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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