Photo credit: Ng Teng Fong General Hospital
Pilot-nurse led physician-supervised Heart Failure Self Management Clinic reduced readmissions of heart failure patients at Ng Teng Fong General Hospital (NTFGH).
Heart failure (HF) is characterised by significant mortality, readmissions, and grim prognosis.
In 2018, Singapore saw more than 3,000 admissions for heart failure from reduced ejection fraction (HFrEF) in spite of ready evidence, health innovations and guidelines behind managing this condition.
In response, Ng Teng Fong General Hospital (NTFGH) set up the nurse-led, physician-supervised Heart Failure Self-Management Clinic (HFSMC) aimed at providing a skilled nursing-led guideline-directed medical therapy (GDMT) clinic.
Spearhead by Ms. Toh Lay Cheng, Nurse Clinician, NTFGH, the HFSMC is a programme instrumental in keeping HFrEF patients well and reducing readmissions. Ms. Toh and her colleagues adopt a pro-active role in coordination and application of post-discharge care. Discharged HFrEF patients are reviewed early at the HFSMC, allowing unforeseen issues to be addressed before they snowball into more serious problems.
At the clinic, Ms. Toh also up-titrates HF medications according to guidelines, empowers patients with self care strategies, ensures vaccinations are updated, and manages mild fluid overload cases. When the need arises, she enlists the help from other allied health colleagues to develop a holistic recovery plan for her patients. Since the initiation of the HFSMC, readmission rates during the vulnerable period transiting into outpatient setting have improved. Mean-duration to fully optimised GDMT has shortened and a larger proportion of HFrEF patients are on at least a beta-blocker and an angiotensin-converting enzyme inhibitor (ACE-I)/angiotensin II receptor blocker (ARB).
Through the HFSMC, more patients now understand the importance of adherence to their medical treatment and are able to recognise symptoms of fluid overload. In addition, outpatients can seek professional medical advice through a telephone helpline as well.
By: Dr. Chan Poh Fun