Improving outcomes for patients with Heart Failure with Reduced Ejection Fraction

Aneurin Bevan University Health Board

Aneurin Bevan University Health Board (ABUHB) were finding that demand was outstripping capacity for patients discharged from acute cardiology care with a primary diagnosis of Heart Failure with reduced Ejection Fraction (HFrEF). Patients were unable to be seen within two weeks of post-hospital discharge, and optimisation of evidenced-based heart failure medication was taking over two years in some instances.

The Heart Failure Service collaborated with ABUHB’s Value-Based Healthcare Team (VBHT) to enhance the patient pathway, using data-enabled evidence (patient and clinically reported outcomes). A project was initiated to develop an improved pathway of care using the principles of Value-Based healthcare, seeking to reduce inappropriate referrals, reduce waiting times and improve clinic utilisation.

Through a series of Plan-Do-Study-Act (PDSA) cycles, a number of pathway changes were made, including modifying referral forms to request more clinical information, additional staff education to ensure consistency amongst nursing staff when rejecting or forwarding referrals, and changes to clinic templates to allow for shorter appointment times for optimisation patients, and longer appointments for complex / palliative needs.

The pathway changes that have been implemented have led to a 6-week reduction in waiting times from referral to first outpatient appointment (from 8 weeks to 2 weeks), a 97% reduction in unavoidable 30-day readmission and a 64% reduction in time from referral to optimisation.

Future plans include the continued development of a community hub to avert the need for low-risk patients to go to the hospital to have their medication optimised.

Dale Evans

dale.evans3@wales.nhs.uk