1. Audit of Nurse Led Triage of Cardiology Referrals Fiona Smith Cardiology Nurse Wrexham Maelor hospital

2. Nurse Led Triage of Cardiology Referrals - Background Welsh Assembly – Designed for Life (2005), SaFF target (2005-2006) Cardiac RTT – 26 week pathway Changes to Cardiologist workload Finance from LDP – allowed employment of second Cardiology nurse specialist 2006 Part of role, triage Cardiology referrals - ?specific to Wrexham Clinics or Non face to face contact Test Only – nurse led from 2010

3. Cardiology referrals (3623) September 2013 – August 2014

4. Test Only investigations completed – single test (756) Palpitation – 268 Echocardiogram – 302 Novacor – 66 24 Hour tape – 85 Omron – 17 Other types of tests – 18 (24 Hour B/P, ETT, 48 Hour tape, DSE, Bubble study, ECG)

5. Test Only investigations completed – double test (43) Ambulatory monitoring + Echo - 29 Novacor + ETT – 4 Echo + 24 Hour B/P – 4 Novacor + 24 Hour B/P – 2 Echo+24 Hour B/P+Novacor – 1 B/P + 24 Hour tape – 1 Palpitation + Echo – 1 ETT + Omron – 1

6. Patient outcomes from Test Only – 799 patients

7. Patients referred directly to a follow up Cardiology clinic - 124 87 patients to 1 Stop (10.88%) 41 patients discharged after 1 OPD (1 patient DNA RIP7/12 AS) 46 patients to F/UP (1 patient RIP at 3/12 awaiting Valve surgery) 22 patients to Valve clinic (2.75%) 9 patients to Arrhythmia clinic (1.12%) 2 patient to HF (0.25%) 1 patients to ACHD clinic (0.12%) 1 patient for Paediatric follow up (0.12%) 1 patient to RACPC (0.12%) 1 patient booked surveillance echo (0.12%)

8. How many patients that were discharged (667) DID NOT undergo test? 71 patients (10.64%) – 19 no symptoms 19 DNP 15 DNA (1 AF ablate 2/12) 7 CNA (1 RIP 3/12 lung+spine) 3 declined (1 RIP 1/12 Bi-vent) 3 seen elsewhere 3 RIP before test (2 patients 10/7, 1 patient 14/7 after referral) 1 became PP 1 GP cancelled

9. How many patients that were discharged following Test Only (667) were re-referred, admitted to hospital or died within 12months of test? 22 (3.29%) patients re-referred – 1 Stop – 11 patients (7 same problem, 4 different problem) Arrhythmia – 6 patients, all same problem RACPC – 4 patients, all different problem HF – 1 patient, same problem 6 patients (0.89%) admitted to hospital under care of a Cardiology team, all patients different problem 13 patients died (1.94%) - 5 Ca, 1 LRTI, 1 pneumonia, 1 declined test (Bi-vent), 1 already under active F/UP with LHCH, 1 PE, 1 Dissected Aortic Aneurysm, 2 IHD (4/12 aged 89 and 11/12 aged 65)

10. Conclusion The use of Test Only during the triage of Cardiology referrals by the Cardiology nurse specialists has reduced the need for Cardiology clinic appointments A small number of patients (6.13%) that were discharged following Test Only were re-referred, admitted to hospital or died Effective and efficient use of Cardiology nurse specialist time Improved communication channels between primary and secondary care Aids education on both sides