Medic One Funded Projects
MSc in Advanced Practice
Ms Sue Bagley
In December 2012, I was accepted at Edinburgh Napier University to study the Research Methods and Dissertation modules, in order to complete my Masters degree in Advanced Practice. I chose to study the ongoing work of the ENP team in the ‘Minors’ area of the Emergency Department (‘Exam’). We had previously tried various models of ‘See and Treat’, in order to find the best way to deal with the volume and flow of patients in this area.
Approximately 50% of patients in the ED are seen in Exam and many are found to have minor injuries which can potentially be dealt with quickly and these patients discharged. I realised that an effective triage process, carried out in an expedient and consistent way could have a very positive impact on patient flow through Exam.
During my research, I discovered the term ‘wasted waiting’. This term has been used to describe the period of time a patient spends waiting the ED whilst having nothing done to move them along their journey. For example, waiting for their triage assessment or, even worse, waiting to be seen after their triage assessment having had no investigations initiated.
The previous model for Exam was to allocated one staff nurse to triage, with ENPs performing a purely care provider role. Often, when the department became busy, the staff nurses left Exam to cover other areas. At this point, triage would cease.
The ENPs are a constant presence in Exam, day and night, and I realised we should be leading this process, ensuring consistent – and continuous – triage. In addition, there is evidence from other EDs that Clinical Decision Makers performing the initial assessment can have dramatic results. Patients can be diverted to the appropriate service, such as their GP, or discharged having received treatment for a minor injury- See and Treat. Other patients have a ‘front load assessment’, where any investigations required are commenced at triage. This ensures a more expedient episode when they are seen by their care provider. As this process encompasses both a triage and care provider role for the ENPs, it was re-named ‘Rapid Assessment Team’ to avoid confusion.
Over the following months, I audited this process. I have found a decrease in waiting times and overall journey times for the Exam area, with an improvement towards achievement of the Flow 1 target. Other factors which may have also contributed to this are recruitment of additional ENPs and Consultants, and the implementation of the Flow role to the Senior Charge Nurse team.
In October 2013, the Rapid Assessment Team project was accepted for presentation at the national RCN conference for Emergency Care in Brighton. Medic One once again provided funding for myself and two other members of the team to attend, enabling us to share the work of the Edinburgh ED with others.