CASE STUDY
Nurse consultant Suzie Robinson, of the A&E team, Hinchingbrooke Hospital, Huntingdonshire.
When I joined the willing and enthusiastic A&E team at Hinchingbrooke Hospital in January 2002 as A&E Nurse Consultant, the trust was seeing an average of 86 per cent of patients within four hours. By the end of April 2005, the average for the year was 99.1 per cent and the team had achieved 100 per cent for three of the last four weeks.Back in 2002 there was no Emergency Nurse Practitioner Service and expanded nursing roles had not been implemented. Medical and nursing staff worked hard but were not integrated. The culture assumed that delays were part of A&E and patients frequently spent long periods in corridors, with limited privacy and dignity. Staff struggled to provide care and maintain motivation but were eager to change. Teams are now divided into minor and major streams with medical and nursing staff contributing to both. An Emergency Nurse Practitioner (ENP) is now established in the minor service, funded for 7.5 hours per day, and medical staff are encouraged to expand their roles into minor treatments and dressings. Sister Judy Ophield says: 'Working here in the A&E department certainly feels a lot better to both nurses and patients than it did two years ago.'The hospital has thrown itself behind A&E in bringing in new and improved ways of working. As a result of this support and hard work, the health system has supported the development of a new integrated emergency care centre. With the assistance of the PCT, we have introduced a social care manager role in the medical assessment unit (MAU) who also works across A&E. This has worked extremely well. The social care manager identifies patients at the earliest opportunity in the emergency process and works directly with his colleagues in transitional care, and the patient and their relatives to avoid unnecessary admissions. In-patient wards have also worked incredibly hard to increase throughput and nurse-led discharge has been introduced on some of the wards and will be rolled out further.To deliver this, the A&E department has moved to the other side of the hospital until January 2006, when its new home will be complete. This is now the ultimate test for the team - providing the service in a temporary facility, sustaining the level of achievement and developing quality initiatives. The A&E team has a strong 'can do' attitude and over the last two years, has provided a much-improved level of service; it is proud of its appetite for change. The challenges now centre around maintaining the fast pace to keep waiting times down despite rising attendances, while ensuring quality measures continue to be addressed. Suzie Robinson was the first A&E nurse consultant to be appointed in East Anglia. It is thanks to her work, along with that of modern matron Karen Mitchell, clinical director for emergency services Howard Sherriff, service improvement manager Nicky Ward, and the rest of the committed A&E team that it is now one of the best performing in England.
