Introduction: Advanced clinical practice (ACP) is an established structured university programme available to registered non-medical clinicians. ACP training prepares those healthcare professionals to safely manage clinical care within both in- and outpatient setting, and incorporates complex clinical decisions and a high degree of autonomy.
Aim: To assess the service impact, safety and efficiency of a clinical cardiology pharmacist with additional ACP training, providing a sustainable, holistic and independent clinical care to non-predefined cohort of heart rhythm patients within a consultant-led cardiology clinic environment.
Methods: A pharmacist-prescriber in their last year of an ACP training programme within a tertiary cardiac centre autonomously reviewed randomly selected patients, face-to-face or virtually, in a busy outpatient heart rhythm clinic, once weekly over a 12-month period. Clinical examination, diagnostic skills and IRMER training were completed prior to commencing. Data was collected from each clinic capturing number of patients reviewed, time spent per patient and consultation outcomes. Clinical decisions made for every patient were timely discussed with the consultant lead to assess the safety of this service concept.
Results: A total of 217 patients were reviewed – 61 (28.1%) were newly referred, 135 (62.2%) were routine follow-up patients and 21 (9.7%) were booked for their first post-intervention review. Mean number of patients reviewed by ACP per clinic was 5.93 (± 1.46) compared with 7.03 (± 1.26) by a consultant. On average 17.5 (± 2.43) minutes were spent per patient. Outcome data revealed 140 (64.5%) had further diagnostic tests organised, 69 (31.8%) had their medications optimised, 31 (14.3%) were discharged and 13 (5.99%) patients were referred to a different specialist. Patients directly referred for an elective outpatient heart rhythm intervention were 26 (11.98%), of which 18 (8.29%) for an ablation procedure, 7 (3.23%) for direct current cardioversion and 1 (0.46%) for a device implantation. No patients were admitted to hospital directly from clinic. Eleven patients (5.06%) had their plan changed following consultant oversight safety discussion. Over 12 months, ACP total patient discharge rate was 14.3%, compared with 14.7% by consultant. Clinic capacity increased by 28% (p<0.01) from 13.4 to 16.8 patients per clinic slot on average.
Conclusion: Our study demonstrates that a clinical pharmacist prescriber with an additional accredited ACP training in cardiology can apply their skillsets and expertise to make safe and appropriate autonomous clinical decisions and provide efficient and complete patient care extending beyond medicines optimization. An ACP pharmacist involvement in a consultant-led heart rhythm clinic has the potential of improving the use of NHS staff resource and increasing outpatient clinic efficiency and patient access to specialist services without compromising patient safety. ❑
Figure 1: Average clinic capacity impact
