The project was evaluated by a clinical audit of effectiveness, and also of patient views and opinions. Some of the success was evident without clinical evaluation. For example, providing same-day access to specialist cardiac investigations, providing results and treatment if necessary on the same day. Clinical audit was conducted by cardiac post-graduate and undergraduate students within the department, and focused on the outcome of positive and negative diagnosis for coronary disease. A total of 142 patients underwent functional imaging, which resulted in positive findings for coronary disease in 33 patients. Of these, 18 had echocardiographic features associated with higher-level coronary artery disease, which required further assessment.
The 15 patients with positive findings which were not considered significantly flow limiting were given management plans for risk reduction and optimization of medical treatment. The other 109 patients were reassured that their symptoms were not related to a cardiac cause. Assessment of both positive and negative findings have shown that functional imaging was 99.5% sensitive and 98% specific for detecting significant flow-limiting lesions. Those patients with positive findings, but not significant for further invasive intervention, and the other 109 reassured patients did not re-present to University Hospital South Manchester with further cardiac related mortality or morbidity.
The result of the pilot and the decision to roll out formally were first cascaded to the cardiology team at University Hospital South Manchester. During these discussions, all staff were asked to contribute their thoughts to how the clinic should run and how roles could change for the better to provide this kind of service. Once in-house decisions were made, this was used to provide evidence to the Trust board for the creation of new innovative roles, ultimately allowing the National Health Service to save money, but also improve patient care.
The model once rolled out, was then used as an example of innovative practise at local healthcare science events, presented nationally at various cardiology conferences as an innovative model for Rapid Access Chest Pain Clinic services. Finally, the project was entered into the Advancing Health Awards in the Clinical Leadership category, thus gaining high-level attention within NHS England and its related stakeholders.
Service was designed by expert staff based on clinical need. A small team was gathered to redesign provision based on each staff group’s own specialist knowledge. There was an audited pilot phase. Audit data was collated and used as a tool for developing the service full-time. Cost analysis with Human Resources undertaken, showing efficiency and allowing changes of roles and purchase of extra equipment in line with cost savings. Gathering new staff, new roles, and equipment to start offering the service initially on small numbers, then building into full clinics.
Changes were all seen as beneficial. The project was sold in a way that promoted staff development and improvement in the service overall. Departmental staff saw increased levels of responsibility and the opportunity to learn and undertake new techniques. It was obvious to most staff that the changes were beneficial to the patients and were necessary to reduce clinical risk.
Most challenges were related to finance– that is staff promotion, purchase of equipment, additional training. However, this was overcome by producing a detailed financial argument that these clinics could see more patients, reduce unnecessary diagnostic tests, reduce patient visits, and streamline staff involved in delivery of care. As such, the extra cost initially was outweighed by long-term potential to save money and reduce patient risk.
We gave feedback forms to all of the patients attending the classes to ask what they thought of the session, if it was useful, and if they had any ideas for improvements or changes. As the project’s now been running for six months, we’ve begun an audit to look at if the people who have attended the classes have returned to the department for any retubes, as these would now be due. Initial findings of this audit are that the return rate is very low.
We’ve communicated the results to our own staff at monthly team meetings within the department regarding the outcomes. And we have future plans to present at Ear Nose and Throat Audit.
We initially mentioned the introduction of our service to our department at team meetings, and asked them to begin to mention it to patients. We created a waiting list in our patient management system of people who were interested in attending. We then had some posters designed to put in the waiting areas and clinical rooms to advertise these classes. Once we were ready to start the classes, I created time within our timetable to have these classes and sent out appointment letters to all the people who had registered interest. Following on from this, any staff member is now able to book patients directly onto the sessions, and we no longer use the waiting list facility.
I amended the timetable, so that there were a number of specific slots available for the classes to take place. Initially, when we were putting interested patients on waiting list, there were a large number of them who did not attend the classes. So we changed the booking system so members of staff could book directly onto the group. This has reduced the number of non-attenders. We’ve also amended our patient journals to indicate if the patient has attended the maintenance class so others can see this. We’re also recording if the patient has been asked to attend and if they’ve declined, so they’re not always being asked to attend if it’s not something that they want to do.
Some members of our team primarily see retube or maintenance appointments, and there was some worry amongst these staff that their job may disappear. We reassured them that this will create training opportunities within the department and expand their roles into other areas of the service, which is dynamic and ever-changing.