First interconsultation between hospital and primary care nurses launched, improving care for pacemaker patients

- Facilities

It is a pioneering circuit in the public health service in Catalonia Patient-experience based, it is part of the Ritmocore innovation project.

The family and community nurses from Delta del Llobregat Primary Care Service (SAP) improve patient care with direct consultation with nurses from the Cardiology Service of Bellvitge Hospital Improved nurse-to-nurse communication saves unnecessary trips to the hospital.

A pilot test has begun on the first interconsultation circuit between Primary Care’s family- and community-nurses and hospital nurses. This interconsultation is taking place within the Ritmocore framework (, a public procurement project for innovative health solutions in which Primary Care at ICS’s Southern Metropolitan Area and Bellvitge University Hospital (HUB) are participating. The aim of Ritmocore is to transform both the care and attention management of patients with bradycardia and arrhythmias.

For the first time in the Catalan public health service, a nurse-to-nurse consultation circuit has been established. Specifically, family and community nurses from Primary Care Centres can consult with nurses specialised in arrhythmias from the Bellvitge Hospital Cardiology Service for patient accompaniment and follow-up.

Traditionally, interconsultation has been understood as a communication process established between two medical professionals from different areas of expertise, in which the requesting person asks the referring physician for an opinion on the patient's pathology. This new circuit favours comprehensive and integrated care for patients with pacemakers, encouraging the resolution of doubts quickly and efficiently in any of the care services where the patient is located.

The need for this single circuit has been identified during the innovation process of Ritmocore, one of the main public procurement projects for innovative healthcare solutions currently underway in the EU. The project, which receives funding from the Horizon 2020 programme, is participated by the following health centres: HUB, Hospital de la Santa Creu i Sant Pau, Hospital Universitari Mútua Terrassa and Liverpool Heart & Chest Hospital NHS Foundation Trust, UK). In addition to the remote monitoring of implanted pacemakers and of vital signs with the help of sensors, devices and mobile applications, Ritmocore aims to improve decision-making and care integration through the exchange of information. By placing the user at the centre of attention and accompanying them through the process, the inter-consultation circuit responds faithfully to this objective.

A first step towards giving nurses greater autonomy

According to Jenifer Ballesteros, nurse at the Sant Josep Primary Care Team, currently located at the CAP Just Oliveras in Hospitalet, the new interconsultation circuit will bring many advantages for both nurses and patients: "The way to solve problems will be much faster, without having to go to specialised care, in a space-time of less than 24 hours". Núria Romero, a regional clinical nurse who has participated in the design of the Cures Plan, adds, "It is a real step forward and, in addition to cardiology, we hope to implement nurse-nurse consultation in other specialties". The primary care nurse will be able to make the consultation asynchronously, attaching relevant information and even photographs using the eCAP platform. If the consultation is made before 13:00 hours, the HUB nurse will respond the same day, otherwise the next day.

"We attend patients from a very wide area, many of whom had to come to the hospital for their wound check-up, which often involves travelling a long distance and the help of family members. There is nursing care that should be emphasised in the primary care centre with its reference nurse," says Elena Calvo, nurse manager of arrhythmias and cardiac haemodynamics from the Heart Diseases Area at the HUB’s Cardiology Service. "The Primary Care team knows the patient and, therefore, the nurse can adapt care to their lifestyle, family support and their needs, and can monitor them over time," Calvo points out. In cases where the patient requires it, they will continue to come to the hospital to review the care that is being given.

"A new direct communication channel between the hospital and Primary Care has been set up in order to respond to those complex and difficult cases in which a care continuum is relevant and necessary. To this end, a generic e-mail address has been set up by the ICS South Metropolitan Primary Care Wound Consultants Group, where these cases will be received first-hand and forwarded to the corresponding teams for follow-up," says Montse Villanueva, nurse and consultant in Chronic Wounds. "We hope that two-way communication will be established, so that from the HUB we will also be able both to make interconsultations with the Primary Care nurses and to notify them about specific cases. This is an important start and we hope it will continue to progress," according to the Bellvitge Hospital nurse manager.