The simple lipid management algorithm: It works
Author: Lorna Keating, ANP Cardiology Chest Pain, Naas General Hospital, Co Kildare
Background: All patients on statin therapy require repeat lipid level within the first three months after initiation (European Society of Cardiology dyslipidaemia guidelines update 2025). An audit of statin therapy practices by the advanced nurse practitioner (ANP) (chest pain) in Naas General Hospital (NGH) in quarter 1 of 2024 identified that only 20 per cent of these patients had lipid monitoring (total cholesterol and low-density lipoprotein) performed within this timeframe.
A statin therapy prescribing and lipid management algorithm (incorporating a risk stratification tool) was designed to guide prescribers on statin prescribing standards and lipid targets based on primary and secondary prevention. An information leaflet was also developed to empower patients and inform them of their current lipid levels, targets, and monitoring dates.
Aims and objectives: This quality improvement aimed to design a tool to individualise and standardise lipid management of patients discharged from the ANP Chest Pain service in NGH to community services by June 2025. The objective was to empower patients through education on lipids, targets, and monitoring.
Method: The Model of Quality Improvement was used. This quality improvement was aligned with Framework for Improving Quality in Our Health Service (HSE 2016) and the HSE Code of Practice for Integrated Discharge Planning (HSE 2008).
Results: The statin therapy practices were re-audited in June 2025 identifying:
✽ 39 per cent of patients had lipids checked ≤ three months of starting statins versus 20 per cent initially
✽ 37 per cent on target at three months
✽ >90 per cent are primary prevention patients
✽ 52 per cent scoring ‘high’ on SCORE2 risk stratification.
Conclusion: This algorithm provided step by step approach assisting clinicians with targeting high cholesterols and improving lipid management. The pathway allows for correct individualised prescribing, optimisation, monitoring, and pathways to assistance with issues. Early detection and treatment of cholesterol is key in the prevention of primary and secondary disease.
Bridging primary and specialist care: An ANP-led GP reach-in initiative to improve respiratory management
Authors: Aoife Bradley, ANP Respiratory, Peamount Healthcare; Dr Minesh Kooblall, Consultant Respiratory Medicine Peamount Healthcare/Tallaght Hospital
Background: Respiratory diseases contribute significantly to Ireland’s healthcare burden. In 2023/2024, 34 per cent of out-of-hours GP consultations and over 100 per 1000 emergency department (ED) admissions were for respiratory conditions. Many could be avoided with earlier intervention in primary care, highlighting the need for improved community-based respiratory pathways.
Aims/objectives: This ANP-led GP reach-in initiative aims to improve timely access to respiratory care, support GPs in managing patients, reduce acute sector burden, decrease outpatient referrals, and enhance patients’ quality of life.
Methods/approach: An ANP provides a direct-access pathway for registered GPs to refer patients for respiratory assessment, diagnostics, and linkage to specialist inpatient/outpatient support. Evaluation forms from GPs and patients assess perceived benefit, quality of life improvements, and potential avoidance of acute care.
Results: To date, 21 patients across 12 of 18 participating GP practices have accessed the service. Of 18 completed care episodes, seven full evaluations were returned.
✽ 100 per cent of GPs and patients reported service benefit
✽ Four of seven GPs would have referred to ED if the service were unavailable
✽ GPs reported achievement of all service aims, including improved access, support, and patient outcomes.
Discussion: The initiative illustrates the impact of advanced practice leadership in enhancing integrated care, preventing avoidable hospital presentations, and supporting primary care in managing complex conditions.
Conclusion/implications for practice: This ANP-led model improves respiratory care access and coordination. It supports GPs, prevents unnecessary hospital attendances, enhances respiratory patients’ quality of life, and demonstrates how advanced practice can lead sustainable, high-impact service innovations. This model offers a blueprint for broader chronic disease management in primary care.
The impact of a respiratory RANP clinic in reducing time to initial assessment
Author: R. Reilly Respiratory RANP, Department of Respiratory Medicine, Cavan Monaghan Hospitals, Co Cavan.
Background: The respiratory RANP clinic was established in Cavan Monaghan Hospitals (CMH) in February 2024. Prior to this, all patients referred by GPs/other hospital consultants were triaged by a respiratory consultant and added to the respiratory consultants waiting list for assessment, diagnosis, and treatment. In 2024, the waiting time for initial assessment by a respiratory consultant was over one year.
Objective: To expedite clinic review for a specific cohort of patients on the waiting list who require assessment, diagnosis, and treatment initiation.
Implementation: The cohort of patients suitable for the RANP clinic was agreed with the relevant stakeholders. Policies were developed and approved by the CMH Medical Services Clinical Governance Committee. Seven clinics per fortnight were implemented in CMH.
Outcomes: Between 1 February 2024 and 31 August 2025, 706 appointments (new and review) were issued, of which 486 (69%) patients attended. In 2024, 21 per cent of patients were waiting >12months for their initial appointment, reducing to 2 per cent in 2025. Furthermore in 2024, 67 per cent of patients were seen in less than months, improving to 83 per cent in 2025.
Confirmed diagnosis included asthma, asthma chronic obstructive pulmonary disease (COPD) overlap (ACO), COPD, bronchiectasis, interstitial lung disease, sinusitis, and gastro-oesophageal disease. A total of 84 patients (17%) required discussion with a respiratory consultant at the fortnightly multidisciplinary team (MDT) patient discussion meetings.
Case management included referral for radiology (22), ordering and interpreting blood (174) and diagnostic (127) tests, writing prescriptions (186), and completing appropriate referrals to MDT/respiratory integrated care (44). A sum of 84 patients were discharged to GP care or linked into other respiratory clinics/services for ongoing management.
Conclusion: The respiratory RANP clinic provides a pathway to earlier diagnosis and treatment for patients on the respiratory consultant waiting list. This clinic reduces the patient’s time to diagnosis and treatment optimisation to less than nine months. Patients are discharged to appropriate care/clinic for ongoing management.
The respiratory post-discharge clinic reduces time to diagnosis and treatment optimisation
Author: R Reilly Respiratory RANP; and M Togher Respiratory cANP, Dept of Respiratory Medicine, Cavan General Hospital
Background: The respiratory post-discharge clinic was established in Cavan General Hospital in January 2024. Prior to this, patients who had an in-patient stay and who were assessed by clinical nurse specialist (CNS)/allied health professional (AHP) as having undiagnosed respiratory disease were referred to the respiratory clinic waiting list for formal diagnosis. The waiting time for review by respiratory consultant and diagnostics in 2024 was less than one year.
Objective: To expedite clinic review for patients requiring diagnosis and/or confirmation of respiratory disease. Clinic appointment includes pulmonary function tests, allowing for diagnosis and treatment initiation on same day. In addition, an oxygen therapy assessment and blood testing are included as necessary. This initiative reduces the number of patients referred to the respiratory consultant waiting list (waiting list avoidance).
Implementation: The clinic is bimonthly and run by registered/candidate ANP(RANP/cANP).
Outcomes: Between 1 January 2024 – 11 August 2025: 101patients were referred. Seventy-eight patients were offered appointments – 58 per cent within 12 weeks and 86 per cent within 16 weeks of discharge. Seventy percent of new patients (55) attended their appointments.
Confirmed diagnosis included asthma, asthma-chronic obstructive pulmonary disease (COPD) overlap, COPD, bronchiectasis, interstitial lung disease, and obstructive sleep apnoea. A total of 22 patients (40%) were on the correct inhaler regime and had the correct inhaler technique, and 20 patients (36%) required an oxygen assessment.
A total of 14 cases were discussed at the multidisciplinary team discussion meetings; eight patients (15%) were discharged following one review; and 47 per cent (26) were linked into other respiratory clinics/services for ongoing management including consultant clinic; RANP clinic; cANP/CNS asthma clinic; ANP interstitial lung disease clinic,; oxygen clinic; sleep clinic; and integrated care.
Conclusion: The respiratory post-discharge clinic provides a pathway to earlier diagnosis and treatment for patients identified during an in-patient stay with an undiagnosed respiratory disease. This clinic reduces the patient’s time to diagnosis and treatment optimisation to 16 weeks. Patients are cohorted into appropriate clinics for ongoing management.
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