The Cardiac Assessment Nursing team at Royal Stoke University Hospital provides 24-hour cardiac support to the hospital's A&E department, providing a cardiology opinion to around 500 patients a month, the majority of which are seen within 30 minutes of referral, and facilitates the management of a further 400 referrals a month from ambulance crews, wards  and other hospitals.

This team of experienced and specially trained, advanced cardiac practitioners deliver a prompt decision-making service to patients presenting to either the emergency portals or to outpatients clinics with a wide array of cardiac symptoms. In the past, patients attending A&E with suspected cardiac problems used to remain in hospital waiting to be seen by a specialist, via admission to the medical assessment unit or referred to a rapid access clinic if further investigation was required.

At Royal Stoke, patients presenting with a cardiac problem are referred to the team, who undertake a thorough clinical assessment and formulate a management plan including diagnosis, initiation of appropriate treatment and/or arrange further cardiac investigations either as an outpatient or through direct admission to the cardiology bed base. The 24 hour / 7 day a week service allows prompt access to a specialist cardiology opinion, reducing patient admissions and reducing outpatient waiting lists. It is estimated this saves the equivalent of six bed days every day for the Trust.

As well as undertaking vital rapid assessment and management decisions about acutely ill patients, the team of ten nurses can talk to patients who aren't admitted about their symptoms, offer reassurance, discuss lifestyle advice where necessary, refer patients for outpatient tests, arrange follow up and inform their GP of the plan directly via letter.

Team lead Dot Morgan-Smith said: "Our senior cardiac nurses have an average of 15 years' experience. To prepare for this role we also trained for a minimum of three years, including general health assessments, independent prescribing, and studying for a postgraduate diploma/MSc in cardiology."

As well as being on-hand to assess in Royal Stoke's busy A&E department, the team also run the rapid access chest pain service, and several arrhythmia and general cardiology clinics providing prompt outpatient assessment and investigation, to diagnose and manage a range of Cardiological presentations. The team also provide a Monday to Friday Advanced Cardiac Practitioner service to the cardiology wards, supporting the junior medical staff to facilitate inpatient diagnostics and making autonomous decisions on patient discharge to facilitate patient flow across the bed base. The on call 'twilight shift' across the 68 beds after 1600 is supported by a junior doctor and a practitioner.

The Cardiac Assessment Nursing team won the British Heart Foundation Alliance Team of the Year in 2017 and also scooped the British Medical Journal Cardiology Team of the Year in the same year.

Echocardiograhpy is ultrasound examination of the heart. It is a non-invasive test. The echocardiography department is one of the busiest within cardiology. The majority of the work is carried out by skilled cardiac technicians, all with British Society of Echocardiography accreditation.  Additional support from cardiology specialist registrars is also given.   

In addition to transthoracic echo we perform transoesophageal studies, dobutamine stress echo and 3D echo reconstruction within the unit. The facilities are predominantly based within the main department, but facilities are also available at the central outpatient department.

This is an active and expanding programme which takes place in partnership with the Trust's Imaging Directorate. The MRI scanner is located in the main radiology department.

The Directorate has successfully introduced exercise testing, and a number of medically supervised tests are being performed. Exercise testing facilities are based both in the cardiology department and the out-patient department.

Ambulatory electrocardiography (out-patient monitoring of heart rhythmn) is run from the main cardiology department. 24 hour and 48 hour continuous holter monitoring as well as Recollect ECG loop recording systems are utilised. Access for patients is via the main reception.

There is a comprehensive cardiac rehabilitation programme run by a Rehabilitation Co-ordinator. Rehabilitation invovles supervised exercise in a fully equipped gymnasium by an exercise physiologist.  There is also a series of counselling and education sessions.

The service provides a comprehensive support and follow up programme for patients recovering from a heart attack, as well as for post-surgical patients.

We provide a nurse led out-patient based heart failure service, to provide support and close follow up. This service has robust consultant support and works in close collaboration with primary care colleagues. There is a weekly rapid access heart failure clinic for GP referrals and an established multidisciplinary heart failure team. 

We run seven RACP clinics per week.  These are staffed by skilled chest pain nurse specialists, specialist registrars and foundation doctors, as well as being supported by the on-call consultant of the week.

The clinics are open to GP referrals in order to assess stable patients reporting chest pain.  Patients are seen within two weeks of the referral. Those who attend undergo both a clinical assessment as well as a treadmill exercise test (where able). ​

Patients taking part will be given access to an online account with Recap Health to enable them to access educational information designed and approved specifically for the individual.

Videos, leaflets and webpages will be available for patients to download with the option to be able to send feedback about the content or request additional information.

Patients will also be set up on 'Florence' which is an interactive text phone service and is checked weekly. One of our team will contact a patient if they respond to the text message that they are not feeling as well as they were.

There are a number of organisations who provide support in the community and can help people with any problems that patients may be experiencing as a result of heart failure.  These include anxiety, depression, housing and finances.  A referral can be made if necessary, to a digital tool called 'I Navigator' for patients to find additional support in these areas.

In order to take part, patients will need:

• A mobile phone that can send and receive text messages.

• An e mail address.

• To be able to read and text in English (or have a carer who will do this on your behalf).

• To live in the North Staffordshire area.

Those wishing to take part will in the pilot will be put in contact with a Telehealth Co-ordinator who will explain in more detail what is involved including how to set up 'Florence' and the Recap Health Digital Library.  You will also be given the opportunity to ask questions.

Patients will be required to be part of the project for a maximum of three months, however, you can stop being part of the project at any stage you may wish.

Your care will not be affected in anyway by not taking part in the project.

Smart With Your Heart: Listening to the messages from Heart Failure Patients: Patient Information 

(Please speak to a member of staff if you need this information in large print, braille, audio or another language)

Background

Approximately 7 out of 10 people leaving hospital with heart failure are re-admitted within 12 months. Sometimes this is because of a gradual deterioration in health and being unsure of what action to take. It may also be due to a lack of knowledge concerning options available for help or support.

Smart With Your Heart Project
How can this help?

The project aims to:

• Help you understand and manage your heart failure with confidence.
• Monitor how you are feeling.

What will I need in order to take part?

• A mobile phone that can send and receive text messages.
• An email address
• The ability to read and text in English (or have a carer who will do this for you).
• Be resident in North Staffordshire
• How long does the Project last?

You will be included in the project for a maximum of 3 months. You can terminate your involvement at any time during this 3 month period.

If I agree to take part what will happen?

A Telehealth Co-ordinator will visit you (and your carer if you wish) to explain exactly what is involved.
During the visit you will be given the opportunity to ask questions.
As part of the project you will also receive information on the Patient Responsibilities and Data Sharing Agreement.

How does the Project work?

An online account with Recap Health will be set up for you. This will enable access to educational information approved by your doctor and designed
specifically for you.

Videos, leaflets and webpages about your condition will be available for you to download. You will also be able to send us feedback and request additional
information.

You will be set up to use the ‘Florence’ interactive mobile phone text service which is checked weekly. It is not an emergency service.

What if I do not wish to take part?

If you do not wish to be part of the project then this will not affect your usual heart failure care in any way.

How is support provided?

In order to understand how you are feeling, you will receive automated messages from the Florence text service. The answers you provide to these
messages will enable us to see where your symptoms place you on the symptom checker used to check your condition.

If your condition deteriorates one of our team will contact you to provide assistance.

Additional support in the community

There are a number of organisations which provide support in the community and can help you with any problems that you may experience as a result of heart failure. This includes issues such as anxiety, depression, or problems with housing or finances. If necessary a referral can be made for you through a digital tool called ‘I Navigator’.

What happens if I need additional help?

If you need any additional information or help with the Smart With Your Heart Project please contact the medical team who will get in touch with the
Telehealth Co-ordinator.

Patient Agreement

This agreement covers your requirements and responsibilities in order to be involved in the Project. It includes your acceptance to the use of the Florence
Telehealth service through your mobile phone and to the use of the Recap Health Library through your email. The Agreement also explains how data collected from you will be stored, used and shared in accordance with the General Data Protection Regulations (GDPR). TO TAKE PART IN THE PROJECT YOU MUST PROVIDE CONSENT BY SIGNING THIS AGREEMENT

Thank you for taking the time to read about our project which will help to improve the support we provide for you and other heart failure patients. It
will also help us understand what is required from medical teams for future patients.

Patient Responsibilities and Data Sharing Agreement:

Data Collection and Data Sharing

Data collected as part of the Smart with Your Heart project will be processed fairly and lawfully. It will be used to monitor the patient’s condition as part of the project and to improve the future services offered to heart failure patients.

Data collection is a requirement of the project and NHS England will oversee this.

The General Data Protection Regulation (GDPR) requires that consent must be given to be able to collect personal data that could be stored on a computer.

In addition:
 You have the right to control how we use your information and this information can be found on the Trust website.
 Your data will be stored safely and securely in digital systems used daily by the NHS and other organisations and, when centralised from many different sources, your NHS number will be used to ensure that your data is identified separately from data collected from other patients.
 Data which is sent to us will be secure and will not reveal your name or personal details. No one outside of the NHS will be able to identify your name, address, date of birth or other personal details from your NHS number alone.
 All data collected as part of the Smart With Your Heart project will be destroyed at the end of the project.

I agree to and accept the Patient Responsibilities described in this agreement and give consent for my data to be collected stored and shared in accordance with the GDPR regulations and additional terms described in this agreement.

Privacy Notice - How we use your information – NHS Test Beds Project 'Smart With Your Heart - Listening to Patients with Heart Failure'

The law determines how organisations can use personal information. The key laws are: the General Data Protection Regulation (GDPR) the Health and Social Care Act 2016, and the Human Rights Act 1998 (HRA), relevant health service legislation and the common law duty of confidentiality.

On the University Hospitals of North Midlands (UHNM) Trust (the Trust) Privacy Notice explains how the Trust manages your data to comply with the Data Protection Act 2018 and the General Data Protection Regulations (GDPR).

The Trust recognises the importance of protecting personal and confidential information in all that we do and all we direct or commission, and takes care to meet its legal duties and takes its obligations around data protection, confidentiality and information security seriously.  As part of those obligations and to ensure that we meet our obligations under the Data Protection legislation, we are required to be open and transparent with regard to how we process your information. 

This transparency is referred to as a 'Privacy Notice' (also known as a Fair Processing Notice) and the following information relates specifically to the data we collect and process as part of the 'Smart with your Heart – Listening to the Patients with Heart Failure' project.

How to access your information

The Data Protection Act 2018 and the General Data Protection Regulation (GDPR) 2018 gives you the right to see the information that UHNM holds about you, how and why we process your data, and who we will share your data with. 

Smart with Your Heart – Listening to Patients with Heart Failure

This notice is a statement that describes how UHNM collects, uses, retains and discloses your personal information in relation to the Smart with Your Heart project.

To ensure that we process your personal data fairly and lawfully we are required to inform you:

• Why we need your data

• How it will be used and processed

• Who it will be shared with

The Trust is also required to explain to you what rights you have to control how we use your information. 

Read the Trust's Privacy Notice by clicking here

The 'Smart with Your Heart – Listening to the messages from Patients with Heart Failure' initiative is a service evaluation project aiming to assess the impact of early detection of pre-hospital deteriorating health, in patients previously admitted with heart failure.

To access the service, which is delivered digitally either via a text-based service or web-based system, you will need to provide a mobile phone number for use by our digital partners which will allow you to access the service and by so doing, will allow us to evaluate this service and by signing a copy of the Terms & Conditions contained in the pack provided to you by your Heart Failure Nurse.  A copy of the Terms & Conditions is contained at the end of this notice.

We will need to collect, on a voluntary basis, basic demographic information (Name, Address DOB) for the project itself and then later on, we will need to collect additional information about your health so that we can evaluate the project and its outcomes.  This evaluation will be done by the Trust Research & Development team working alongside two external evaluators.  The complete list of information categories that we will be collecting throughout the project are listed below:

• Name
• DOB
• Age
• Gender
• Address (inc. Postcode)
• Phone Number/Mobile Number
• E-mail
• NHS Number
• GP details
• Racial or Ethnic origin
• Health information (physical and mental)
• Any Hospital admissions data (date of admission, length of stay etc.)

This information will be shared with our partners in this project:

Simple Healthcare (FLO Telehealth) 

Health2Works (for Recap Health Library)

Signum Health (for iNavigator)          

These organisations are providing the Trust with digital technology to allow patients to upload their data for monitoring and service evaluation; to enable patients to receive information leaflets and to facilitate onward referral to other clinicians or service providers, if appropriate.  The Trust will be auditing the feedback from patients for the purposes of improving patient outcomes in the area of Heart Failure.

The Trust has taken steps to assure itself that our digital partners meet the legislated requirements in terms of Cyber Security.

To allow us to collate, process and evaluate your information, we are relying on the following, to provide the legal basis:

GDPR Article 6(1)(e) -Public Interest for the demographic information, and

GDPR Article 9(2)(h) – Provision of health or social care for the medical information

The Terms and Conditions that have been produced by our 3 digital partners can be found here – these will need to be reviewed and signed by patients before embarking on the project.

If you have any comments relating to this initiative and the data sharing required, please contact the Data Protection Officer in the first instance (DPO.UHNM@uhnm.nhs.uk).

If you wish to make a complaint about this project or about how the Trust processes your information, you should contact the Complaints Department (complaints.department@nhs.net) in the first instance.

Link to Ts & Cs

Final Evaluation Report

Final Evaluation Summary