Article of Interest: Small changes in heart failure pathways lead to lasting improvements.
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The exhaustion of health care resources caused by the COVID-19 pandemic amplified existing inefficiencies in health care pathways. During the second wave of the pandemic in the UK, there was a 41% decline in hospital admissions related to heart failure (HF), and a 34% decline in heart attack admissions.
This heavy decline in cardiac related admissions contributed to over 2000 excess deaths in England and Wales. Barton et al recently published an article in The British Journal of Cardiology in which they describe their experience transforming local HF care pathways in North West London.
“During the pandemic an estimated 23,000 diagnoses of heart failure (HF) were missed” - Barton et al.
Barton et al aimed to improve HF patient outcomes by creating long-term, sustainable changes to HF pathways. The team focused on making changes to organizational frameworks, communication standards, technology functions, and SystmOne, the EHR system used by the community HF service and primary care). The team was able to identify a multitude of small inefficiencies throughout each core category which aggregated to “significant breakdowns at various points in the pathway”.
Many of the noted issues were related to inadequate coding. For example, they estimated that 60% of a Heart Failure Specialist Nurse’s time is spent on administrative tasks; however, labor-intensive form templates, poor integration with General Practitioner (GP) records, and insufficient referral clarity meant that the nursing templates on SystmOne could not contribute to correct coding or documentation to support GPs.
At the time of publishing, interim data have shown a 7% increase in HF service referrals, 300 new HF patient records, 100 newly coded HF patients per month, and a 70% reduction in incorrect blood test requests. They also estimate the new referral process resulted in cardiologists saving 40 minutes per week. In our opinion, this is an excellent example of how the cumulative effect of minor data and communication problems throughout a care pathway decreases efficiency and negatively impacts the health of patients, while a well-designed HF pathway can create lasting care improvements for HF patients.
