Cardiac Nurse Case Management HBDHB

1. Cardiac Nurse Case Management HBDHB Maureen Bent 19.10.05

2. Practice setting Heath Care Services is the major public health provider in the region comprising � Hawke�s Bay Hospital on the Heretaunga Health Village site in Hastings (400 bed capacity) Rural health centres in Wairoa and Central Hawke�s Bay, a city health centre in Napier and health services at the Chatham Islands

3. Case Coordination in Hawkes Bay DHB Presently 9 Case Co-ordinators Respiratory/ Cardiac/ Wound/ Urology/ General Surgery/ Orthopaedics/Older persons x 2/ Paediatrics � respiratory/ ACC All these roles have similarities but are designed to meet the needs of the patient group

4. Generic referral criteria for all case coordinators Patient having difficulty coming to terms with their new condition Chronic illness with deteriorating symptoms (ongoing planning and management required) Patients with multiple variances on clinical pathway delaying discharge Patients with illness causing social isolation � not coping either physically or emotionally, family dynamics impaired, requiring multiple services and planning Potential for or actual readmissions with same diagnosis

5. Background Cardiac CC Personal � RN with extensive Cardiac experience 15 years Ch/N ICU and CCUs Post Grad Certs ICU/ CCU BN ECHO Cardio graphic training USA & Australia Post Grad Cert Case Management � Melbourne University Post grad Dip Resuscitation � Otago University Completing Masters Nursing - EIT

6. History of the Role Commenced Oct 2000. This position was new to the organisation Cardiac highest admitting diagnosis with several readmissions Limited resources prior to 2000 (<4hours rehab per week) Plan of action � setting up cardiac rehab service Referral system / Pathways Dissemination of information / communication across both primary and secondary care

7. Philosophy of Cardiac Case Management

8. Goal of Cardiac Case Management To ensure that the individual patient receives the services and resources that he or she needs when they are needed

9. Aims Working with and for the patient; Enhancing patients� access to services; Actively involve and empower the patients; Co-ordinate services for consumers by spanning organisational boundaries.

10. Four Guiding principles of CM Empowerment of the patient; Consumer focus; Continuity of service; Single point accountability;

11. Case Coordination is about people: people as clients, case coordination means developing and working through relationships with these people at a personal level. CC do not work with these people in the abstract, but rather face to face. This substantially demands different skills because of the interpersonal skills and tasks required. This complexity helps explain why the nature of case management is so hard to communicate, and can be difficult to grasp at financial level

13. Cardiac Case Co-ordinator specific � Target group Worsening symptoms of LVF Complicated MI Unstable angina medically managed Arrhythmias � complex ICD s or people undergoing CRT Three or more admissions in the last 6 months

14. C C works across the continuum of care (�breadth of role�) Based on advanced clinical expertise (�depth of role�) Requires rapid decision making and autonomy of practice Has a broad picture (organisational) focus across funding streams and management boundaries Promoting inter-organisational relations and networks CC supports and enhances strategic links and direction Recognises and is part of clinical practice structure for nurses Advances nursing practice

15. Strengths Patient satisfaction Advocacy Decrease in readmissions Pivotal person for ensuring care is followed up in a timely and appropriate way Advanced clinical knowledge required allows for credibility across settings and boundaries Passionate about cardiac nursing Rewarding empowering patients to monitor and maintain their own health Challenging breaking down boundaries

16. Weaknesses Volume of clients Infra structure in the community not always available in a timely fashion Some other disciplines find the role threatening Frustrating having to justify the benefits over and over again Who owns the patient !!

17. Key Points

19. Beautiful Hawkes Bay