A high-level pathway was produced, describing what “Good Care” looked like, and four essential aspects to a heart failure service were identified: Diagnostic Pathway, Community Heart Failure Specialist Team, in-patient heart failure, and chronic disease management in Primary Care. Through a series of Plan-Do-Study-Act (PDSA) cycles, a heart failure hub in Gorseinon Community Hospital was established, delivering a daily diagnostic heart failure clinic, while the community heart failure service encouraged integrated working between hospital and community teams.

The Diagnostic Pathway offers a rapid access diagnostic heart failure clinic, using NTproBNP blood test as gatekeeper and to triage urgency of assessment. It has been estimated that use of NTproBNP prevented 505 inappropriate referrals, 201 unnecessary out-patient appointments and 408 echocardiograms. The new service model was introduced in March 2020 and the benefits demonstrated following assessment in diagnostic clinic are the result of immediate transition of care to the community team who deliver patient education allowing self-management and optimal medical treatment. Waiting times for the highest risk patients have reduced sustainably from more than 180 days to 19.4 days.