Innovator

Shirley is an Advanced Nurse Practitioner (ANP) and her speciality is the assessment and diagnosis of chest pain.

Main Innovation

Shirley set up the Hospital’s first ANP-led Community Chest Pain Clinic in 2011. She wanted to set up the service because she believed that if patients could be identified and treated earlier, many would not need to be admitted to the Hospital.

It turns out that is just what happened—within a year of Shirley’s ANP-led service being up and running, admissions to the wards had reduced by a massive 60%. As well as this being much better for patients and their health, it also reduced the pressure on beds for the Hospital, and there was also significant cost savings. This decision to appoint a second ANP in 2017 has supported the growth of the service,   and this nurse-led clinic is now embedded in the fabric of emergency care in TUH.

Before Shirley set up her service, chest pain was a principal presenting symptom of coronary heart disease and a significant caseload for the Hospital’s Emergency Department (ED) with over 5,000 presentations annually. In fact, in 2009, 48% of all chest pain presentations to our ED were admitted.

The Motivation

Shirley says, “In my ANP role in ED, I noted that a lot of patients were sent to ED after a GP visit. I was driven to find an ED avoidance pathway for these patients, as they often waited hours to be seen. I carried out an audit which showed that approximately one-third of all patients who present to ED with non-acute chest pain, did so after seeing their GP. As 78% of these GP referrals were low risk, this led to prolonged patient experience time, including some patients who did not wait to be seen.  Less than one per cent of GP chest pain referrals were having a heart attack. The ED was not the appropriate place for the majority of these patients. Patients would often tell me that their GP had sent them to the ED. Observing the patient journey and listening to the patient’s voice drove me to create a business case for a ‘Community Chest Pain Clinic’ as an alternative to ED for non-acute chest pain patients.”

Biggest Learning

This inspiring TUH Innovator says, “My biggest learning is to never give up! You will meet many barriers and it is important to be resilient and maintain your patient focus, as that is why we innovate. Successful projects are not always obvious at the start, continue to analyse the data, record what you are doing and publicise it!”

Advice

Shirley says, “In my experience the key to successful innovation is to look at the problem, then spend time reflecting on what will improve it, taking time to think and plan is vital. Next, gather the data and see where you can influence that. Always have a business case in your back pocket as you never know when funding will become available. We had two weeks’ notice for the Sláintecare application for the Community Chest Pain Clinic! And ask for help, the TUH Innovate Health team are there to support you.”

What’s next?

Shirley is currently auditing the results of her ANP-led telephone clinic which provides ANP-referred CT Coronary Angiogram tests for patients, thereby reducing general Outpatient attendances. She says “In the community setting I would like to expand the ANP service to accept a cohort of patients usually referred by GPs for stress testing. This has the potential to avoid unnecessary use of diagnostics and reduce waiting lists in the acute setting.”

Shirley believes strongly that ANPs can offer clinical expertise and strategic planning to shape new pathways to improve the care we can deliver to our patients.