Case study: Community based and Hospital supported Cardiovascular Services – north central London

LOCATION: 

The Whittington Hospital (UCL’s teaching hospital), the North Middlesex Hospital, Haringey, Barnet, Enfield and Islington PCTs as well as the patient in their own environment.

WHO IS INVOLVED?

The service functions from 30 General Practices, three community pharmacists, one polyclinic and one community hospital.  These distributed services are supported by the hospital anticoagulant and stroke prevention services, clinician education and clinical governance.

BACKGROUND

The North London CCG has, for many years, kept pace with the evolution of a more community-led approach to delivering anticoagulant and stroke prevention services, progressively developing its services in iterative steps, piloting each new model of care delivery.

As healthcare IT has developed, the team has used UCL’s advisory systems, to inform dosing and testing intervals, and introduced an increasingly sophisticated EHR (Electronic Health Record).  This has enabled the service to become more distributed, with delivery closer to the home of the patient.  Progress has been continuous, but the CCG wanted to enhance the benefits of these developments with clinical governance and education.

The combination of software, education and governance delivered by HeliconHeart is very compelling and we have been delighted with the impact of the service, so much so that we intend to use it to help us manage other long-term conditions, such as heart failure, atrial fibrillation and coronary artery disease, where the overlaps with anticoagulant treatment are considerable.

Dr John Luckit, Consultant Haematologist, North Middlesex Hospital

By partnering with Helicon Health, they were able to combine the wealth of knowledge within UCL and the Whittington Hospital with Helicon’s innovative, integrated approach, which offers advisory systems, education and clinical governance in one package.

PLANNING AND IMPLEMENTING THE SERVICE

Advisory system

The Helicon Health team worked closely with the commissioners to agree the parameters for the use of HeliconHeart.  Within 4 – 6 weeks, the relevant team members were given access to the software, with user logins, and training was delivered to ensure that everyone involved in the programme was conversant with how to use HeliconHeart to manage patients and monitor outcomes.  As HeliconHeart is a clinical module of the underlying Electronic Health Record (EHR), it is accessible via a personal computer (PC), laptop or tablet.  The EHR server is sited at the Whittington Hospital and the EHR is supported by the IM&T Department.

Governance

The team now comprising Helicon Health worked closely with the North London CCG’s clinicians to develop innovative and robust clinical governance, including the establishment of a Clinical Governance Board and the comprehensive scoping of measures of satisfaction and safe performance.

The Clinical Governance Board includes patients, hospital consultants (haematology and cardiovascular), anticoagulant practitioners (GPs, Nurses, Pharmacists), commissioners and clinical GP leads, as well as an academic social scientist,  a statistician, a computer scientist, a legal advisor and an IT representative from Whittington Hospital.  A key priority for the Board was to agree measures of satisfactory quality of service in a changing clinical environment.

Education

The educational programme is based on a knowledge based and experiential course, which all anticoagulant practitioners undertake. There is a clinical examination, which tests their knowledge and their skills. The twice-yearly educational event is designed for all anticoagulant practitioners and forms part of their professional development and re-validation.

Results

The community based stroke prevention service is now building progressively; the patient numbers are over 1,500 and expected to rise quickly as confidence in the quality and safety of the service grows.

An independently commissioned survey demonstrated that the patients interviewed unanimously favoured the new anticoagulation service over the hospital-based service used previously.  This was for a number of reasons:

  • Convenience (closer to home, easier to park)
  • Shorter waiting time
  • Friendly staff with professional manager
  • Minimally invasive test (much less risk of bruising)
  • Blood test less operator-dependent
  • Sample analysed in front of patient (very low risk of samples getting lost or mixed up)
  • Clear, structured paper printout
  • Good explanation of result and what action to take
  • Ad hoc advice available from pharmacist on other medication and general health issues
  • Less risk of hospital acquired infections (especially for immunocompromised patients)

We now collate a wide range of data, from blood test results to instruments and devices used.  This enables us to monitor and measure the quality of all aspects of the anticoagulant and stroke prevention service, from education to patient outcomes and the safety of the clinical environment.

In addition, we conduct an annual review of the patient, drawing on the Electronic Patient Record, information about the patient on the GP Practice information and personal knowledge of the patient.

The educational components have been extremely well received and are now being enhanced to enable elearning.