Cardiac rehabilitation – a clinical referral pathway to a physical activity programme

The Cardiac Rehabilitation Team at Oxleas NHS Foundation Trust collaborates with Healthwise, a GP referral scheme, to provide support through a multi-disciplinary team at the Waterfront Leisure Centre in Woolwich, to patients that have suffered a cardiac event.

Background

Oxleas NHS Foundation Trust provides a Phase III Cardiac Rehabilitation service for those that have suffered a cardiac event in the last 6 months. Within 5 days of receiving a referral “Phase 2” a specialist cardiac nurse makes contact with the patient to inquire how they are feeling and talk through any concerns they may have.  The nurse discusses with the patient their options and if they wish are invited to attend the pre assessment exercise clinic.

Good Practice

The clinic is based in the community at the Waterfront Leisure Centre, outside of the clinical setting.  A patient meets a specialist cardiac nurse and an exercise specialist at clinic.  The nurse discusses their recent event, carries out an examination, reviews their medications and answers any questions they may have.  The exercise specialist explains the benefits of exercise, intensities at which to exercise and conducts a functional sub-maximal exercise test.

An 8 session exercise programme known as a “Phase 3” exercise class is offered to the patient in clinic.  If the patient accepts our invitation to class they can choose to attend a morning class or afternoon class at the Waterfront Leisure Centre.  The class is staffed with 2 cardiac specialist nurses, 2 cardiac exercise specialists and supported by Healthwise staff.

Healthwise is a GP referral scheme run by ‘Better – GLL’, the operator of the Waterfront Leisure Centre. Healthwise forms part of a multi-disciplinary team providing instructor support (BACPR qualified) within the Phase III elements of Cardiac Rehabilitation. The integrated service provides a smooth transition from community Phase III exercise to Healthwise sessions to enable patients to remain physically active within a safe and effective environment. This partnership approach means the transition from the rehab classes to continuing the patients exercise habits into exercise maintenance known as “Phase 4” is seamless.

The majority of patients that come through the rehab programme at Oxleas have never exercised in their adult life, or at least in the last 20 years.  So stepping into an environment, perhaps alien to them coupled with any anxiety they may have related to their recent cardiac event is a very daunting experience.  However, both Healthwise and the team at Oxleas believe using a clinic room, courtesy of Healthwise in a leisure centre makes for an easier step.

If a patient expresses an interest in continuing to exercise in a gym environment the Community Cardiac Rehabilitation Service completes a referral form to Healthwise detailing the patient’s cardiac history. Healthwise aims to contact the individual within two weeks to arrange an initial appointment.

Healthwise delivers low cost individually tailored physical activity opportunities designed to develop confidence, skills and motivation amongst individuals needing to become and remain physically active. For those coming through cardiac Rehabilitation a circuit class as well as a supervised gym classes are available across the borough. Healthwise offers both support and motivation to individuals referred to the 12-week programme, and places particular focus on behaviour change, education, independence, self-management and long-term adherence.

The collaboration between the Cardiac Rehab Team and Healthwise has shown to be invaluable. The use of the facilities and staff maintain a continuity of care and makes for a safe intervention as the team are able to discuss any concerns Healthwise may have about a patient’s health deteriorating or indeed exceeding our expectations when entering into Phase 4.  Statistically the individuals who come through this rehab programme and continue to exercise thereafter through Healthwise are exceptional.