1. Leeds cardiac unit & discharge planning
Hannah Saven
Ward 51 - Sister

2. Leeds Congenital Heart Unit
Supra regional service for Yorkshire and the Humber (covering a population of 5.3 million)
Outpatient clinics in Leeds and 19 DGH’s
Ward, HDU and PICU care
Team of Specialist Cardiac Nurses
Surgical procedures
Interventional and diagnostic catheter procedures
MRI/CT scanning
Large MDT

3. Congenital Heart Figures at LGI
Surgical
Catheter – Intervention
Catheter – Diagnostic
Adult
121
192 81
Paediatrics
343
336
126
Total
464
528
207
Surgical
Catheter – Intervention
Catheter –
Diagnostic
Adult
101
219 69
Paediatrics
337
262 98
Total
438
481
167

4. Ward L51 Ward manager – Debbie Smith (Band 7)
8 Sisters (Band 6) – 2 currently on Mat leave
24 staff nurses (7 new starters)
x2 trainee Nursing Associates
Trainee Clinical Support Worker
Clinical support worker
Ward clerk
x2 Hospital Play Specialists

5. Discharge after a catheter
Patients who have a diagnostic catheter often go home the same day, and keep their usual outpatient appointment
Patients who have had an interventional catheter, where something is ballooned, coil occluded or stented, stay overnight. The following morning, they will have an echo +/- and CXR prior to discharge. They will be seen in outpatients with 2 weeks

6. Discharge after surgery
Most patients go home on day 5 after surgery, if the surgery is more complex, then the length of stay is often longer
All families receive an advice after surgery leaflet, which answers questions about: wound care, immunisations, back to school etc
A community nurse referral is often made for children who require a drain stitch removing. This is completed using our standardised referral form
Some children require NG feeding post surgery, these children are routinely transferred back to their local hospital for further training and community set up

7. Discharge on Warfarin Mechanical valves, Fontan
Approx 130 patients on Warfarin, 100 use home testing
Established on Warfarin in hospital, here in Leeds, families receive education from, our specialist pharmacist, CCNS and ward staff
Suitable patients are trained to ‘home-test’
Others are referred to local hospital for testing
Referral is made to Warfarin clinic for dosing
Patients referred to local Paediatrician

8. Discharge - ‘high risk’
All patients on a single ventricle pathway, between first and second stage surgery. (i.e. Norwood's/Damus).
All patients reliant on Ductal Stent or BT shunt for pulmonary blood flow.
Patients on a single ventricle pathway who are un-operated on discharge.

9. Aim of the ‘high risk’ clinic
Regular, close monitoring of complex patients in order to reduce morbidity/mortality and highlight any parental concerns
Continuity of care, named consultant
Timely planning of interventions/investigation’s
Ensure all patients receive local follow up
Specialist advice/support to ensure parents are well informed about child’s cardiac diagnosis and prognosis

10. Discharge Checklist Referral to local paediatrician
Referral to community nurses, weekly O2 saturations and weight
RSV prophylaxis… All high risk patients fit criteria
Saturation monitors (Norwood's/Damus initially)
Open access to local paediatric ward/assessment unit
Offer BLS training to parents/carers

11. Discharge documentation/advice
Condition specific written information (including any information re: procedure i.e. ductal stent, BT shunt and risks of dehydration)
Advice after surgery information.
Parent held documentation:-
Cardiac condition
Operation/procedure
Acceptable Saturations
Record of Sats and weight

12. Local Hospital children’s ward - use open access T.
‘Red flags’
Who to contact and when: Advised to contact with concerns and aim for same day review where required.
Consistently Irritable and difficult to console (more than normal)
Not taking feeds /diarrhoea/vomiting (more than normal)
Change in colour (Blue, grey, pale)
Decreased oxygen levels <75% (good trace, two limbs, two minutes)
Sweating, particularly with feeds (more than normal)
Change in breathing pattern (too fast/slow/hard)
Increased sleepiness
Fever > 38°C
Cough, wheeze, congestion
Poor weight gain
NON-EMERGENCIES
Cardiac Nurse Specialists T
Ward 51 T
Community Nurse T.
Local Hospital children’s ward - use open access T.
EMERGENCY
999
Nearest Hospital
Discussion with on call Cardiologist in Leeds

13. ‘High risk’ care Patients seen in clinic in Leeds every 2 – 4 weeks
Review - ECHO, O2 Saturations, Weight, general cardiology review
Named consultant/on call cardiologist available for advice/urgent review where required
Liaise with local paediatricians regarding follow up and treatment plan

14. What we want from you Regular local paediatric follow up
Support in the community for children and families
Regular assessments and saturation monitoring in the community
Liaison with us in Leeds, contact us with
any concerns or questions about a patient

15. What would you like from us?
What don’t we do well?
What existing area’s can we improve?
What do we do well?

16. Thank you
Any questions?

17. Our Contacts Hannah Saven 0113 3927551 hannah.saven@nhs.net