Suggestions included: having a single professional to co-ordinate care; using heart failure nurses to facilitate cross-boundary working; and having conjoint working between primary and secondary care via means of a shared-care agreement . Methodology serious limitations LOW Coherence minor concerns Relevance minor concerns Adequacy moderate concerns Table 134: Summary of Evidence for Communication Study design and sample size Findings Quality assessment Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: No of studies contributing to the finding Design Criteria Rating Overall assessment of confidence 3a Poor communication between services Focus group with HCP in care homes Interviews with pt with advanced CHF and their care network Interviews with pt 2 x secondary analysis of interviews with pt Interviews with HCP People with heart failure, their informal carers and professionals within and outside HF services all felt that there was poor communication across boundaries, and this affected patient experience and patient care. Methodology serious limitations MODERATE Coherence no or very minor concerns Relevance no or very minor concerns Adequacy no or very minor concerns 3b Barriers to clear communication Interviews of HCP in HF care Questionnaire to HCP Healthcare professionals felt that some barriers to cross-boundary communication were fragmented and incompatible information systems, and difficulties trying to speak to other health professionals. Methodology moderate limitations LOW Coherence no or very minor concerns Relevance no or very minor concerns Adequacy serious concerns 3c Information after discharge from HF services Interviews with pt People with heart failure experience being well-informed in HF clinic, but receiving no information after being discharged to primary care, which some took to mean they no longer needed care for their heart failure. 