Pioneering a non-medical, clinical practitioner-led cardiac monitoring path
Lead arrythmia nurse specialists, Carolyn Campbell-Cole and Kerrie Horkan, explain how St George’s Healthcare NHS Trust has transformed its approach to cardiac monitoring, post-Covid-19.
Syncope – characterised by a sudden, temporary loss of consciousness resulting from a transient disruption in blood flow to the brain – places a significant burden on health services. Each year, 251,000 people are hospitalised for syncope, yet half of the patients admitted to hospital due to the condition leave without a diagnosis. Episodes can lead to falls, injuries, and an overall sense of unease. The management of syncope can be challenging and complex, particularly in an ageing population where the disease progression requires longer-term management.
Recognising that early detection and effective management can help improve patients’ quality of life, two lead arrythmia nurse specialists at St George’s Healthcare NHS Trust in South London championed a new pathway for patients to minimise the impact of cardiac syncope on daily activities and streamline the care pathway.
Pivoting syncope care post-pandemic
Implantable cardiac monitors (ICMs) are often recommended for patients with syncope as a long-term monitoring option. These devices are inserted during a minimally invasive procedure, afterwards recording and storing data about a patient’s heart rhythm for up to 5 years. They are designed to detect and alert healthcare professionals to any heart rhythm abnormalities. The data collected by cardiac devices can help physicians diagnose and manage cardiac conditions timely and effectively.
During the pandemic there were diagnostic management delays for syncope patients visiting St George’s. This led to growing waiting lists, placing additional pressure on hospital resources and impacting patient outcomes. In 2021, the waiting list for syncope patients awaiting implantations at St George’s reached one year. Specialist arrythmia nurses Carolyn Campbell-Cole and Kerrie Horkan recognised an opportunity to optimise the pathway and alleviate the increasing burden on resources.
Patients were traditionally managed using a clinician-led model for implantation of ICMs. Campbell-Cole and Horkan introduced advanced clinical practitioners (ACPs), who were non-medically trained but initially assessed by medical clinicians, to take over the ICM implantation role. By introducing a new service process that allowed clinicians to relinquish some of their routine responsibilities to non-medical practitioners, it freed up their time to focus on more complex cases.
Campbell-Cole and Horkan worked closely with the admissions team, cardiologists and stroke specialists to set up the new pathway, arranging doctor-guided training for the ACPs. Having ensured rigorous governance, over a few weeks the ACPs were assessed by medical clinicians using a competency document and a practical demonstration before conducting implantations. The ACPs were able to exercise autonomy and were accountable for often complex decisions, assessing varying risks and uncertainty.
Quantitative and qualitative success
Between January 2021 and October 2022, nearly 300 successful procedures were performed by three ACPs, resulting in a reduction in the waiting list from over 52 weeks to two weeks. The patient satisfaction score was approximately 96 per cent and findings showed ACPs performed a safe and excellent service and procedural complication risks were not increased.
With patient experience at the heart of the service, Campbell-Cole and Horkan were determined to ensure patient satisfaction throughout the new pathway. Patients had access to ACPs at all times, guaranteeing a face-to-face appointment with the dedicated practitioner the same day as a phone enquiry, be it related to treatment concerns or implant queries. Patients also reported that fears and anxieties were alleviated due to the implantation taking place in a non-clinical environment. The health professional also had more time to speak through the procedure and share educational materials, such as an online video demonstrating what to expect, which patients found invaluable.
The novel approach not only generated impressive results, but also garnered industry interest and accolade. In 2022, Syncope Trust And Reflex anoxic Seizures (STARS) Healthcare Pioneers Report, showcasing best practice, recognised the St George’s team’s efforts, awarding them a Centre of Excellence accreditation for their progressive work.
Evolution and optimisation of the workforce
Due to the positive results, the team were able to set up an explant service. Looking ahead, the team would be interested in conducting patient surveys to understand any psychological effects around the aesthetic result of the explant procedure, as it involves a suture. Additionally, steps are being taken to further streamline the admission process and communication channels to increase efficiency throughout the service.