Blackpool Victoria Hospital
Scenario Blackpool Victoria Hospital is the location of the North West’s leading Cardiac Centre.
Blackpool has one of the UK’s highest rates of cardiovascular disease and associated cardiac events, alongside vast health and social inequalities, placing increased demand on the Cardiac Centre to prevent, manage and treat CVD in its community.
The Cardiac Centre is also the home to a highly committed cardiac rehabilitation (CR) team, who lead outpatient CR sessions (Phase III) in accordance with the BACPR and ACPICR guidelines. The team is led by cardiac specific physiotherapists, with assistance from nurses and occasionally from CR exercise instructors, but they typically feature in Phase IV.
The Phase III CR Programme runs within the Cardiac Centre and due to funding cuts the CR service has reduced from three sessions to two sessions per week (this happened 18 months ago). The sessions are run in a small exercise facility and they are currently unable to conduct any baseline fitness assessment using an exercise tolerance test or CPET. When possible, they perform a 6-minute walk test (6-MWT) or an Intermittent Shuttle Walk Test (ISWT) but this is not consistent and they rarely do post-CR fitness assessments. In light of recent CR research suggesting UK-based CR is ineffective at improving health outcomes and mortality, the team are concerned and lacking confidence that their CR sessions are making a difference.
Since reducing to twice weekly sessions, the CR team have made a number of anecdotal observations that demonstrate the service does not seem to be meeting its intended aims and outcomes. The following observations were shared with the Clinical Commissioning Group:
• Patients don’t appear to be getting fitter and therefore there is a major concern that there will be no/limited improvement to their health and mortality.
• Patients are not as well-informed about making positive steps to improve their lifestyle as would be expected upon completion of the 8-week intervention.
• There have been a number of readmissions following a subsequent cardiac event so this does concern the team that the CR sessions are not reducing risk of recurring events.
• They have increasing patients on the waiting list, which is leading to a delay in the optimal timeframe to start CR and therefore negatively impacting on health outcomes.
The CCG have increased funding so the CR team are now in a situation where they need to find solutions to ensure patients are starting CR in the recommended timeframe and receiving the most effective dose to optimise their health outcomes. Can you re-design their CR intervention to offer more effective CR to the Blackpool community?
The questions for you to consider are:
• Do we keep patients attending twice weekly for an 8-week CR intervention and deal with a growing waiting list?
• Do we reduce the exercise dose to once weekly so we can increase the number of patients entering CR and reduce the waiting list?
• Is there anything we can do to the hospital-based CR to make it more effective?
• Is there anything we could do to offer additional sessions outside of the hospital setting so our patients meet the BACPR recommendations?
• Are there any suggestions for altering the educational aspects to be more effective at encouraging our patients to make and adhere to healthier lifestyle choices?
• How can we determine the effectiveness and success of our CR programme to ensure we can make a difference and optimise the health outcomes of our cardiac patient population?
