Page 119 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP3.2 Clinical Safety and Quality Service I 14:30 Room 221

The Impact of Transcatheter Aortic Valve Implantation (TAVI) Nurse Coordinator on Patients Management of Monday, 18 May

TAVI Programme in Queen Elizabeth Hospital
Chan MC 1, Lee MKY 1, Lam CB 1, Leung C 1, Chan LK1, Chan KC 1, Chui SF 1, Wong CY 1, Chan KT 1, Chiang CS 1, Fan MY 1,
Leung KW 1, Cheung HL 2, Ng V 2, So E 3, Fok D 3, Chan MK 4, Chan W 4, Yip SF 4, Cheung A 4
1Department of Medicine, 2Department of Cardiothoracic Surgery, 3Department of Anaesthesiology,
4Department of Diagnostic Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong

Introduction

Transcatheter aortic valve implantation (TAVI) has become the standard of care in the management of patient with severe
aortic stenosis and high or prohibitive risk of surgical aortic valve replacement (SAVR). Heart team approach is the
recognised and recommended mode of service for TAVI programme development. TAVI coordinator acts as the primary
contact point for patients and families, clinical triage coordination and communication with clinicians. Cardiac nurse with
clinical assessment skills in cardiovascular care can lead the coordination of the programme and facilitate patient-focused
process of care.

Objectives

(1) To optimise TAVI patients’ outcomes through better collaboration among the multidisciplinary team, and (2) to reduce
length of hospital stay with liaison by TAVI nurse coordinator in Queen Elizabeth Hospital (QEH).

Methodology

From December 2010 to January 2015, 45 patients have undergone TAVI in QEH. All of them were declined for SAVR after
assessment by our cardiac surgeons. Since the start of the programme in 2010, patients waiting for TAVI procedure have to
be admitted three days or even one week before the procedure for pre-operative preparation such as anaesthesia and dental
consultation. In 2013, a designated cardiac nurse was assigned as the TAVI coordinator. She served as the first contact point
for patients and relatives for communication, education, counselling and support. Besides, she has to arrange pre-TAVI work
up such as computed tomography aortogram, coronary angiogram; organise pre-TAVI meeting for patient selection and post
TAVI follow-up and echocardiographic studies.

Results

45 patients (29 males, 16 females) with mean age of 81.56 (4.98) were recruited. The mean Logistic EuroSCORE was
19.94 +/- 11.37 and STS score 6.2 +/- 3.99. This showed that they were all high surgical risk candidates for SAVR. Since the
introduction of TAVI coordinator in 2013, the mean hospital days for pre-TAVI work up was significantly reduced from 2.6 to 0.8
days. With better coordination among different clinical departments, redundant workload was much reduced. The quality of
life of post-TAVI patients using the most extensively validated generic health status tool SF-12 showed profound improvement
in both the mental component and physical component (p<0.05). They perceived that their health status was getting much
better. Similar results were shown in the New York Heart Association (NYHA) functional class, 74% of patients have improved
one class, 21% with two classes and 5% with no change after TAVI.

Conclusion

In Hong Kong, QEH is the first hospital to perform TAVI and adopt TAVI coordinator. This has greatly enhanced the process
of care and clinical triage coordination. This group of elderly patients after TAVI has shown promising results in terms of
improved quality of life and functional capacity. In conclusion, multidisciplinary team approach with the TAVI coordinator as
the central hub is the key factor for success of the TAVI programme.

HOSPITAL AUTHORITY CONVENTION 2015

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