‘We own this service’ Ward sister Lou Harkness-Hudson and her team have created a ‘radically different’ clinical assessment clinic. Mary-Claire Mason reports
SUMMARY
When emergency services were reorganised at Rochdale Infirmary, Lou Harkness-Hudson was faced with the challenge of helping to create and run a new clinical assessment service. As part of the reorganisation by Pennine Acute Hospitals NHS Trust, the infirmary’s A&E unit was closed and replaced with a walk-in urgent care centre for people with non-life-threatening injuries. But the most innovative change was the closure of the medical emergency unit, which had taken referrals from A&E, and its replacement by the clinical assessment unit, which takes referrals from the urgent care centre and community. GPs were a driver for the new unit – they had pushed for somewhere they could refer patients to directly.
Above, left to right: healthcare assistant Lynne Pollitt offers a patient a shave; a triage phone can be used to organise services such as ordering an ambulance; and ward sister Lou HarknessHudson keeps track of cases
A reorganisation of emergency services at Rochdale Infirmary has opened the way for a new kind of clinical assessment service. The short-stay unit provides a rapid diagnostic and treatment service. Nursing staff are encouraged to report concerns and put ideas for improvement into action. Author Mary-Claire Mason is a freelance journalist
20 june 5 :: vol 27 no 40 :: 2013
Having worked in emergency medicine for 13 years and been nurse manager at the medical emergency unit for its last six months, Ms Harkness-Hudson was well placed to take on the role of nurse lead at the clinical assessment unit, working alongside consultant physician and clinical lead Shona McCallum. For her and the rest of the team, this was a chance to work in a service they had built from scratch.
Creating the unit
‘It has not always been plain sailing, but the radically different service was created by us, the front line staff – nurses, doctors, and consultants – drawing on our experience, working together and liaising closely with the local community,’ she says. ‘We had a series of weekly meetings to flesh out how to create this new unit. Apart from the staff budget, there was little involvement from senior managers. They left us to get on with it because they accepted we knew what was needed.’ The clinical assessment unit opened in April 2011. A short-stay unit, it offers a rapid
diagnostic, assessment and treatment service. It has 15 beds and 25 staff, including 13 nurses and six healthcare assistants. Staff who were not retained from the old medical emergency unit were redeployed to other posts in the trust. The new unit sees around 500 patients a month and deals with problems such as headaches and urinary tract infections. Patients who need a full emergency service are transferred to A&E facilities elsewhere in the trust, at hospitals in Bury, Oldham and Manchester. Two years on, Dr McCallum and Ms Harkness-Hudson say the unit – which won an Age UK dignity award last year – is a resounding success. Ms Harkness-Hudson points out that the average length of stay is about 2.5 days and, although it is difficult to make a direct comparison, this is significantly shorter than in the old unit. Dr McCallum says infection rates are low and there are no hospital-acquired pressure ulcers. A triage system operates at the unit, so every patient is assessed first by a nurse, who decides whether they are in the right place for treatment. The nurse then estimates how long the patient will be in the unit, doing away with the need for bed managers. Patients are then seen by a senior doctor.
NURSING STANDARD
JOHN HOULIHAN
A transfer of care team, consisting of nurses employed by the trust, spend several hours each day on the unit, arranging continuing health care for patients. This has cut delays in the discharge process, as has the use of a private ambulance service. Nurses can order an ambulance for a specific time so that patients know exactly when they will be taken home. Ms Harkness-Hudson emphasises that front line staff continue to play a pivotal role in developing the service. This means being open to change, as well as acknowledging and learning from mistakes. She adds that, apart from setting standards, her job is to engage staff. ‘Nurses can become demoralised and resentful if they feel that changes are imposed from above. ‘It is essential to listen carefully to their views about what is right or wrong with the service and how to improve it. You need to empower staff by getting them to take more responsibility and, wherever possible, make changes themselves,’ she says. Ms Harkness-Hudson’s manager at the time the
NURSING STANDARD
Staff engagement policy In 2012 chief executive John Saxby signed up the trust to a staff engagement programme run by the company Optimise. Led by divisional nurse manger Julie Owen, early feedback suggests the Listening into Action model is improving staff morale. The programme asks staff three questions: What gets in the way of you giving patients the best care? What can be done to change this? Who will make these changes? www.listeningintoaction.co.uk unit was being set up was Julie Owen, a divisional nurse manager at the trust. ‘My philosophy is to be supportive, but have a hands-off approach, because this builds confidence,’ says Ms Owen. ‘When Lou came to me with various ideas, for example a possible triage service, I listened and said “run with it”.’
Open door policy
Ms Harkness-Hudson works regular nursing shifts so staff know that she understands the pressures, and also operates an open door policy. ‘My staff know they can come to me with their concerns at any time,’ she says. ‘If someone has an idea, we discuss it and if it seems
Above from left to right: healthcare assistant Lynne Pollitt, clinical lead Shona McCallum and ward sisters Lou HarknessHudson and Julie Archibald at a team meeting
good, I ask them to go away and work out how to do it.’ In addition to nursing duties, staff are divided into teams of three to deal with other specific issues, including infection control and falls. Sister Julie Archibald asked if staff could have time off the nursing rota to undertake these duties, and rota changes have now been made to accommodate them. HCA Linda Shepherd told Ms Harkness-Hudson she was concerned that stock items such as incontinence pads kept running out: ‘She thanked me for bringing it to her attention and asked me to work out how to solve the problem – which I have done by liaising directly with the store department,’ says Ms Shepherd. Other ideas from staff include the safety board check: three times daily, at 8am, 4pm and 10pm, the entire team on duty go through the names of patients on the board and do a risk assessment, noting those who may have special requirements. Ms Harkness-Hudson now also manages the urgent care centre. ‘When nurses feel they own a service, that in turn leads to the best possible care for patients,’ she says NS june 5 :: vol 27 no 40 :: 2013 21
SUMMARY
When emergency services were reorganised at Rochdale Infirmary, Lou Harkness-Hudson was faced with the challenge of helping to create and run a new clinical assessment service. As part of the reorganisation by Pennine Acute Hospitals NHS Trust, the infirmary’s A&E unit was closed and replaced with a walk-in urgent care centre for people with non-life-threatening injuries. But the most innovative change was the closure of the medical emergency unit, which had taken referrals from A&E, and its replacement by the clinical assessment unit, which takes referrals from the urgent care centre and community. GPs were a driver for the new unit – they had pushed for somewhere they could refer patients to directly.
Above, left to right: healthcare assistant Lynne Pollitt offers a patient a shave; a triage phone can be used to organise services such as ordering an ambulance; and ward sister Lou HarknessHudson keeps track of cases
A reorganisation of emergency services at Rochdale Infirmary has opened the way for a new kind of clinical assessment service. The short-stay unit provides a rapid diagnostic and treatment service. Nursing staff are encouraged to report concerns and put ideas for improvement into action. Author Mary-Claire Mason is a freelance journalist
20 june 5 :: vol 27 no 40 :: 2013
Having worked in emergency medicine for 13 years and been nurse manager at the medical emergency unit for its last six months, Ms Harkness-Hudson was well placed to take on the role of nurse lead at the clinical assessment unit, working alongside consultant physician and clinical lead Shona McCallum. For her and the rest of the team, this was a chance to work in a service they had built from scratch.
Creating the unit
‘It has not always been plain sailing, but the radically different service was created by us, the front line staff – nurses, doctors, and consultants – drawing on our experience, working together and liaising closely with the local community,’ she says. ‘We had a series of weekly meetings to flesh out how to create this new unit. Apart from the staff budget, there was little involvement from senior managers. They left us to get on with it because they accepted we knew what was needed.’ The clinical assessment unit opened in April 2011. A short-stay unit, it offers a rapid
diagnostic, assessment and treatment service. It has 15 beds and 25 staff, including 13 nurses and six healthcare assistants. Staff who were not retained from the old medical emergency unit were redeployed to other posts in the trust. The new unit sees around 500 patients a month and deals with problems such as headaches and urinary tract infections. Patients who need a full emergency service are transferred to A&E facilities elsewhere in the trust, at hospitals in Bury, Oldham and Manchester. Two years on, Dr McCallum and Ms Harkness-Hudson say the unit – which won an Age UK dignity award last year – is a resounding success. Ms Harkness-Hudson points out that the average length of stay is about 2.5 days and, although it is difficult to make a direct comparison, this is significantly shorter than in the old unit. Dr McCallum says infection rates are low and there are no hospital-acquired pressure ulcers. A triage system operates at the unit, so every patient is assessed first by a nurse, who decides whether they are in the right place for treatment. The nurse then estimates how long the patient will be in the unit, doing away with the need for bed managers. Patients are then seen by a senior doctor.
NURSING STANDARD
JOHN HOULIHAN
A transfer of care team, consisting of nurses employed by the trust, spend several hours each day on the unit, arranging continuing health care for patients. This has cut delays in the discharge process, as has the use of a private ambulance service. Nurses can order an ambulance for a specific time so that patients know exactly when they will be taken home. Ms Harkness-Hudson emphasises that front line staff continue to play a pivotal role in developing the service. This means being open to change, as well as acknowledging and learning from mistakes. She adds that, apart from setting standards, her job is to engage staff. ‘Nurses can become demoralised and resentful if they feel that changes are imposed from above. ‘It is essential to listen carefully to their views about what is right or wrong with the service and how to improve it. You need to empower staff by getting them to take more responsibility and, wherever possible, make changes themselves,’ she says. Ms Harkness-Hudson’s manager at the time the
NURSING STANDARD
Staff engagement policy In 2012 chief executive John Saxby signed up the trust to a staff engagement programme run by the company Optimise. Led by divisional nurse manger Julie Owen, early feedback suggests the Listening into Action model is improving staff morale. The programme asks staff three questions: What gets in the way of you giving patients the best care? What can be done to change this? Who will make these changes? www.listeningintoaction.co.uk unit was being set up was Julie Owen, a divisional nurse manager at the trust. ‘My philosophy is to be supportive, but have a hands-off approach, because this builds confidence,’ says Ms Owen. ‘When Lou came to me with various ideas, for example a possible triage service, I listened and said “run with it”.’
Open door policy
Ms Harkness-Hudson works regular nursing shifts so staff know that she understands the pressures, and also operates an open door policy. ‘My staff know they can come to me with their concerns at any time,’ she says. ‘If someone has an idea, we discuss it and if it seems
Above from left to right: healthcare assistant Lynne Pollitt, clinical lead Shona McCallum and ward sisters Lou HarknessHudson and Julie Archibald at a team meeting
good, I ask them to go away and work out how to do it.’ In addition to nursing duties, staff are divided into teams of three to deal with other specific issues, including infection control and falls. Sister Julie Archibald asked if staff could have time off the nursing rota to undertake these duties, and rota changes have now been made to accommodate them. HCA Linda Shepherd told Ms Harkness-Hudson she was concerned that stock items such as incontinence pads kept running out: ‘She thanked me for bringing it to her attention and asked me to work out how to solve the problem – which I have done by liaising directly with the store department,’ says Ms Shepherd. Other ideas from staff include the safety board check: three times daily, at 8am, 4pm and 10pm, the entire team on duty go through the names of patients on the board and do a risk assessment, noting those who may have special requirements. Ms Harkness-Hudson now also manages the urgent care centre. ‘When nurses feel they own a service, that in turn leads to the best possible care for patients,’ she says NS june 5 :: vol 27 no 40 :: 2013 21
