Leading Better Value Care

LBVC Portfolio Highlights 13 INITIATIVES | PATIENT REPORTED MEASURES | LBVC DASHBOARD

Chronic Heart Failure

Two Teams

Chronic heart failure is a complex condition with exacerbating features caused by structural or functional abnormalities of the heart. It is a severe, disabling condition with multiple comorbidities which negatively impact on quality of life. The aim is to reduce unwarranted clinical variation and to support patients to self-manage their condition. This is achieved by tailoring education and resources to meet their needs and facilitate optimal care across the continuum and between settings, particularly after discharge and at the end of life.

Cardiologists Team Leads

Clinical Nurse Consultant

Clinical Nurse Specialist

Exercise Physiologist

Dietitian

Administration Assistant

Achievements

Challenges • Funding allocation for a psychologist and clinical pharmacist • Overcoming barriers in the inpatient setting and sourcing pre-discharge referrals to this service

Goals 2023-2025

• Establishment of a Multidisciplinary Team (MDT) Transitional Care Clinic for Chronic Heart Failure patients in Westmead. • Reduction in readmission rates • The commencement of Patient Reported Measures program • Development of the Chronic Heart Failure (CHF) Dashboard • Initiated a trial phase program through equity funding at BMDH

• Permanent funding for the service at BMDH reduced readmission & ED presentation rates • Commencement of a home visit heart failure service and a diuretic service • Expansion of Westmead

service to include a pharmacist & clinical psychologist

Leading Better Value Care 2017 – 2022

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