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
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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
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Accrington Minor Injuries Unit
Operates 08:00-20:00
Nurse led by Emergency Nurse Practitioners
Supervision provided by Consultants at Royal
Blackburn Hospital
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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
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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
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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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