Lightbulb Innovation: Nurse revolutionises service for cardiac patients, saving lives and money.

In our new series called 'Lightbulb Innovations', we highlight the remarkable impact innovative nurses are having on the patient experience and public health. By thinking creatively and working differently, many are improving care and reducing costs to the tax payer.

Six years ago, nurse consultant Mike Paynter set out to transform the way cardiac problems are diagnosed and treated in the community where he works. He piloted the use of a telemedicine service whereby clinicians get fast, expert interpretation of electrocardiogram (ECG) results, enabling them to provide timely preventative care as well as avoiding unnecessary and expensive trips to hospital.

Data from the pilot showed that an astonishing 82 per cent of patients receiving ECGs didn’t need to be referred on and within less than 10 minutes could be reassured about the seriousness of their symptoms and what needed to happen next. Now, since its humble beginnings at Bridgwater Community Hospital, the system has been rolled out across all 13 nurse-led minor injury units in Somerset.

“Previously, all patients with chest pain or known cardiac conditions were referred automatically to the neighbouring acute NHS trusts for assessment, diagnosis and management,” says Mike. “This was time consuming, stressful for the patient and placed a significant workload on secondary care and the ambulance service. Cardiac telemedicine has brought the expertise of leading cardiologists right into the immediacy and convenience of the community setting, meaning that patients receive early preventative care in their local environment.”

Mike believes that the efficient delivery of the service is dependent on an appropriately trained workforce but the very fact that it is in place can help develop and maintain nurses’ skills.

“Practitioners must be fully supported and have enough seniority and experience to make decisions based on the diagnosis. But the introduction of telehealth has brought real and tangible benefits to staff development, helping to refresh skills potentially lost by senior nurse practitioners who have transferred from emergency medicine in the acute sector to primary care. For junior staff it is a fantastic learning opportunity, giving them a greater understanding of cardiac monitoring and how to interpret results.”

Over the years the service has, time and again, proven effective in saving lives. Mike recalls one incident whereby a patient attended a minor injury unit having fallen and sustained a wrist and forearm fracture. The staff nurse identified a slow heart rate and performed an ECG, which showed a profound bradycardia with heart block, probably the cause of the fall.

The team confirmed the ECG as a complete heart block and the patient was transferred to the coronary care unit for pacing. “Without the astute observation of the nurse and the reporting service, the symptoms could have been overlooked with potentially devastating consequences,” Mike says.

More generally, it has meant that conditions have been identified earlier and care has been delivered that prevents and mitigates against more serious, often more costly, complications. Put simply, the innovation has saved money, as well as lives.

Now, six years on, the range of cardiac problems dealt with in the community has been expanded, treatment is provided closer to home and clinical decision making has been strengthened.

“The trust acknowledges that this is a safe, effective and more efficient way of working,” concludes Mike. “What started off as a small pilot has become something that influences care delivery across the county.”