The Trust’s pioneering Cardiac Homecare service bridges the gap between hospital and home. In 2007 this service won the 'excellence or innovation in cardiac intervention or surgery’ award at the Cardiac Nursing Awards.
The small team of highly qualified specialist nurses provides a ‘hospital at home’ service that allows eligible patients who recover well after routine heart surgery, to return home within four days.
Alongside this the team gradually developed the equally innovative ‘Fit for Surgery’ programme, in which homecare nurses keep a watchful eye on patients waiting for cardiac surgery.
Identifying patients' concerns
They visit them regularly at home to screen for problems and support them in managing risk factors, such as weight and blood pressure, which may delay their operation or affect their recovery.
Emma Peters, who helped to set up the service and leads the team says: “From a nursing perspective we get to see a different side of patients when they are at home. It helps us to see them as individuals and it’s much easier to identify their concerns.
“I saw a patient recently, for example, who had a weak leg and was worried about how this would impact on him after his cardiac surgery. I talked to him about how our physiotherapists would help and we had a look at some simple home adaptations.”
Identifying problems early
Whilst research is currently underway to look at the programme’s effectiveness in managing patients’ risk factors prior to surgery, Emma points to other evidence of its benefits: “We pick up potential problems in many patients – abnormal blood results are common – that we can sort out well in advance of their operation date. It means we are preventing operations being postponed and patients having extended stays in hospital.”
Seventy year-old Alan Spruce, who underwent quadruple heart by-pass surgery in September 2003, describes the Homecare service as “gold-star”. Alan had had a heart attack in 1996 followed by a slow deterioration in his angina and was put on the waiting list for surgery in December 2002.
He takes up the story: “Because my operation was not urgent – normally my life was OK and I would only get breathless when I was hill walking or on cold mornings – I was told to expect to wait for about nine months.
'Care and knowledge'
“As I was regularly attending my local cardiac rehab gym and am a keen walker, I was pretty fit so was looked after by the Homecare team.
“In the months before the operation I was visited at home four times by the homecare nurses. They would weigh me, check my blood and blood pressure and generally keep an eye on my condition over that time. It was very impressive – and way above my expectations for the NHS.
“The nurses were thorough, caring and knowledgeable, and of course it was extremely convenient from my point of view in that I didn’t have to travel up to London. In fact, I only went there once before my operation.”
Less travelling for patients
According to plan, Alan had his surgery under Mr Tony DeSouza and was earmarked for early discharge with support from the Homecare team.
“I had my op on the Monday and was up and walking within a day or so. It was agonising at first because of the wound on my leg where they took the veins from, and the physios showed no mercy! But I felt three hundred per cent better the following day, continued to make good progress and was discharged from hospital on the Friday.
“I was really pleased to get back home. I got my appetite back and could do what I wanted. The Homecare nurses came three or four times in the next five days. They kept a close eye on me to make sure there were no side effects and that my wounds were healing properly. It all went very well – I’ve never needed to go back since.”
Alan was seen at his local rehab centre six weeks later for a treadmill test and resumed his regular exercise there shortly afterwards.
“I’m absolutely cured!” he declares. “I spend a lot of time walking in the hills in North Wales and no longer have to stop every hundred metres to catch my breath. I did a twelve mile hill walk yesterday.”
