1. University Hospital of Wales, Acute Coronary Syndrome (ACS)Unit. Innovation and Research-Innovative models of care. Victoria Williams Cardiology Nurse Practitioner Louise Birch Cardiology Nurse Practitioner Michelle Ball Cardiology Nurse Practitioner Sarah Barnett Cardiology Nurse Practitioner

2. Aims of the presentation To outline the expanding role of the nurse practitioner within Cardiology at University Hospital of Wales (UHW) To Describe and illustrate the development of the role through the establishment of a nurse led Acute Coronary Syndrome (ACS) service, demonstrating innovative ways of working to improve patient care.

3. Learning Outcomes To illustrate the role of the advanced practitioner within Cardiology at UHW To understand how the ACS service is run and how successful outcomes have been achieved To consider how the role and the service will evolve and develop in the future.

4. Background of the NP role within Cardiology Established in 2010 In response to European work Time Directive (EWTD) To streamline the patient Journey Improve multi-disciplinary communication Improve patient outcomes and satisfaction

5. Cardiology Co-ordinator established role since 2004 Roles merged 2010 Both practitioners undertaking MSC Advanced Practitioner Pathway Team has expanded to include 2 further Part-time positions ACS service launched in September 2010.

6. University Hospital of Wales Tertiary Cardiology centre Contracted to provide tertiary services to District General Hospitals within south east Wales

7. Aims of ACS service Reduce patient length of stay in both DGH & tertiary centre Reduce waiting times for intervention Meet European and NICE guidelines Improve patient outcomes Improve patient journey

8. Collaborative working Cardiology Nurse Practitioners Central point of contact. Co-ordinating the care pathway from point of referral to discharge. Electronic referral system Telephone triage of ACS/Complex transfers. Advanced Clinical Assessment Skills. Cardiac Catheter Theatre Allocated catheter slots Re-organisation of consultant rota Flexi sessions to back fill for annual leave/study leave Cardiology Ward Protected beds within ward area High turnover of ACS patients Increased workload and expertise. Collaborative approach between nursing staff, NPs & Medics Nurse-led discharge protocols. District General Hospitals Electronic referral within strict criteria Training and education re: ACS protocols Pre-operative workup and investigations Repatriation of patients awaiting follow on services

9. Electronic Referral

10. Advanced clinical skills All members of the team are at different stages of their Msc pathway We all utilise advanced clinical skills as part of the role to enhance the service. Undertaking regular competency based training and assessment

11. Wider components of the NP role within cardiology Co-ordination and organisation of complex patients Organisation of in-patient and outpatient pacing calendar Reviewing A&E admissions with the Cardiology SPR. Assist the junior medical team and nursing staff with ward duties as necessary.

12. Successful outcomes Reduced bed days in DGH and tertiary centre Reduced waiting times for intervention A more streamlined service for patients Improved communication between all members of the team Improved patient satisfaction and less complaints

14. The future of the ACS service Plans to develop a cardiology assessment ward utilising 19 beds within the directorate accommodating all cardiology admissions and transfers Development of an assessment tool and pathway to be utilised in A&E by both NPs and SPR To streamline in house service

15. Future of the NP role Independent prescribing Post intervention clinics Ultimately all Msc trained first point of contact for the assessment acute and sick patients Incorporated into the junior doctor rota.