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Improving patients

 

The Picker Institute published a bulletin 'Improving Patients'. Experience' in July 2001 which reported on the survey and included brief snapshots of examples of 15 local initiatives to improve the quality of care. http://www.pickereurope.ac.uk/publications/nhs_survey.htm

This page contains 15 vignettes.

1: Access to care

Speeding up cardiac care.

Creating a rapid access chest pain clinic in Newham, East London

Representative local GPs and colleagues from the Department of Cardiology at Newham Hospital agreed, in 1995, that something had to be done about waiting times. Patients were being put at risk. They decided to explore whether they could develop a local rapid access chest pain clinic. This would offer a prompt diagnostic service for a limited group of patients. Criteria for referral to the clinic were agreed. Adjustments were made to the cardiology work programme to accommodate the new clinic, which opened in January 1996. It is open from 12 noon until 2pm every weekday. The siting of the clinic within the hospital enables the full range of diagnostic tests to be undertaken.

Referrals from primary care are through a dedicated fax line within the Cardiology Department. Patients are seen within 24 hours: those referred in a morning on the same day: those referred in the afternoon the following day. The fax line is accessible only to medical staff to safeguard patient confidentiality. A computer-based proforma guides the cardiac assessment and creates a report for the GP. The letter is semi-structured with details of diagnosis, cardiac history, risk factors, investigation results, recommended treatment and follow-up arrangements. The report is faxed to the GP as soon as the consultation is completed. Since the new service was launched in January 1996, about 75 patients each month are being seen at the clinic. The service is well regarded by local GPs and patients. The initiative was awarded Beacon status in 2000.

To find out more, contact

Val Church
Cardiac Manager
Newham General Hospital
Telephone 020 7363 8487
Fax: 020 7363 8262
Email val.church@newhamhealth.nhs.uk

 

Easing the waiting time for surgery

Introducing a new post at Southampton Hospital to provide support to patients on the waiting list for cardiac surgery.

At any time about 500 patients are waiting for surgery at Southampton Hospital. Managing the waiting lists and making effective use resources is complex. The cardiac team recognised that while patients were waiting their condition could change and they may become increasingly anxious. In 1999, the team decided to test a new post – surgical co-ordinator. Could it improve the organisation of the service and reduce the need to defer admissions? Could this provide support for patients as they waited their turn? The post was introduced initially on a pilot basis. The post has two main parts.

First , making sure that the process for creating operating lists for the cardiac surgeons is as efficient as possible, taking account of clinical priority, of surgical time, of the operation and support available. The new post has ensured that now there are few gaps in the surgical lists: valuable surgical time is rarely wasted. Importantly, although the co-ordinator may not necessarily talk to all the patients individually, she has time to get to know their needs.

Second , providing a telephone help-line for patients. Patients are told about this when they are added to the hospital’s waiting list. It provides direct access to the surgical co-ordinator so that patients can contact the cardiac team. Experience has shown that patients appreciate the help-line. They like to be able to talk to someone in the team about their anxieties and to help them understand what to expect when they are admitted. It also provides a sure way for patients to iron out any apparent inconsistencies in the advice given to them by different clinical staff.

To find out more, contact

Michelle Watkins Surgical Co-ordinator: Coronary Care Services
Southampton University Hospital
Telephone 023 80 79 4573
Fax 023 80 79 8508


Setting up a day unit: a way of stopping cancellations

Making sure that admissions are not cancelled at Coventry Hospital

Like many others, Coventry Hospital was faced with emergency demands that meant that sometimes they had to defer cardiac admissions. The cardiac team wanted to find a way to prevent this disruption. They thought that a day unit equipped to carry out diagnostic tests might be the answer. It could increase their capacity overall. But resources would be a problem; budgets were under pressure and trained staff scarce.

Progress was possible when the cardiac unit received a bequest of £27,000 from a former patient. Funds were now available to secure necessary equipment. Floor space adjacent to the CCU would be used as a Day Unit. They decided to use the bequest to help purchase a suite of nine trolleys - rather than beds. This means that the unit’s work is not be affected by pressures on hospital beds. The next step was to find the staff required. Recruitment of qualified nursing staff was a problem so they recruited four staff with level NVQ 3 rather than nursing qualification. Some were already employed within the hospital as nursing auxiliaries. The four 'cardiac support workers' would work under the guidance of a senior staff nurse/sister. The proximity of other cardiac service means that other clinical support is always close by.

The new unit opened in February 1999: it is a resounding success. Since it opened, the team has not had to cancel any admissions. The use of semiskilled staff has been a success with the appointees growing into their new role. Patients also like the new approach. A telephone survey of patients who had attended the day unit shows that they are very positive about the new unit.

To find out more, contact

Alan Dawson
Acting Head of Nursing,
Cardiac Services University Hospitals,
Coventry and Warwick NHS Trust
Walsgrave Hospital
Telephone/Fax 024 7653 5157


2: Physical Comfort

Taking away the pain

Delivering a better pain service at Poole Hospital

Survey of patients' views (1994 and 1996) had shown that pain control in Poole Hospital was inadequate, patients were ill informed and response times were often lengthy. Nevertheless this knowledge had little impact on local policy. Staff training had been used as the main trigger for change but with little effect. More radical steps were needed if a better pain management system was to be implemented. Eventually after much negotiation by the Acute Pain Service the hospital agreed a policy for change across the hospital.

The policy aims to concentrate on removing delays in the administration of pain relieving drugs and to:

All staff were consulted on the changes. A trial in 1999 showed that it would work. The Trust guidelines and an education programme for all staff backed up implementation. For example a ‘filofax’ page on evidence and pain management was created for junior doctors.

The evidence- based acute pain management guidelines bring together published evidence as well as local experience. Wards and speciality areas were encouraged to develop their own approach within the broad Trust policy. Health care assistants have been trained to record the pain intensity voiced by patients. Previous efforts to encourage nurses to do this had not been successful. Some aspects were challenging but soon became accepted policy.

The new system is used across the hospital. Better records are maintained and staff have confidence in it. A recent questionnaire indicated that virtually 100% of nursing staff felt the changes had benefited patient care. The possibility of all senior staff within other directorates, principally coronary care, obtaining additional education and providing rapid analgesia without prescription is currently being investigated. A recent survey of patients has shown that they welcome the changes that have been introduced. They sense that their pain is under control. As a patient in a recent independent research study said ' It was magnificent. I was in real pain and within a very short time it was under control and I was comfortable '.

To find out more, contact

Eileen Mann Lecturer Practitioner
Poole Hospital
Telephone 01202 665511 ext. 2770
Fax: 01202 442770
Email: eileens_mail@yahoo.com

Being comfortable in hospital

Better pain control and organisation of cardiac services at Airedale Hospital.

The drive to improve cardiac care prompted by the publication of the National Service Framework led to the creation of a new seven-bedded Coronary Care Unit at Airedale Hospital. Previously, like in many other general hospitals, cardiac patients were allocated to medical beds across the hospital: they were not grouped together. The Trust agreed that changes to create the CCU should be implemented from April 2000. Since then all cardiac admissions have been referred to one of the two cardiologists at the hospital. The first step was to change the hospital admission policy to ensure that, when appropriate, all suspected myocardial infarction admissions through the hospital’s A&E Department are transferred promptly to the CCU. It is a small unit and all patients have said that they prefer to be in the small specialist unit with dedicated, trained staff. The new arrangements have enabled the cardiac team to implement a series of measures to improve the quality of care for patients.

An important part of the new service has been the formulation and application of a new pain control protocol. The protocol was researched and produced by a senior coronary care nurse and is now used by nurses within the CCU. It brings together measurements of patient’s perception of pain and their description of it, for example does it radiate from one source? Based on an assessment of pain scores the protocol provides for a tiered approach to the management of pain using of effective drugs. Staff in the CCU and the cardiac rehabilitation team have also produced a new booklet for patients. Patients contributed to this work. The booklet is designed to help patients understand their condition, the treatment options and steps they need to take after discharge from hospital.

A questionnaire is sent routinely to all patients after their treatment has been concluded to check whether the separate elements of care had suited them. So far all the responses are encouraging. Patients like the new approach and have praised the advice they receive from the dietician and pharmacist. Patients also say that they particularly like the group sessions within the rehabilitation programme. The local rehabilitation programme is based on the Heart Manual developed in Edinburgh. Patients say these sessions help them improve their knowledge, confidence and awareness about their condition. It is good also to meet and share experiences with other patients.

To find out more, contact

Sharon Follows
Cardiac Liaison Nurse
Airedale Hospital,
Keighley
Telephone 01535 652511
Fax: 01535 29201


3: Hospital environment

Speeding access to a Coronary Care Unit

Designing direct access to the CCU at Scarborough Hospital

Over the years the cardiac team at Scarborough Hospital has made a number of pioneering changes to improve the care of their patients. They were the first hospital to introduce nurse-led administration of thrombolytic drugs. This helped reduce delays in treatment - ‘door to needle’ time. Scope for further improvement with the current configuration of hospital facilities seemed limited and depended on the relocation of the coronary care unit.

The Trust agreed in 1998 to the development of a new purpose-built Coronary Care Unit, with four beds, and an adjacent, ‘step down’ area with five beds. This would bring together all the cardiac facilities within the hospital. A big advantage would be that it would allow direct ambulance access to the Coronary Care Unit. It could speed up the process by which patients get into the care of the cardiac team. Scarborough is the main centre for secondary care within the Trust, with other services provided at smaller local hospitals in Bridlington, Malton and Whitby. To further reduce delays in treatment, these hospitals have been developed to be the first port of call for many cardiac patients. Whitby and Bridlington have cardiac monitoring facilities. The Trust is many miles from regional cardiac surgery centres.

The new approach was introduced in 1998. Steps were taken to ensure that paramedical staff and general practitioners knew about the new service and understood how it should be accessed. Criteria were drawn up to ensure that the ‘right’ patients were delivered to the right hospital at the right point of entry at that hospital. GPs were encouraged to seek advice from the Cardiac Nurse Practitioners if necessary. Implementation of plans for a second cardiologist at the hospital will ensure that, from the time they are admitted, all cardiac patients care will be supervised by a cardiologist.

The new approach is working well. Paramedical staff like the new approach it helps them get patients to the right place. Surveys and anecdotal evidence shows that patients like it. They feel confident that the right team in the specialist area is caring them. The new service has helped to speed up the assessment process. Immediate assessment is undertaken by Cardiac Nurse Practitioners as soon as the patients arrive at the CCU.

To find out more, contact

Andrew Mooraby
Clinical Nurse Specialist – Cardiology
Scarborough General Hospital
Telephone 01723 342332
Fax 01723 342332

Getting about again

Helping patients getting going again after MI and acute angina at Frimley Hospital

The demand for hospital beds for patients following a myocardial infarction or acute angina prompted Frimley Park Hospital to look again at the facilities available. These discussions led to the extension of the Coronary Care Unit that from spring 2001 will provide 8 beds. An important element of the approach to managing the Unit is an annual survey, which seek the views of patients on the care, treatment and facilities provided. As the work to develop the Coronary Care Unit has been taken forward the team focused on two areas where the patients survey indicated that further improvements were required. These were advice for patients recovering after myocardial infarction or acute angina, such as about diet and about ‘getting back on your feet’ again.

Making the right choices from the hospital menu is important for patients as they start to get better. It is easy to be tempted by the wrong things. Recognising that patients are free to exercise their own choices, the nutrition team at the hospital was keen to avoid telling patients what to eat. Instead they have chosen a way to annotate the daily menu to indicate the sensible choice. Alongside items on the menu a range of symbols are used, such a ‘heart’ to indicate that it is a healthy choice – suitable for cardiac patients - or a letter ‘D’ if it is suitable for people with diabetes. The reaction from patients has been favourable with patients responding well to the confidence placed in them

While bed rest is important in the immediate period after a myocardial infarction or acute angina attack getting moving again is equally important. The team has devised ‘mobilisation guidelines for cardiac patients’. These go through five stages to help patients’ ease themselves from inactivity to a level of activity suitable for their condition. They encourage patients and nurses to talk about symptoms experienced. Patients like the new approach.

The team has since redesigned their booklet ‘Advice following heart attack’ to cover these points in the context of wider advice. Patients are also encouraged to use the series of detailed leaflets produced by the British Heart Foundation. Patients say that they find the hospital’s booklet helpful, particularly as a basis for discussion with their families and carers.

To find out more, contact

Sharon Parkin
CCU Manager
Frimley Park Hospital
Camberley
Telephone 01276 604524
Fax: 01276 604188


4: Information and Communications

 

Getting lifestyle advice to Asian patients

Improving communication between the cardiac rehabilitation team at New Cross Hospital and their Asian patients.

Wolverhampton is a multi-cultural urban area with a high incidence of coronary heart disease. In the twelve months up to January 2000, 13% of all heart attack patients in Wolverhampton were Asian. 66% of these patients were unable to speak English (9% of the total number of patients admitted with a heart attack). Experience had shown that few Asian patients got involved in local cardiac rehabilitation services. The multi-disciplinary cardiac rehabilitation team recognised that if they were to be successful in reducing coronary heart disease in Wolverhampton they needed to increase the uptake of rehabilitation services and promote a better understanding of the need for changes in lifestyle of cardiac patients.

The team believed that better patient education would lead to better understanding of the importance of changes in lifestyle. The main barrier seemed to be communications. Many Asian patients did not understand English; moreover they may not be able to read their mother tongue. Other issues that they needed to address were how to encourage physical inactivity and a healthy diet and more general cultural issues, for example Asian women may not wish to exercise in mixed sex groups. Discussions with a group of patients emphasised the need for careful attention to detail. An important question is who in the family helps with translation or indeed whether the family could be relied on to help with the translation of what could be sensitive and confidential, for example, advice about sexual activity.

To get over the communications barrier the team decided to translate the written advice they offer to post heart attack and angina patients and record it on audiocassette tapes. The work has been a collaborative venture involving the team and the cultural awareness adviser from the health promotion service. Patient volunteers from the Wolverhampton Coronary After Care Support Group are also involved, testing the suitability of the tapes. They like the idea of using tapes and say it will be a great help. The tapes will be available in Punjabi, Hindi and English, and will be issued to patients on the Coronary Care Unit for them to take home and use. They cover the diagnosis of, and living with, coronary heart disease and points about a healthy lifestyle.

To find out more, contact

Rosalind Leslie
Senior Physiotherapist
Cardiac Rehabilitation Services
The Royal Wolverhampton Hospitals NHS Trust
Telephone 01902 307 999 ext. 2718
Fax 01902 643 069
Email cardiac.rehab@rwh-tr.wmids.nhs.uk

Supporting self help rehabilitation

Creating a distance learning rehabilitation package for Papworth Hospital

About two thirds of the patients seen by the cardiac team at Papworth Hospital have to travel long distances to the hospital. Papworth is a regional centre serving East Anglia. Follow up after discharge is difficult. It is not always practical for patients to return to the hospital to join the rehabilitation programme, or indeed for the team to visit patients. Some patients are able to join local rehabilitation programmes but the provision across the region is limited. The Cardiac Rehabilitation Team decided to develop a ‘distance learning’ approach to providing rehabilitation services.

The team created the package that was endorsed by the local cardiologists and surgeons. It is in three parts: a video containing a programme of exercises: a tape to teach relaxation techniques and books and videos about lifestyle changes and secondary prevention. They are also told about a telephone help-line that they can use if they have any questions about their recovery or the use of the package. Patients are also encouraged to talk to their GP about the rehabilitation programme: they are given a letter for their GP.

The programme starts 6 weeks after surgery with a visit to the Hospital. A thorough assessment is undertaken and patients are advised about how to use the package at home. All patients are contacted by a member of the team each week to review progress and discuss patients’ plans for the next week. Progress is also reviewed when they return to the hospital six weeks later to discuss life style changes and secondary prevention with the team. At this stage patients return the package but retain the written material. A further review takes place when they return about a year after surgery.

Success is assured by:

The package has been well received by patients: they like to be able to use it at home when it suits them. They also like being able to involve their families in their rehabilitation. The initiative was awarded Beacon status in 2000.

To find out more, contact

Nicola Greenleaves
Cardiac Rehabilitation Co-ordinator
Telephone 01902 307 999 ext. 2718
Fax: 01480 364216


5: Patient Involvement

Patients' objectives drive the care programme

Making a reality of patient-centred care at the Cardiothoracic Centre, Liverpool.

Increasing frustration with the care being provided to patients with angina prompted discussion about ways to do better at the Cardiothoracic Centre. Patients were receiving a range of different treatments depending on the clinician and hospital they visited. The variation in clinical practice was unacceptable. A team at the Centre was determined to find a better way of caring for this group of patients.

The team believed that the key to managing chronic refractory angina would be a process which, allays patients’ fears, understands patient’s objectives ( what do they want to be able to do ?) and presents all the treatment options (and risks). There would be things the doctor could do (such as prescribing drugs) and things the patient could do (such as avoiding smoking). The bottom line would be patient-centred care, designed to support patients’ own objectives. A dramatic change in the traditional relationships between doctors and patients was required. Patients would set objectives and doctors would suggest a strategy to achieve those objectives.

Creation of a guideline was the first step carried out by the multidisciplinary team. All members of the team (cardiologists, pain specialists, psychologists, rehabilitation specialists, nurses and patients ) have learnt from one another and the collective experience has grown. Implementation required a new approach. Time was required so that the objectives of the medical team are exactly the same as those of the patients and carers. Clinicians needed to ensure that patients could articulate their objectives. The team learnt that many patients have quite simple and reasonable aims that can be dealt with without major surgery. As one patient said ' All I want is to do is go to America on holiday with my wife to see our grandchildren '. Experience has shown that an initial consultation needed to be about one and quarter hours– in an informal setting – a sitting room – rather than a clinician’s office.

The standard of care has improved dramatically and has shown that patient-centred care is achievable. Patients like the new approach. Doctors too are realising that low cost, low risk therapies can provide an alternative to complex treatments such as bypass surgery. The team was awarded a Nye Bevan award in 2000 and has done much to promote and support similar development across the UK and internationally.

To find out more, contact

Dr. Michael R Chester, Director
Dr Austin Leach, Deputy Director
The National Refractory Angina Centre
The Cardiothoracic Centre
Liverpool
Telephone 0151 293 2448
Fax 0151 293 2269
Email ali@angina.org
Website www.angina.org

Getting patients involved in designing a Coronary Care Unit

Working with voluntary organisations at the Countess of Chester Hospital, Chester

Creating a new Coronary Care Unit was seen as essential to support the delivery of better clinical care for cardiac patients. It would group cardiac patients together rather than allow them to be admitted to different wards in the hospital. The pending publication of the National Service Framework added impetus to the local pressure for change. After extensive discussions within the Trust these facilities were set up in the summer 1999. The suite consists of a 10 -bedded CCU, pacing room and 2 chest pain assessment beds. The capital required to build the unit was raised through a major two-year fund raising appeal strongly supported by local newspapers, companies and voluntary organisations.

As creation of the new facilities was being discussed the cardiac team was keen to build on the existing links with voluntary organisations including the Zipper club and the Chester Heart Support group. Members of these groups were invited to sit on the fund raising committee and, as ex-patients, were encouraged to air their views as the design for the unit took shape. A series of discussions were arranged with Bill Tunnicliffe from the Zipper club and Mike Norfolk from the Chester Heart Support group.

As the CCU has evolved the merits of the new approach are becoming evident. Bringing together staff caring for cardiac patients in the CCU has had a positive influence on multidisciplinary working. Supported by suitable training all members of the cardiac team are growing in confidence. This better team working has extended beyond the CCU to stimulate better working with other parts of the hospital and with primary care. Key developments have been: the creation of a care pathway; a systematic drive to improve thrombolysis times; the creation of a new package of information for patients and links with primary care to engage patients in cardiac rehabilitation and secondary prevention programmes.

Strong links continue between local voluntary organisations and cardiology services. Support is renewed with the publication of the NSF and our current focus is on Cardiac Rehabilitation and the will to see patients lead as full and as long a life as possible. The voluntary organisations continue to provide invaluable advice to current service users and to raise funds to improve patient care.

To find out more, contact

Caroline Salden
Directorate General Manager
Adult & Elderly Medicine Directorate
The Countess of Chester Hospital
Chester
Telephone 01244 365288
Fax 01244 366229
Email Caroline.Salden@coch-tr.nwest.nhs.uk


6: Co-ordination and continuity

 

Supporting patients’ return home after surgery

Developing a home visiting service from Blackpool Victoria Hospital

Traditionally patients who had cardiac surgery at Blackpool Victoria Hospital remained in hospital longer than the national average. The appointment of two new Cardiothoracic Surgeons in 1996 prompted a reduction in the length of stay and a review of the discharge policy. This raised anxieties in the minds of local GPs: were patients being discharged too early? GPs and community nurses may not have the experience to care for patients at this stage in their recovery. The cardiac team decided to explore whether they could provide an outreach service after patients were discharged.

The team decided to explore whether a new nursing post – a Home Care Sister – might be the answer. This nurse would visit patients after discharge to check that all was well and make any necessary changes – such as medication. The hospital provides cardiac surgery for a wide geographic patch but the new service would be limited to local ‘district’ patients. The new role was explained to community nurses and GPs before the work started. Transport might have been a problem – but a local car dealer offered to provide a car for use by the nurse. In 2000 this sponsorship was taken over by a patient who had been cared for by the cardiac team. As a sign of his gratitude he now provides a car through his company’s car pool.

The Home Care Sister sees all patients shortly before they are discharged, to introduce herself, explain her role and make an appointment for the first home visit. Links are also established with primary care to ensure that care continues. This post was funded from internal resources and ways to expand the service are being explored.

The team was keen to know what patients thought about the new service and organised a survey in 1999. Patients praised the initiative and, almost universally, wanted more visits. Experience has shown that most patients benefit from two visits by the Home Care Sister, although for a few patients more time is required. Like any other similar initiative based on one individual there are problem about continuity, for example during annual leave. For ‘out of district’ patients the service is limited to contact by telephone.

To find out more, contact

Bernie McAlea
Home Care Sister
Blackpool Victoria Hospital NHS Trust
Telephone 01253 303410
Fax 01253 303668

Empowering patients to manage their heart failure

Preparing patients for discharge from Aintree Hospital

Over the years the cardiac team at Aintree Hospital got used to seeing patients in whom heart failure had been diagnosed. They returned regularly as their health deteriorated. There was a growing sense that they ought to be able to do better. Could they find a way to provide information and support for patients and their families that would enable them to manage their condition better? The team was unable to find any research evidence to guide them but they had a sense that they had to try to find a way to provide better support for patients.

The team decided to explore the creation of a new nurse specialist post. The new post would focus on empowering patients to manage their condition. By learning about their condition they would be able to manage it at home and prevent re-admissions. There was no recognised model for the post, or suitable training courses, so the cardiologists provided training. Care was taken to ensure that all the members of the team understood the new role. Discussion with patients showed that they needed good information as well as fast access to advice should the need arise.

Four distinct parts to the post were identified:

The new post has been well received by patients: they like to be able to contact the nurse directly. Patients are familiar with the nurse they see and are confident that they will listen to their problems. They know they will receive prompt answers to queries. Patients’ families find it reassuring to know they can call for advice. The post has grown from strength to strength – although it has unearthed a demand that is difficult to meet. It has particularly improved links between the hospital and primary care prompting the creation of a network of cardiac advisers in primary care. These nurses work with patients in primary care and have more time for their patients. They look to the nurse specialist at the hospital for expert support. The initiative was awarded Beacon status in 2000.

To find out more, contact

Barbara Appleton
Cardiac Nurse Practitioner for Heart Failure
Aintree Hospitals NHS Trust
Telephone 0151 529 2690
Fax: 0151 529 2724
Email: barbara@appletonb67.freeserve.co.uk


7: Discharge and Transition

 

Getting back in shape

Providing a cardiac rehabilitation service for the population of Dudley

The Action Heart cardiac rehabilitation programme was launched in the late 1970's and its development culminated in the building of a dedicated rehabilitation centre in 1994 - the Action Heart Centre at Russells Hall Hospital, Dudley. The programme provides a comprehensive multi-disciplinary approach to cardiac rehabilitation. A multi-disciplinary team committed to rehabilitation provides the service. The Centre is open from 10.00 hrs to 21.00 hrs Monday to Friday: these hours have improved accessibility to the service.

Referral by a doctor triggers patients’ involvement and during the programme they have access to a cardiologist. The programme is tailored to suit each patient’s needs. The assessment takes into account their current health, lifestyle and modifiable cardiac risk factors. The programme starts with a daily plan of re-mobilisation during patients’ typical five to seven day hospital stay. As they progress education and counselling are provided for patients and their families. In the second phase, after discharge, a cardiac liaison nurse visits patients at home. Patients are invited to a series of seminars on topics such as lifestyle and cardiac medications. In phase three, patients attend the Centre three times per week for six months for supervised exercise sessions. Home exercise advice is available for those patients who find it difficult to attend the Centre. They are also invited to a series of courses relevant to their needs, such as smoking cessation and weight reduction. A formal re-assessment is the prelude to the final and more relaxed approach as patients take on more responsibility for their own health. A second formal re-assessment, typically after 12 months, concludes the programme and the majority of patients are then discharged.

The programme is popular with patients. Most comments on the regular evaluation form are complimentary: action is taken when problems are recorded. For example, transport is as a problem for some patients and possible solutions are being explored with the local CVS. A bi-monthly newsletter keeps patients (and ex-patients) in touch with the programme. It also invites comments: two typical readers’ said: 'Action Heart has been a lifeline for me' and 'The other important thing is that I can talk to other patients who are in the same boat as me'. The initiative was awarded Beacon status in 2000.

To find out more, contact

Russell Tipson
Director of Action Heart
Dudley Hospital
Telephone: 01384 230222
Fax: 01384 254437
Email: info@actionheart..com
Website www.actionheart.com

Helping patients help themselves

Developing a cardiac rehabilitation programme in the East Riding of Yorkshire.

During a review of cardiac services by the District Auditor in 1998 concerns were raised about support for patients in the East Riding of Yorkshire who had suffered a myocardial infarction. Few were involved in rehabilitation programmes. This co-incided with the transfer of Professor Bob Lewin to the University of Hull from a similar post in Edinburgh where he had been involved in the production of the Heart Manual. This describes a six-week home-based rehabilitation programme of physical activity, health education and support. Evaluation had shown the benefits of the programme for patients. He was keen to promote the development of a similar approach in the East Riding.

A proposal to set up a pilot programme was drawn up by representatives from primary and secondary care and funding secured from the East Riding and Hull Health Authority and the British Heart Foundation. A project manager was appointed to co-ordinate the work across the health authority patch. Systems were needed to identify all patients who might benefit from the programme and facilitators to help patients undertake the programme described in the Heart Manual. A key feature of the programme is the network of about 100 trained facilitators.

In hospitals they identify patients who would benefit from the programme, tell them about it and give them a copy the Heart Manual. In primary care they visit patients in their homes for the first six weeks after discharge and support them as they undertake the programme. At the end of the six weeks, progress in reviewed and patients are either discharged, referred to their GP or to the hospital clinic. The programme secretary maintains a database of all patients so that the progress of all those involved can be monitored and reported to their GP.

The programme is popular with patients. An independent survey has shown that they are benefiting for their involvement. Patients appreciate the support and advice been given – and like being supported in their homes: visits to hospital are not required. As one patients said ' The contact with the nurse was reassuring, it’s good to know you are doing the right things '. Facilitators find the work particularly rewarding. But, it’s not all plain sailing. Staff turnover means that the recruitment of facilitators is a continuing task and backing from local managers is essential. The new PCGs are pleased with progress and have taken over funding of the work after the initial support from the BHF. The initiative was awarded Beacon status in 2000.

To find out more, contact

Julie Jones
Operations Manager
East Yorkshire Primary Care Group
Telephone: 01482 862832
Fax: 01482 860176