M6 Breathlessness rapid evaluation, assessment, treatment and health education (breathe); a novel approach to breathlessness in stockport. (15th November 2017)

• Record Type: Journal Article
• Authors: Gupta, V; McEwan, K; Ansbro, P; Viswesvaraiah, RR; Fern, K; Oxenforth, H; Okolie, N; Thompson, J; Davies, N; Lewis-Jones, K; Poisson, F; Gaduzo, S
• Is Part Of: Thorax. Volume 72(2017)Supplement 3
• Page Start: A239
• Page End: A239
• Publication Date: 2017-11-15
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2017-210983.428
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: As part of a collaborative 100 day rapid testing programme with NHS England and Stockport Together, we aimed to improve the way patients with breathlessness are assessed, diagnosed and treated. Between June 2015 and June 2016 5.2% and 9.1% of cardiology and respiratory patients seen at Stockport NHS Foundation Trust respectively were subsequently referred to the other specialty causing delays in diagnosis and multiple clinic attendances. Breathlessness is a common reason for unscheduled presentation to ED and primary care. Aims: To provide a one stop multidisciplinary clinic to step down 75% patients presenting with breathlessness in 2 visits or less to primary care or appropriate specialist community teams, with clear diagnoses and patient led management plans. Methods: A clinic consisting of a cardiologist, respiratory physician, cardiac and respiratory physiologists and a member of The Prevention Alliance (TPA) was set up initially in the community and then in Stepping Hill Hospital. Primary care referrals on existing outpatient waiting lists were used and a GP referral template was also created. In a single day patients had CXR, ECG, ECHO and spirometry prior to seeing both consultants together. TPA supported the patient to explore and develop their own plan and signposted to appropriate 3rd sector or self-help organisations. Results: Between June 2016 and May 2017 62 patients were seen in the clinic (28/34 male/female; mean age 67.7±1.5). To date, 43.5% patients have been stepped down and a further 19.4% are awaiting investigations and pending step down within 2 visits. The rest require further follow up with respiratory (22.6%), cardiology (9.6%) or both specialties (4.8%). Patient feedback was extremely positive; with a median rating of 1 (range 1–3) in overall helpfulness (1 being most helpful; 5 least helpful) and multiple comments in favour of the multi-speciality clinic. Conclusion: This multi-disciplinary approach to breathlessness has successfully led to a significant number of patients being stepped down from secondary care quickly and efficiently, within 2 visits and with appropriate management plans and education. This model will hopefully prevent these patients being referred to cardiology/respiratory services in the future, reduce attendances to ED and primary care and ensure patient led management.