Rehabilitation the four phase process
the service is delivered at the Royal Sussex County Hospital
process runs from admission to discharge, including the referral process: There
are four phases of Cardiac Rehabilitation:
1: In-Patient phase
2: Immediate post discharge rehabilitation
3: Outpatient rehabilitation
4: Long term maintenance of changed behaviour
Phase 1 (In-Patient phase)
this in-hospital phase, a Cardiac Rehabilitation Nurse sees each patient and an
individual assessment is carried out to assess risk factors and provide an individual
plan for discharge, as per government guidelines. The issues we consider for in-patient
both verbal and written
- Risk factor assessment
- Education of patients and carers
and discharge planning
- Current cardiac condition
- Previous medical history
government guidelines state that every hospital should ensure that more than 85%
of people discharged from hospital with a primary diagnosis of heart attack or
after bypass surgery or angioplasty & stent insertion are offered cardiac
rehabilitation; a recent audit of this milestone at the Royal Sussex County Hospital
showed that the Cardiac Rehabilitation team exceeded this with 95% of eligible
patients being offered the service.
2 (Immediate Post-Discharge rehabilitation)
Phase 2, the goals set in Phase 1 are reviewed and other members of the multi-disciplinary
team (see below) are employed as necessary to achieve them. The Cardiac Rehabilitation
team at this Trust achieves Phase 2 by providing a telephone follow up service.
The Cardiac Rehabilitation nurses refer patients to the physiotherapist for a
exercise capacity assessment prior to commencement of the Phase 3 exercise programme
guidelines set the following targets in relation to Phase 2...
assessment of cardiac risk, including physical, psychological and social needs
for cardiac rehabilitation; and a review of the initial plan for meeting those
- Provision of lifestyle advice and
psychological interventions according to the agreed plan from relevant trained
therapists who have access to support from a cardiologist.
involvement of relevant informal carer(s).
involvement with cardiac support groups
resuscitation training for family members.
Trust meets all of these targets for Phase 2 Cardiac Rehabilitation.
Multi-Disciplinary Team is made-up of the following disciplines:
- Smoking Cessation Nurse Specialist
- Brighton & Sussex Take Heart Group membership (patient
support group) <more info>
3 (Out-Patient Rehabilitation)
a six week course led jointly by the Cardiac Rehabilitation Nurses and the Cardiac
Rehabilitation Physiotherapists. It runs for 2 hours twice a week, so patients
are invited to attend for 12 sessions in total. In respect of patient choice,
there are 3 programmes to choose from, one at the Latilla gym in the hospital
and two at the Moulscoomb Leisure Centre.
phase consists of exercise-based training and educational input from the multi-disciplinary
team. It usually begins within 3-4 weeks post-discharge for Heart Attack patients,
two weeks post-discharge for patients following angioplasty & stent insertion
and six weeks post-discharge for cardiac surgery patients.
to their commencement of the programme, a physiotherapist assesses each patient
in line with standards for the exercise component of Phase 3, and they are graded
according to their functional capacity. Following this assessment the patients
attend an induction session and then start the programme.
to the start of each exercise session, each patient is individually assessed by
a Cardiac Rehabilitation nurse taking in to account any ongoing symptoms, changes
in vital signs and changes to medications. The Cardiac Rehabilitation nurses work
jointly with the physiotherapists to provide supervision during exercise and take
action as necessary if patients report chest pain, breathlessness or any other
Using a high degree of clinical expertise
the rehabilitation nurses refer back to consultant cardiologists, cardiac surgeons
or patients' General Practitioners, depending on symptoms and risk stratification.
This facilitates early intervention which could reduce risk of readmission into
hospital. The Cardiac Rehabilitation nurses use validated tools to assess perceived
exertion during exercise and target heart rate using heart monitors.
multi-disciplinary team is involved throughout Phase 3 with input (1hr. every
six weeks). Other sessions, including anatomy & physiology of the heart, the
importance of exercise and secondary prevention are led by members of the Cardiac
The Phase 3 programme
is an ideal chance for you to maximise your exercise capability, gain confidence
and to attend talks about staying healthy. Our aim is to cater for all ages and
abilities and to give patients the opportunity to meet other people who have been
through a similar experience. The Phase 3 programme is funded by the hospital
as part of your ongoing care.
are quotes from patients who have experienced all three phases of the service
at the Royal Sussex County Hospital (quotes are taken from a patient satisfaction
"It has been a confidence boosting service, offering good
support in both nursing and physiotherapy - can't see ways for improvement"
excellent programme - without exaggeration I can say that I feel a lot fitter
and happier with my condition - even from the first session. I have in fact lost
7lbs from my original weight of 13st. The staff were really top quality in their
attention to everybody (as individuals) always cheerful & friendly. I shall
be signing on at Hove for Phase 4 - thanks to you all".
The cardiac rehabilitation
service also provides a helpline for patients and carers; if we are not available
to take your call leave a message on the answer phone and we will get back to
you during working hours, which are between 09.00 and 17.00, Monday to Fridays. In an emergency please dial 999.
4 (Long-term Maintenance of Changed Behaviour)
completion of Phase 3, patients are referred to Phase 4 programmes. These are
community-based exercise programmes providing long term maintenance of changed
The Cardiac Rehabilitation Team
have been instrumental in providing supervision to applicants undertaking the
Phase 4 B.A.C.R. course and as a consequence we can now offer more choice to our
patients on discharge from Phase 3.
five programmes to choose from, the 'Take Heart Group' which is a patient-run
support group based at Stanley Deason Leisure Centre, which provides long term
maintenance of exercise and group support for patients with cardiac problems.
The other four exercise programmes are based at a gym in Hove and the David Lloyd
Centre in the Brighton Marina. These are all funded at a subsidised rate.
Phase 4 is vital if patients are to gain long term benefits, since habitual
exercise over months and years is likely to contribute to a reduction in the progression
of any underlying coronary disease.
who can use the service
Brighton and Hove City Primary Care Trust patients
admitted to the Royal Sussex County Hospital or the Princess Royal Hospital in
Haywards Heath, following Myocardial Infarction (Heart Attack), Coronary Artery
Bypass Surgery, Valve Surgery, Internal Cardioverter Defibrillator and Angioplasty
& Stent insertion. We also see patients from the District General Hospitals
along the south coast at RSCH. The service is available to all patients over 18yrs.