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The ambulatory heart failure unit - Inpatient care on an outpatient basis

The ambulatory heart failure unit delivers standard inpatient care on an outpatient basis to; Increase patient choice Reduce costs Reduce inpatient bed demand Improve quality Results
The HF unit has met and exceeded all initial expectations regarding key performance measures, over the first 12 months the HF unit; Treated 305 episodes of decompensated HF 0% mortality for active patients receiving care in the clinic versus 10% nationally for the same group receiving standard inpatient care Directly closed 9 inpatient beds Saved at least 300,000 which has been reinvested elsewhere Significantly reduced the number of patients requiring admission into hospital with decompensated HF Been well received by patients The unit won the Nursing Times award for cardiac nursing 2011 The unit has been shortlisted for the Health Service Journal Efficiency Awards 2012 awards night 25/09/2012 The unit has been shortlisted for the Health Service Journal Awards 2012 awards night 20/11/2012
Chart 1 Admission figures with decompensated HF into the UHNS before and after implementation of the HF clinic (clinic started April 2011). The outpatients figure represents individual attendances into the HF clinic. Chart 2 Admission figures for sample population before and after attending the HF clinic.

Overview of the Project

Within the United Kingdom medical costs for HF are estimated to be over 625 million with the majority of this going on inpatient care, admissions are predicted to rise by 50% over the next 20 years. People with HF suffer with significant morbidity, frequent hospital admissions and a prognosis worse than most cancers. Discussions with our patients revealed that the majority would prefer to avoid admission yet the level of care required was only available on an outpatient basis. The project was to implement an intensive HF unit to provide the level and intensity of care traditionally only available to inpatients on an outpatient basis. This model of care is a novel concept within the UK.

Leadership Challenges
Successful implementation of the project created a number of leadership and managerial challenges. Challenges can be expected when implementing change, yet the scale of the challenge was higher than previously encountered by myself or the wider members of my team as; The project required input and support from a number of people and organisations outside of the HF team The project is a novel concept for HF care delivery without established pathways, paperwork, procedures or a governance framework The project needed to be both financially and clinically effective to obtain long term investment, proving these aspects was difficult
Chart 3 Bed day utilisation for sample population before and after attending the HF clinic.

Contact Information
James Rushton Senior Clinical Nurse Specialist, Heart and Lung Centre 01782 55(2116)