Bridging the Gap, Dr Georgina Robinson
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Transcript Bridging the Gap, Dr Georgina Robinson
Bridging the Gap
Advanced Nurse Practitioners in the Emergency Department
Consultant Georgina Robertson
ANP Janet Oliver
Trainee Advanced Physiotherapist Stuart Barker
East Lancashire Hospitals NHS Trust
180,000 patients per year
3 sites
7 Consultants
4 fulltime Speciality Doctors
3 part time Speciality Doctors
3 higher trainees in Emergency Medicine
Full compliment of junior doctors
Three sites
Accrington Minor Injuries Unit
Operates 08:00-20:00
Nurse led by Emergency Nurse Practitioners
Supervision provided by Consultants at Royal
Blackburn Hospital
Urgent Care Centre at Burnley General Hospital
24 hour service
Consultant led 09:00-17:00
Emergency Nurse Practitioners 08:00-23:00
Middle Grades and junior doctors
GP 19:00-23:00 mon-fri 11:00-23:00 sat & sun
Emergency Department and Urgent Care Centre at
Royal Blackburn Hospital
Consultant led service from 08:00-00:00
Junior and Middle Grade doctors
Emergency Nurse Practitioners 08:00-23:00
GP 19:00-23:00 mon-fri 11:00-23:00 sat & sun
Service Developments
Advanced Nurse Practitioners
First contact physiotherapists
Advanced Physiotherapy practitioner
Consolidation of ENP skills
Enhanced skills of Clinical Support Workers
Clinical Fellow rotation and middle grade
secondments
Departmental GPs
Advanced Nurse Practitioners
Two fully qualified
Three more in training
Assess and manage majors patients in a holistic manner
refer to all specialities
Senior, experienced members of staff
Career progression clinically for nursing staff
Development projects within the department
Teaching and clinical support of nursing staff within the
department
First contact Physiotherapist
Paid for a physio service which provided mobility
assessments and aids
Now have 1-2 physios assessing and managing MSK
patients in both UCC 08:00-18:00
At UCC at RBH physio 14:00-18:00 sat & sun
Physio run MSK clinic three times per week
Can refer to fracture clinic and speciality orthopaedic
clinics
Teaching within the department
Advanced Physiotherapy Practitioner
Assesses and manages patients with MSK problems
Development of pathways within the Department in
conjunction with orthopaedics – Ankle Injury Pathway
Teaching of medical and nursing staff
Increased through put in the MSK clinic reducing
unnecessary referrals to fracture clinic
Will have an extended scope of practice once qualified
e.g. head injuries, chest injuries, burns.
Currently independently request and interpret x-rays.
Impact of Physiotherapy
Physio’s see 200 patients per month on average
Offer real time clinical support to doctors and nurses
for MSK conditions and discharge planning
Provide direct referral to outpatient physio without
the need for patients to be sent back to the GP
Aiding with the development of links with
orthopaedics
The Physio team has recently won extra funding for
additional staff. 3 wte to 5 wte.
Consolidation of ENP skills
Enhanced teaching programme to include minor
illness
Peer review
All moved to UCC at BGH with rotation to MIU at
Accrington
Clinical support workers
Departmental training days focused on the six ‘c’s
ECG recording, taking and recording of observations
IV cannulation and blood taking
Clinical Fellow Rotation
Six clinical fellows
Rotate between ICU/Anaesthetics, MAU and EM over a
two year period
Encouraged to take MCEM, paid for ALS,ATLS & APLS
Four hours per week of study time
Progression to Middle Grade job
Permanent Middle Grades given three month
secondments to other specialities
(ICU/Anaesthetics/Paeds/MAU)
Departmental GPs
GPs given sessional contracts to work in UCC at RBH
at weekends and to cover GP teaching
Streaming Pilot
6 month period
UCC patients at RBH
Computer programme to stream back to GP
Majority of patients unwilling to go back to the GP
once in the department
Triage took too long
Service not continued
ANP Service Improvement
Facilitation of appropriate prescribing activities
Tetanus
Oxygen
Implementation of an innovative approach to pain
management in # Femoral Neck
Audit
Staff development
Middle-grade teaching
Nurse and health care support worker development
ANP Service Improvement
Care Bundles
Diabetic Keto-Acidosis
Referral Pathways and Patient Information
Deep Vein Thrombosis
Implementation of national guidance via decisionmaking tools
Chest Pain of Recent Onset (NICE CG95, 2010)
Patient Experience Snapshot Survey
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