Same day CT angiography in a nurse-led Rapid Access Chest Pain Clinic

Funding Acknowledgements None Background Rapid Access Chest Pain clinics (RACPCs) were established in the UK in 2000 following the publication of the National Service Framework for Coronary Heart Disease. Patients underwent an exercise test (ETT) in the clinic as part of a ‘one-stop’ protocol with follow-up only if further investigation was required. In 2010, the National Institute for Health and Care Excellence (NICE) produced guidelines for the assessment and diagnosis of chest pain of recent onset (CG95), replacing the recommendation for ETT with non-invasive functional testing for patients with an intermediate pre-test probability of coronary artery disease (CAD), necessitating multiple appointments to evaluate the patient’s symptoms. The guidelines were updated in 2016, with a new recommendation that patients with atypical or typical chest pain should undergo CT coronary angiography (CTCA) as the first diagnostic test. Purpose The aim of this study was to investigate the feasibility and potential benefit of performing same -day CTCA in the RACPC. Method From November 2016 all patients with atypical or typical chest pain attending the RACPC at this tertiary cardiac centre were referred for CTCA unless alternative investigation was clinically indicated. From February 2018, same day CTCA was offered to some patients. Up to two scans could be performed in each clinic, which was increased to up to three in June 2018. Results A total of 985 patients were seen in the nurse-led clinic between 12/02/2018 and 30/11/2019. 473 patients were referred for CTCA (48.0%) and 314 scans were carried out in the clinic (66.4%). Of those scans carried out in clinic, 128 patients had a CTCA which showed no evidence of CAD (40.8%) and 34.4% of scans showed non-obstructive CAD. In 18.2% of patients, the CTCA showed significant CAD and in 21 patients (6.7%) the scan was inconclusive. Patient with inconclusive scans underwent further testing which was negative in all cases. The outcome for patients with significant CAD (57 patients) is shown in the table. Conclusion CTCA on the same day as the RACPC appointment is feasible and facilitates rapid further investigation and treatment of patients with potentially significant CAD. It also enables patients with non-significant or no CAD to be reassured that their symptoms are unlikely to be cardiac which will reduce anxiety and allow timely investigation of other causes of the chest pain. Nurses need training in the risks of radiation in order to be able to request the scans and enable the clinic to be nurse-led.

Survey to evaluate care of complex clients in residential setting

AimsDelivering a new efficient assessment and shorter term secondary mental Health intervention service for individual sectorsBackgroundIn November 2015, there was a transition to services with the focus on delivering more efficient service to clientsPreviously we had been a combined sector Service. This transition, a reduction in resources and a move away from delivering care Through specialist mental health teams created from the national service framework - such as Assertive outreach, early intervention in psychosis and community rehabilitation - to a more Streamlined generic service, catering for these differing groups of people using a “Pathways Model” approachResultAcross the two sectors we had 47 clients on CPA Pathway living in 24 hour residential Settings who all had a current care coordinator.These 47 clients represented the workload currently of 2.8 FTE Band 6 care coordinators.There were at Origin, 13 Residential/Nursing/Secure 24 Hour care providers, where clients were residing.However of these 90% of residents lived in one of 5 settings, 3 settings in Ashfield and 2 in Mansfield.Over 50% of individuals residing did not have existing connections with Mansfield or Ashfield before being placed into the area.18 Clients (%38) were under section of the mental health act and 1client (%2) was on a life-Licence from criminal justice.ConclusionTransfer of CPA Care Coordination ProtocolTo send paper referral to our Single Point of Access Meeting at the listed address at the earliest point relocation/placement is confirmed.Formal handover meeting for care will be coordinated, not sooner than 3 months after the placement commences. It will be expected that services currently involved in provision of service continue to hold care responsibility in the interim period.As we move to a paperless environment, provision of electronic documentation such has previous CPA documents, Risk assessments, social circumstance reports & Discharge summaries, would be greatly appreciated

Cardiac rehabilitation

This chapter looks at the role of cardiac rehabilitation for those at risk of cardiac disease or who have sustained a cardiac event. Cardiac rehabilitation has been a priority area for a long time in the National Service Framework for Coronary Heart Disease, NHS Improvement Plan, and now features in the NHS Long Term Plan. The introduction of certification for cardiovascular prevention and rehabilitation programmes (CPRP) has meant that their quality can be measured. The introduction of more technology-based interventions has opened up the opportunity for more people to participate, particularly for individuals who could not, or did not want to attend a traditional CPRP.

What choice? Risk and responsibilisation in cardiovascular health policy

Employing a policy-as-discourse approach, we explore how the language of choice, risk and responsibilisation influences cardiovascular disease policy. We analyse four key pieces of public health literature produced in the UK between 1999 and 2013 that consider the prevention and treatment of coronary heart disease: Saving Lives: Our Healthier Nation; National Service Framework for Coronary Heart Disease; Mending Hearts and Brains and Cardiovascular Disease Outcomes Strategy. This critical discourse analysis problematises how neoliberal discourses of responsibilisation, risk and choice operate to govern health practices. Textual analysis reveals there are multiple dimensions evident in the way that responsibility for health is framed. Organisations are considered responsible ‘for’ illness prevention strategies and service provision, while individuals are conceptualised as responsible ‘to’ maintain healthy lifestyles. Conceptualising individuals as responsible health-conscious consumers enables a backward-looking narrative that holds individuals to account. Furthermore analysis reveals assumptions and messages that demonstrate the operation of moral discourses around patient behaviour. We suggest moral dimensions to public health strategies obscure the structural disparities that influence healthy life chances, imposing a system of limitations and exclusions that lead to allocation of liability and attributing blame for illness.

Victorian maternal child health nurses’ knowledge, attitudes and beliefs towards national registration changes

In 2010 National Registration for nurses was established which was likely to impact the role of the maternal and child health nurses (MCH) in Victoria. This study explored the perceived impact of the national changes to the MCH nurse workforce in Victoria following the implementation of national registration and a proposed national service framework. A qualitative exploratory descriptive design was employed with the purpose of exploring the knowledge, attitudes and beliefs of Key Stakeholders (KSH) to the recent changes and perceived impact to Victorian MCH nurses. The significance of this study lies with understanding the gaps in current knowledge of KSH to the national changes. Outlined briefly in this paper will be main findings from the KSH. This involved interviewing 12 KSH from management positions, including Local Government Coordinators, Policy Advisors to the Department of Education and Early Childhood Development, the Municipal Association of Victoria, along with academics from Universities that provide postgraduate Child and Family Health education programs for the MCH nurse qualification. Date was transcribed verbatim and content analysis used. Categories were developed by identifying recurrent patterns from the data, labels were then chosen which reflected the participant’s words: “common standard”; “losing our identity”; “universal service”; “we do it well” and “imposed from above”. Overall the KSH were concerned how the disparity in education and qualifications would be resolved and the effect this would have on the service. Findings from this study highlight the importance of comprehensively investigating services offered by all jurisdictions and using collaboration, communication and leadership to effectively introduce change.

Alternative Perceptions of Statutory Community Aftercare: Patient and Responsible Medical Officer Views

The need for more effective means of caring for mentally disordered individuals in the community has been given a prominent place by the Department of Health. The inclusion of user perspectives in mental health care research, to inform and improve the development of services, has also been given a high priority and the necessity of incorporating patients’ and carers’ views has been recognised by the Department of Health in the National Service Framework for Mental Health published in 1999. Studies incorporating both the service user and professional viewpoints of statutory community care have been relatively sparse. This study, looking at the process of conditional discharge of restricted hospital order patients sought the views on the benefits, deficits and recommendations for change from those people providing and receiving statutory community aftercare. The findings may assist in any future review of the Mental Health Act, policy development and in the planning and delivery of psychiatric services to other groups of severely mentally ill people.

Cardiac rehabilitation

This chapter looks at the role of cardiac rehabilitation for those at risk of cardiac disease or who have sustained a cardiac event. Cardiac rehabilitation was one of the few areas of the National Service Framework for Coronary Heart Disease where targets were not all met. It is now one of the priority areas for NHS Improvement Heart. A new pathway has been devised for cardiac rehabilitation and this is included here.