A new heart failure unit at Beaumont Hospital is showing good results in patient treatment but they would like more staff, writes RONAN MCGREEVY.
AT A time when health budgets are under severe strain, the Beaumont Hospital heart failure unit has been a model of good patient practice and value for money.
Set up in 2006 by cardiac consultant Dr Brendan McAdam, the unit has had a proven record in looking after patients with heart failure, a constellation of ailments which affect an estimated 80,000 people in Ireland.
Heart failure is a serious drain on health resources as patients often have to spend a long time in hospital receiving intensive treatment.
The unit won an HSE award last year for the northeast region for best innovation in a new service for a hospital.
It was based in a day care ward, but a dedicated space has now been found for it and the new unit will be officially opened on Thursday by the Minister of State with special responsibility for Older People and Health Promotion Áine Brady.
It is located on the ground floor of the hospital and has two beds, couched chairs for administering drugs intravenously, two trolley stretchers equipped with blood pressure and heart rate monitoring equipment and a television with DVD for educational and entertainment purposes.
The unit is being funded by the hospital and from private sources including pharmaceutical companies.
It is based on a very successful model which has been running for 10 years at St Vincent’s Hospital, Dublin, and is already well established in the US, the UK and elsewhere.
Patients with heart conditions such as hypertension, cardiomyopathy (a disease of the heart muscles), and those who have suffered damage to their heart from previous heart attacks are all treated in the unit.
It operates on the principle that such complicated conditions can be managed much more successfully in a dedicated unit where the patient is looked after in a holistic fashion which means careful monitoring of drug treatments, diet and exercise.
It seeks to address the problems of heart failure early to lessen the progression of the disease.
An audit of the service was carried out last year and the results were quite remarkable. Prior to its development, the average rate of re-admission for heart failure to Beaumont Hospital was 28 per cent with average lengths of stay of 14-21 days.
In the unit, the average length of stay for patients admitted is seven to eight days. The level of re-admission has also dropped dramatically to 12 per cent.
Patients receive a plan of care on the first day of admission including an estimate of the expected day of discharge.
The level of mortality for the most seriously ill patients has dropped from 30-40 per cent to just 6 per cent a year.
Michael Vinall (77), from Griffith Avenue in Dublin, who attends the unit at least every fortnight, says he cannot speak highly enough of the service.
He had a triple bypass 14 years ago and has a pacemaker, but is now able to go to the gym three times a week, take long walks and go swimming.
“I feel healthy in myself. I do things I didn’t usually do. They put a lot of emphasis on exercise. I would not be as fit as I am now, but for the hospital,” he says.
“I owe a great debt of gratitude because, thanks to them, my quality of life is terrific.”
In total, the unit, which has treated hundreds of patients, is estimated to save Beaumont Hospital €1.4 million a year through decreased stays and re-admissions.
It is also carrying out a number of clinical trials of new drugs for heart failure patients.
Yet, it has only two staff members – Dr McAdam and heart specialist nurse Clare Lewis.
McAdam says he was inspired to set up the clinic by his experience working as a doctor in America and by the success of the unit in St Vincent’s Hospital run by consultant cardiologist Dr Ken McDonald.
“This is not something we discovered ourselves. Ken McDonald has shown that this is very effective. Internationally, it has been shown that this mode of presenting an organised format of care has been extremely effective. It is something that we are mirroring nationally.
“I saw that proper heart failure management allows patients to be seen frequently in an outpatient unit. It gets them seen in 24 hours, keeps them well and keeps them out of hospital.
“Traditionally you go into hospital, spend two days in casualty, then 15-20 days in hospital and you go home. But, because of a lack of expertise, 30-40 per cent of patients are re-admitted within three months.”
Initially, McAdam funded the nurse’s salary from private sources until the hospital itself could see the benefits of the unit and took her on staff.
“The unit took blood, sweat and tears on my own part and it took me nearly four years to get it,” he says.
He explains that, despite the success of the unit, they have been unable to recruit another specialist nurse and part-time secretary as a result of the embargo on health recruitment.
“When a patient calls, my nurse practitioner has to be there to answer otherwise there is nobody on the end of the line which is very frustrating. We could do so much more with just a few extra staff.”
McAdam says such units should be in every centre of excellence in the country and were flagged up in the Government’s cardiovascular strategy a decade ago as the best way of treatment.
Progress, he believes, has been too slow though the Mater Hospital, Tallaght hospital and University College Hospitals in Cork and Galway have fledging services.
McAdam says the HSE should be true to its own strategy of trying to keep patients away from acute hospitals where alternative treatment procedures are available.
“Mary Harney [Minister for Health] was out at St Vincent’s celebrating its 10th anniversary and she said it was a pretty good idea and is consistent and resonates with the HSE’s plans to provide ambulant care and keep patients out of hospital,” he says.
“Yet, I’ve been writing to her personally, Brendan Drumm and some of the middle management in the HSE looking for funding. The award we won is for me and my nurse practitioner for a service that we broke our neck to provide without support. It is a fantastic thing, but we need a few extra bodies to keep the show on the road.”