Bridging the GapAdvanced Nurse Practitioners in the Emergency

DepartmentConsultant Georgina Robertson

ANP Janet OliverTrainee 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.

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.

Impact of Physiotherapy

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

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 decision-making tools Chest Pain of Recent Onset (NICE CG95, 2010)

ANP Service Improvement

Patient Experience Snapshot Survey

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