Acute heart failure

13th September 2021

Across Kent, Surrey, and Sussex (KSS) there are over 50,000 patients with heart failure, with evidence showing significant variation in admission and readmission rates, in-hospital crude mortality, and other outcomes. People with heart failure need optimal diagnosis, treatment, and surveillance.

KSS AHSN and Unity Insights use proven improvement science, large scale change methodology, and shared learning to drive rapid implementation of best practice, leading to a reduction in inappropriate variation and improvement in patient outcomes. The pathway created is a measure-based intervention and comprises six measures as part of a ‘care bundle’, where if a patient receives all six then optimal treatment has been achieved. Unity Insights work closely with ten trusts across KSS who provide monthly data that feeds into a dashboard at site and trust level to benchmark the quality of care provided.

Almost 24,000 patients have benefitted from the care bundle between April 2015 and September 2019 (implementation period). During the baseline period (April 2012 to March 2015), the mortality rate was 14.3%, which dropped to 12.2% during the implementation period. Due to the baseline data being largely out of date, we took the prudent approach of using a rolling baseline every 12 months.

Impact

During the implementation period, there were:

  • 347 lives saved
  • Over 15,000 bed days saved
  • 715 same cause readmissions saved

A dashboard developed by the team provides an ongoing insight into the care provided, enabling providers to retrospectively learn from past data to drive service change.

Since April 2017, we have integrated the Best Practice Tariff (BPT) which enables trusts to see how they are performing in relation to receiving an additional payment. The tool created enables trusts to actively participate in discussions with commissioners. This BPT information has also been used to help support business cases for additional staff to support heart failure services.

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