Lightbulb innovation: Nurse-led cardiac day lounge a success

Image of a lightbulb with the words lightbulb innovationsA day lounge for patients has been developed in a busy cardiology unit by a team of nurses in Northern Ireland. Improving the experience of patients requiring either a coronary angiogram or percutaneous coronary intervention (PCI) has been at the heart of this innovative redesign. The preadmission lounge offers a more relaxed atmosphere, so patients are less apprehensive about their treatment.

Nuala Cummins felt there was a better way to manage patient throughput within the cardiology unit at Belfast City Hospital, and, with her nursing colleagues and the Cardiology nursing development lead, Avril Redmond, invited patients to reflect on their experience of the care they received. One of the key themes that emerged from listening to patients was their frustration in having to wait around for up to five hours for a consultant to check their results and give them further information before being discharged. At the same time, Nuala knew that the unit was sometimes used as an overflow area for the main hospital, leading to bed shortages and last minute cancellation of operations.

Nuala realised that blockages in the system could be overcome with the introduction of a nurse-led care pathway. Patients appreciate the continuity of care provided by the nurses, whilst the workload of junior doctors is reduced because nurses are able to undertake a comprehensive systematic assessment using the care pathway. "The reduction of incident report forms and patient complaints is evidence of the way the new system is working" says Nuala.

And there are further benefits. The introduction of nurse-facilitated discharge has enabled safe same day discharge of patients following PCI. At the same time, nurses are able to talk to patients about cardiac rehabilitation, aspects of their diagnosis, post-procedural care and any potential follow-up. This novel approach means that the unit can now be closed at night, reducing operating costs.  As consultants are no longer required to reassess patients prior to discharge, they have time to do more procedures: a real win win.

Evidence from similar cardiology units in Liverpool and Amsterdam suggested that some patients find recliner chairs more relaxing than beds, both pre and post operation. Nuala and her team use the day lounge to assess all patients, and beds are only utilised when deemed clinically necessary. Not only is this better for the patient, but it also utilises resources more effectively.

All change can produce feelings of anxiety, and Nuala and her nursing team were careful to articulate what they proposed every step of the way. They were supported throughout this process by colleagues from the Belfast Health and Social Care Trust Person centred Practice Research team and the Person centred Practice Research Centre at the University of Ulster. The use of patient stories and questionnaires provided an insight into the patient journey which allowed their experience and suggestions to influence the changes, and feedback from staff suggested that they were enabled and empowered to own the practice change.

So successful has this nurse-led redesign been, it is currently being looked at in other acute hospital sites across Northern Ireland. If you would like to know more, please contact Nuala Cummins, email: nuala.cummins@belfasttrust.hscni.net.

For more information about the Person centred Practice Research Centre at the University of Ulster, contact Brendan McCormack, email: bg.mccormack@ulster.ac.uk, or see their website: http://www.science.ulster.ac.uk/inr/pcp.php

Website: RCN Frontline First

 

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