Help for ‘mini A&Es’ Staff in minor injuries units in Somerset have instant access to cardiology specialists, writes Lynne Pearce APEX
A nurse’s bright idea, tested in a six-week trial in 2008, is today a routine service for patients in Somerset who present with chest pain or have collapsed for unknown reasons. The telemedicine service initiated by Mike Paynter, a nurse consultant in urgent care at Somerset Partnership NHS Foundation Trust, ensures that clinicians at the trust’s community hospitals get fast, expert interpretation of electrocardiogram (ECG) results. Usually patients who are experiencing chest pain or who have collapsed suddenly are seen in an acute hospital. ‘In Somerset, because of the way our services are designed, we are seeing the same type of patient in a community hospital setting,’ says Mr Paynter.
Admissions avoided
Mike Paynter’s telemedicine service has resulted in ‘outstanding’ benefits
Nurse practitioners
SUMMARY
The trust has minor injuries units and a treatment centre based in eight community hospitals, all run by emergency nurse practitioners. ‘In a sense they are mini emergency departments,’ explains Mr Paynter. Back in 2008, Mr Paynter was worried that nurses in the units might not see
enough ECG results to retain their skills at advanced interpretation. Patients experiencing chest pain were sent to the neighbouring acute trust. This timeconsuming and expensive process often proved to be stressful for patients. Mr Paynter thought the solution could lie in a
Mike Paynter, a nurse consultant in urgent care at a Somerset trust, set up a telemedicine service in 2008 that gives clinicians at minor injuries units access to fast, expert interpretation of ECG results. The service prevents an estimated 900 acute admissions per year. Author Lynne Pearce is a freelance journalist
NURSING STANDARD
history and carries out a physical examination. The patient is then given a 12-lead ECG, and the findings are transmitted to an NHS-accredited national cardiology reporting service. An experienced cardiology specialist can give an immediate analysis of the results over the phone, before a written report is returned to the clinician in the minor injuries unit, usually within a few minutes. This informs the clinician’s decision but they do not abdicate responsibility to the off-site expert. ‘All clinicians are acutely aware that a “normal” ECG does not exclude an acute cardiac or other significant event,’ says Mr Paynter. ‘The overall patient presentation and clinical picture is of vital importance.’
telemedicine service that would allow staff in the minor injuries units to access remotely an expert cardiology opinion. He tested the idea in a trial involving 32 patients. He says: ‘The benefits were outstanding, even on this small scale. The trust acknowledged that this is a safe, effective and more efficient way of working.’ As a consequence, funding was agreed to roll out the service to all minor injuries units in the county. A patient who requires investigation will be evaluated by a nurse practitioner who takes a detailed clinical
About 75 per cent of patients are discharged home, with no further evaluation needed. Mr Paynter estimates that the service prevents around 900 patients a year being admitted to an acute hospital. It has been expanded to mental health units, where it is used to monitor patients who are on potentially cardiotoxic antipsychotic medication. GPs are also keen to use it. ‘The service gives a level of reassurance and clinical guidance to those who do not specialise in cardiology,’ says Mr Paynter. It is popular with patients too. ‘They feel that they are getting a level of care in the community that at least matches that of an emergency department and is more than a GP consultation,’ he says NS
january 8 :: vol 28 no 19 :: 2014 23
Downloaded from RCNi.com by ${individualUser.displayName} on Sep 15, 2016. For personal use only. No other uses without permission. Copyright © 2016 RCNi Ltd. All rights reserved.
A nurse’s bright idea, tested in a six-week trial in 2008, is today a routine service for patients in Somerset who present with chest pain or have collapsed for unknown reasons. The telemedicine service initiated by Mike Paynter, a nurse consultant in urgent care at Somerset Partnership NHS Foundation Trust, ensures that clinicians at the trust’s community hospitals get fast, expert interpretation of electrocardiogram (ECG) results. Usually patients who are experiencing chest pain or who have collapsed suddenly are seen in an acute hospital. ‘In Somerset, because of the way our services are designed, we are seeing the same type of patient in a community hospital setting,’ says Mr Paynter.
Admissions avoided
Mike Paynter’s telemedicine service has resulted in ‘outstanding’ benefits
Nurse practitioners
SUMMARY
The trust has minor injuries units and a treatment centre based in eight community hospitals, all run by emergency nurse practitioners. ‘In a sense they are mini emergency departments,’ explains Mr Paynter. Back in 2008, Mr Paynter was worried that nurses in the units might not see
enough ECG results to retain their skills at advanced interpretation. Patients experiencing chest pain were sent to the neighbouring acute trust. This timeconsuming and expensive process often proved to be stressful for patients. Mr Paynter thought the solution could lie in a
Mike Paynter, a nurse consultant in urgent care at a Somerset trust, set up a telemedicine service in 2008 that gives clinicians at minor injuries units access to fast, expert interpretation of ECG results. The service prevents an estimated 900 acute admissions per year. Author Lynne Pearce is a freelance journalist
NURSING STANDARD
history and carries out a physical examination. The patient is then given a 12-lead ECG, and the findings are transmitted to an NHS-accredited national cardiology reporting service. An experienced cardiology specialist can give an immediate analysis of the results over the phone, before a written report is returned to the clinician in the minor injuries unit, usually within a few minutes. This informs the clinician’s decision but they do not abdicate responsibility to the off-site expert. ‘All clinicians are acutely aware that a “normal” ECG does not exclude an acute cardiac or other significant event,’ says Mr Paynter. ‘The overall patient presentation and clinical picture is of vital importance.’
telemedicine service that would allow staff in the minor injuries units to access remotely an expert cardiology opinion. He tested the idea in a trial involving 32 patients. He says: ‘The benefits were outstanding, even on this small scale. The trust acknowledged that this is a safe, effective and more efficient way of working.’ As a consequence, funding was agreed to roll out the service to all minor injuries units in the county. A patient who requires investigation will be evaluated by a nurse practitioner who takes a detailed clinical
About 75 per cent of patients are discharged home, with no further evaluation needed. Mr Paynter estimates that the service prevents around 900 patients a year being admitted to an acute hospital. It has been expanded to mental health units, where it is used to monitor patients who are on potentially cardiotoxic antipsychotic medication. GPs are also keen to use it. ‘The service gives a level of reassurance and clinical guidance to those who do not specialise in cardiology,’ says Mr Paynter. It is popular with patients too. ‘They feel that they are getting a level of care in the community that at least matches that of an emergency department and is more than a GP consultation,’ he says NS
january 8 :: vol 28 no 19 :: 2014 23
Downloaded from RCNi.com by ${individualUser.displayName} on Sep 15, 2016. For personal use only. No other uses without permission. Copyright © 2016 RCNi Ltd. All rights reserved.
