Enhancing heart valve disease surveillance: a quality improvement project demonstrating cost-effective triaging and Clinical Scientist-led services to improve patient care

Heart valve disease (HVD) is increasing in prevalence in the UK due to the ageing population, placing greater demands on diagnostic heart valve clinics. While many services recognise the need to improve efficiency and standardisation, initiating and implementing excellent quality improvement projects (QIPs) remains a challenge. Particularly for time-constrained service leads with limited resources and experience. This QIP describes a practical, replicable intervention to enhance HVD surveillance services using structured process mapping, root cause analysis and iterative Plan-Do-Study-Act (PDSA) cycles. Key issues identified included premature surveillance bookings, delays in result dissemination, and underutilisation of Clinical Scientists, contributing to inefficient workflows for consultant cardiologists and unnecessary visits for patients. The project introduced guidelined-aligned surveillance intervals, a refined triaging system, and a parallel Clinical Scientist-Led Valve Clinic (SLVC) pathway. Over four PDSA cycles, adherence to British Society of Echocardiography surveillance guidelines improved from 33% to 88%. Mean surveillance earliness was reduced from 3.4 months to 1.2 months in the Cardiologist-Led Care (CLC) pathway and to 0.5 months in the SLVC. Result dispatch times also improved significantly, with SLVC letters averaging 1.4 days (93% dispatched within five working days). A simple cost model suggested a 21% cost reduction if the SLVC pathway was scaled across the surveillance population, with estimated productivity gains of 12% in CLC and 17% through the SLVC, yielding a total projected improvement of 15%. These gains are attributed to optimised triaging, reduced overprocessing and the lower per-patient cost of SLVC delivery. This paper provides a detailed, real-world example of an adaptable QIP. It offers a practical framework for improving HVD surveillance services in resource-constrained settings while achieving measurable clinical and operational benefits.