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Bridging the Gap

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

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Bridging the Gap

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  1. Bridging the Gap Advanced Nurse Practitioners in the Emergency Department Consultant Georgina Robertson ANP Janet Oliver Trainee Advanced Physiotherapist Stuart Barker

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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.

  10. 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.

  11. 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

  12. Clinical support workers Departmental training days focused on the six ‘c’s ECG recording, taking and recording of observations IV cannulation and blood taking

  13. 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)

  14. Departmental GPs GPs given sessional contracts to work in UCC at RBH at weekends and to cover GP teaching

  15. 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

  16. 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

  17. ANP Service Improvement • Care Bundles • Diabetic Keto-Acidosis • Referral Pathways and Patient Information • Deep Vein Thrombosis • Implementation of national guidance via decision-making tools • Chest Pain of Recent Onset (NICE CG95, 2010)

  18. Patient Experience Snapshot Survey 100% 100% 100%

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