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BACR Standards: A Useful Tool?. Jennifer George / Michelle Bull SWL Cardiac and Stroke Network. Overview. Background . 2. Our work before the standards. 3. How we have used the standards. 4. Some Issues . 5. Conclusion. Networks. - PowerPoint PPT Presentation
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BACR Standards: BACR Standards: A Useful Tool?A Useful Tool?
Jennifer George / Michelle BullJennifer George / Michelle BullSWL Cardiac and Stroke SWL Cardiac and Stroke
NetworkNetwork
OverviewOverview
1. Background
2. Our work before the standards
3. How we have used the standards
4. Some Issues
5. Conclusion
NetworksNetworks
“Should come together to form local networks of cardiac care,
agreeing detailed locally relevant referral criteria and care
pathways”CHD NSF (2000)
NetworksNetworks The purpose of a network is to guide The purpose of a network is to guide
and support the services that comprise and support the services that comprise it and the people that use them.it and the people that use them.
Organisations join networks because Organisations join networks because they can do what they need to more they can do what they need to more effectively effectively togethertogether than if they than if they operate alone.operate alone.
National Stroke Strategy 2007National Stroke Strategy 2007
South West London South West London
Tertiary Centre
• 7 programmes• 1 Tertiary Centre• 4 DGHs• 2 Community Hospitals
• Task group
Work before the Work before the standardsstandards
Baseline AssessmentBaseline AssessmentAimAim: : To create an accurate picture of CR provisionTo create an accurate picture of CR provision To identify any gaps in the current service To identify any gaps in the current service
across SWLacross SWL To use information to determine a work To use information to determine a work
programme for the task group.programme for the task group.
MethodMethod: : All 7 programmes completed the assessment All 7 programmes completed the assessment
which was designed against Chapter 7 of the which was designed against Chapter 7 of the NSF.NSF.
Baseline AssessmentBaseline AssessmentOutcomesOutcomes:: Staffing levels, team make-up and funding were Staffing levels, team make-up and funding were
variable and did not appear to be based on need.variable and did not appear to be based on need. All programmes had a waiting list.All programmes had a waiting list. Current data systems did not allow for assessment Current data systems did not allow for assessment
against NSF goal of 85% of people with diagnosis of against NSF goal of 85% of people with diagnosis of AMI or revasc being offered cardiac rehabilitation.AMI or revasc being offered cardiac rehabilitation.
Next steps: Next steps: An audit to gain an understanding of patient numbers An audit to gain an understanding of patient numbers
and patient movement through each programme.and patient movement through each programme.
Work before the standardsWork before the standards Retrospective AuditRetrospective Audit
AimAim:: Justification of service e.g., referral numbers.Justification of service e.g., referral numbers. Patient flow and movement through programme e.g., Patient flow and movement through programme e.g.,
identify specifics of where they drop out & why.identify specifics of where they drop out & why. BenchmarkingBenchmarking
MethodMethod:: One years worth of dataOne years worth of data Patients with either a diagnosis of MI or after Coronary Patients with either a diagnosis of MI or after Coronary
Artery Bypass Graft, PCI or other intervention (e.g., valve) Artery Bypass Graft, PCI or other intervention (e.g., valve) were included in line with the NSF.were included in line with the NSF.
Hospital admission data was requested from IT departments Hospital admission data was requested from IT departments Data was collected manually by pulling individual patient Data was collected manually by pulling individual patient
files. files.
Assessment & Audit Assessment & Audit OutcomesOutcomes
Each programme provided different services to Each programme provided different services to patients, leading to inequity of provision and patients, leading to inequity of provision and making comparison across the sector difficultmaking comparison across the sector difficult
Agreed there was a need for core elements Agreed there was a need for core elements that a rehab service should include (in line that a rehab service should include (in line with NSF standards and latest evidence)with NSF standards and latest evidence)
Endorsement of the BACR standardsEndorsement of the BACR standards
The StandardsThe Standards1. A Co-ordinator who has overall responsibility for
the CR service2. A CR core team of professionally qualified staff
with appropriate skills and competences to deliver the service
3. A standardised assessment of individual patient needs
4. Referral and access for targeted population5. Registration and submission to the NACR6. A CR budget appropriate to meet the full service
costs
The Core ComponentsThe Core Components Lifestyle
Physical activity and exercise: Diet and weight management: Smoking cessation:
Education Risk factor management Psychological status and quality of life Cardio protective drug therapy and
implantable devices Long-term management strategy
1. A Co-ordinator who has overall responsibility for the CR service
2. A CR core team of professionally qualified staff with appropriate skills and competencies to deliver the service (included in core components section)
3. A standardised assessment of individual patient needs
4. Referral & access for targeted patient population;- Exertional angina - ACS (unstable angina or NSTEMI or STEMI) following
medical/surgical management - Before & after revascularisation - Following any stepwise alteration in CHD condition - Other atherosclerotic disease e.g., peripheral arterial
disease - Stable HF & Cardiomyopathy - Following implantable device interventions
5. Registration and submission to the National Audit for Cardiac Rehabilitation (NACR) database
6. A CR budget appropriate to meet the full service costs
1. Lifestyle
I) Physical activity & exercise: CR should include;
- Risk stratification & baseline assessment of physical activity status & exercise/functional capacity
- Prescription - Staffing levels & state the hours of work;
Specialist Nurse Specialist Physio
Dietician Pharmacist Clinical Psychologist Audit & Clerical
How we used the Standards?
Assessment tool -
FindingsFindings
Prog 1 Prog 2 Prog 3 Prog 4 Prog 5 Prog 6 Prog 7
Standard 1 (co-ordinator)
Standard 2 (team)
Standard 3(assessment)
Standard 4 (pt groups)
Standard 5(NACR)
Standard 6(Budget)
Not meeting the standard Partially meeting the standard
Totally meeting the standard
What we did with results What we did with results Sector wideSector wide
Quality assurance roleQuality assurance role NACRNACR Agreed ideal pathway Agreed ideal pathway Increased profile for cardiac rehabIncreased profile for cardiac rehab
Individual ProgrammesIndividual Programmes Development of new servicesDevelopment of new services Supporting programmes through changeSupporting programmes through change
Standard 4Standard 41 2 3 4 5 6 7
Exertionalangina
ACS
Before &after
revasc
Followingstepwise alteration
Other Atheroscleoticdisease
Stable HF &
Cardio-myopathy
Following Implantablee devices
Programme 2Programme 2
Standard 4 - ICD pilot Standard 4 - ICD pilot
Standard 2 - Business case development Standard 2 - Business case development for heart failurefor heart failure
Clinical Clinical leadlead
Specialist Specialist NurseNurse
PhysioPhysio DieticianDietician PharmacisPharmacistt
Clinical Clinical PsycPsyc
Audit & Audit & ClericalClerical
Programme 2Programme 2
Standard 2 – core team development Standard 2 – core team development Regular physiotherapy inputRegular physiotherapy input
Clinical Clinical leadlead
Specialist Specialist NurseNurse
PhysioPhysio DieticianDietician PharmacisPharmacistt
Clinical Clinical PsycPsyc
Audit & Audit & ClericalClerical
How we used the How we used the standardsstandards
Prog 1 Prog 2 Prog 3 Prog 4 Prog 5 Prog 6 Prog 7
Standard 1 (co-ordinator)
Standard 2 (team)
Standard 3 (assessment)
Standard 4 (pt groups)
Standard 5 (NACR)
Standard 6(Budget)
Not meeting the standard Partially meeting the standard
Totally meeting the standard
Programme 5Programme 5 Standard 5 – web based NACR pilotStandard 5 – web based NACR pilot Standard 4 - PCT secured funding to Standard 4 - PCT secured funding to
develop local community based develop local community based programmeprogramme
Standard 2 - Appropriate staffing Standard 2 - Appropriate staffing levelslevels
Able to advise re appropriate modelAble to advise re appropriate model
How we used the How we used the standardsstandards
Prog 1 Prog 2 Prog 3 Prog 4 Prog 5 Prog 6 Prog 7
Standard 1 (co-ordinator)
Standard 2 (team)
Standard 3 (assessment)
Standard 4 (pt groups)
Standard 5 (NACR)
Standard 6(Budget)
Not meeting the standard Partially meeting the standard
Totally meeting the standard
Programmes 3 and 4Programmes 3 and 4 Local programme resourced by staff Local programme resourced by staff
from PCT and acute trustfrom PCT and acute trust Plans to move phase 3 to community Plans to move phase 3 to community
as part of review of CNS rolesas part of review of CNS roles Conflict between providers and Conflict between providers and
commissionerscommissioners
Programmes 3 and 4Programmes 3 and 4 Core ComponentsCore Components
Process mappingProcess mapping Peer reviewPeer review Links with other servicesLinks with other services Phase 4 mappingPhase 4 mapping
Standard 2 Standard 2 Skills assessmentSkills assessment
Where the standards have Where the standards have caused debatecaused debate
DefinitionsDefinitions ACS ACS Cardio protective drug therapyCardio protective drug therapy
Staffing levelsStaffing levels BudgetBudget CommissioningCommissioning Annual reviewAnnual review
Who will assess thisWho will assess this ““Programme under development”Programme under development”
Are they a useful tool?Are they a useful tool? Yes Yes
Useful driver to support development Useful driver to support development work work
Support for programmes undergoing Support for programmes undergoing changechange
Informing commissioningInforming commissioning
But …….But ……. Need to have strategic commitment Need to have strategic commitment
at local levelat local level
Need higher national profileNeed higher national profile
Need agreement re “enforcement” Need agreement re “enforcement”
