Project name: Development of Integrated Heart Failure Project Project period: April 2017 – May 2018 Project summary: The Trust is working to improve the heart failure (“HF”) services. Locally, 9,000 people are estimated to be living with HF but less than 3,000 are known to the Trust. Early and accurate diagnosis, access to heart failure specialists, prescription of the right evidence based therapies and coordinated care can significantly improve prognosis, and quality of life; specifically, such objectives can be achieved by:
Introducing a dedicated, multi-disciplinary heart failure team for each of the 3 localities in Lambeth - North, South East and South West Lambeth
Conducting a primary care audit and care optimization programme;
Supporting care coordination through integrated pathways;
Delivering a comprehensive education and training programme for primary care, specialists and patients.
The Project aims at supporting and implementing the carrying out of the primary care audit and optimization programme mentioned above; it will run in multiple phases with nurses identifying and triaging HF patients from GP records and referring patients to HF specialists for optimization of care, in order to improve patients’ outcomes.
The multi-disciplinary team will organise its activities in four segments, as follows:
Audit of patients in primary care;
Assessment and triage and referral into secondary care of those patients needing extra investigation;
New clinic set up to receive referred patients for investigation/initiation of medicines/ device by HF specialist;
Data analysis and issuance of report in writing, containing findings/outcomes.
Expected Patient Outcomes for this Project: The achievement of the aims and objectives outlined above shall be measured through the following:
Increase in the number of patients on the Left Ventricular Systolic Dysfunction (“LVSD”) HF register, compared to project baseline;
Increased number of patients optimized according to standard of care therapy, compared to project baseline.
Portsmouth Hospitals NHS Trust Melanoma Service Development at Queen Alexandra Hospital
Project Name: Portsmouth Hospitals NHS Trust Melanoma Service Development at Queen Alexandra Hospital Project Period: 12 months Joint Working Project Summary: The Trust lacks a specialist melanoma service for melanoma patients in the Portsmouth area. Melanoma patients with complex needs are currently being referred to University Hospital Southampton NHS Foundation Trust due to its more advanced melanoma facilities, resulting in patients travelling long distances for specialist treatment. The Joint Working Project aims to set up a dedicated local melanoma service in the region consisting of a melanoma consultant and a dedicated melanoma Clinical Nurse Specialist. The service will provide specialist melanoma clinical support and after treatment care according to patient needs.
Expected Patient Outcomes for this Project: It is expected that the dedicated local melanoma service will provide consistent care to the melanoma patient population and improve patients’ outcomes. Specifically, the following outcomes are expected:
a 50% improvement in melanoma patient experience across the range of questions pertaining to patient experience, compared against baseline;
a 50% reduction in travel distances on average for relevant patient population, compared against baseline;
a 50% reduction in travel times on average for relevant patient population, compared against baseline;
a 20% reduction in melanoma patient’s waiting times at each scheduled appointment, compared against baseline;
a 10% increase in average number of melanoma patients discussed at Trust Sarcoma Melanoma and Rare meetings (“SMART”), compared against baseline;
a 10% reduction in average time taken from Multi-Disciplinary Team discussions to commencement of advanced melanoma patient’s treatment, compared to baseline.
Start Date and Duration: April 2017 – April 2018
Chelsea And Westminster Hospital NHS Foundation Trust
Project name: Chelsea And Westminster Hospital NHS Foundation Trust Heart Failure Clinic Initiative Project Period: 12 months
Joint Working Project Summary: The Joint Working Project shall have duration of 12 months and aims at:
improving detection and treatment of Heart Failure in primary care;
educating patients to manage their condition at home for the purposes of improving outcomes for individual patients and benefiting the health system as a whole, by the provision of better care.
This will be achieved by:
searching Hounslow CCG’s existing primary care’s databases and systems for the purposes of identifying: undiagnosed Heart Failure patients; and updating the patients receiving suboptimal care;
establishing a new Heart Failure clinic to optimize care for the patients’ cohort identified according to the databases and systems searches mentioned above;
educating patients to self-care and monitoring at home by the provision of appropriate materials.
The Joint Working Project will cover the Hounslow CCG’s Heart Failure patients. It is expected that the primary care records of about 3000 Heart Failure patients will be searched, with an estimated 900 receiving sub-optimal Heart Failure care being identified and reviewed at the newly established nurse-led clinics.
Where it is identified that treatment does not meet best practice according to NICE guidelines, these patients will be invited to nurse-led Heart Failure clinics based within primary care to review and optimize treatment, (with consultant input where necessary) and to be provided with relevant materials to educate patient’s self-care at home.
Expected Patient Outcomes for this Project: The main objective of the Joint Working Project is to optimise care for Heart Failure patients, irrespective of setting of care, specifically by improving detection and treatment of Heart Failure in primary care and educating Heart Failure patients on managing their condition at home.
Start Date and Duration: April 2017 (12 months duration from Actual Commencement Date)