LAUSR

We set up our ambulatory care unit and heart failure (HF) lounge to improve management of heart failure (HF) patients;reduce A&E attendances and hospital admissions;optimise medicine administration;facilitate discharge from our wards and promote an holistic approach. We kept the lounge running as a 'green' zone through the Covid pandemic in 2020. Methods The programme used a combination of quality improvement and Lean methodology working with staff and patients to create new pathways The service processes were reviewed and referral pathways aligned to support community to specialist referral and redesign of service was completed. The team monitored quality outcomes such as patients access to specialist review, medication review and patient experience of the service, also identifying patterns of attendance and admission pre and post attendance to the lounge. Results The evaluation of the programme, centred on the experience of staff and patients, has shown improved information sharing between primary and secondary care staff;the patients described the care as efficient, enabling them to remain in their own home, with effective continuity of care. In 2020, despite the pandemic, the ACU was kept as a 'green' zone and 521 patients attended;- 87% of patients referred from community services did not have to attend A&E;- 100% of patients received a Specialist Review;- 100% of patients received a full medication review and optimisation;- there was a reduction in A&E attendance following attendance to the lounge of 90%. - There was a reduction in bed days of 310, with a cost reduction of £231,649. Conclusion The ACU Heart lounge has proven that the day case concept can be extremely useful in managing complex chronic disease like heart failure, benefiting patients and service providers, even in circumstances of the continuing Covid19 pandemic.