Ensuring a safety net of care after a heart attack

It takes a village to look after a patient following an acute coronary event and that’s what Nelson Marlborough Health (Nelson Marlborough District Health Board) cardiology services and their extended community team are aiming to achieve.

It all started when project lead and Nelson GP Dr Elizabeth Wood saw the Health Quality & Safety Commission’s Atlas of Healthcare Variation.

'We found that only 62 percent of post-stent patients in our region were taking life-saving triple therapy in the year after their heart attack,' she says. So she decided to rally health services to close this gap, and put together a proposal for the Commission’s Whakakotahi primary care quality improvement challenge.

''Living longer and feeling better following a heart attack' is one of the three successful initiatives supported by the Whakakotahi programme,' says Dr John Wellingham, Chair of the Commission’s Primary Care Expert Advisory Group, 'The Commission provides advisors, support, training and $6000 to offset costs; the project teams provide the local knowledge and expertise, the can-do enthusiasm and the drive to improve care.'

The project team is extensive and includes Nelson Marlborough Health, Nelson Bays Primary Health, three general practices (Mapua Health Centre, Harley Street Medical and Tima Health); Te Piki Oranga (Māori health NGO); the Heart Foundation; a community pharmacist and consumer representatives. The team’s aspirational aim is to help patients achieve 100 percent medication adherence at 3- and 12-months post-stent across the three general practices by December 2017.

Dr Wood says the team is just at the beginning of trying to fully understand where the problems lie. 'Cardiology does an amazing job. However, when it comes to discharge from the service, things can unravel – starting with the transfer of information to the patient, the GP and community care.'

With support from the Commission’s quality improvement advisors, the team has conducted a thorough analysis of the issue – an essential step before making changes. In a process mapping exercise, each professional group talked about their section of care to the wider group to gain a shared understanding of the whole process and most importantly, what the journey is like for the patient.

'We identified a whole raft of factors,' says Fran Mitchell, quality improvement co-ordinator at Nelson Marlborough Health. 'These include that there was no standard process in the year post-discharge, poor integration between professional groups, and IT barriers. An 'ah-ha' moment was when the hospital proudly said it never discharged a cardiac patient without the discharge summary, and the GPs replying that they don’t always see it.'

'From a patient, family/whānau perspective there was often a lack of understanding about how to get back to wellness after a stent, what was needed for self care and making positive choices, as well as a degree of fatalism.'

Using these insights, the team has come up with four key areas to work on; improving the discharge process, establishing a post-stent health pathway, reducing barriers to follow-up, and improving patient education. Putting together a set of measures to gauge success, it is embarking on testing a series of change ideas using plan-do-study-act cycles.

It appears others are noticing the 'Living longer and feeling better' project as well. At a recent community pharmacy regional symposium, the Nelson Marlborough community pharmacist team member spoke to around 40 of her colleagues about the project and how it would involve community pharmacy. This was received with much interest.

'Watch this space!' Dr Wood says. 'Hopefully we will be seeing impacts on provider processes and patient outcomes by Christmas.'

For more information on the Whakakotahi programme or the selection timeline, click here.