Opinion
Letter Three-tier care IN RESPONSE to Nick Triggle’s overview of Sir Bruce Keogh’s service review in last month’s Emergency Nurse, the concept of a two-tier emergency service has been generally accepted. It is acknowledged that major centres can manage major trauma, stroke and heart attack comprehensively, and can ensure optimal clinical outcomes. Meanwhile, regular emergency departments (EDs) with on-site senior cover and supported by standard critical care services can provide the mainstay of emergency care. The third emergency service tier was not mentioned, however. It is proposed that urgent
care centres will provide the bulk of care for patients who do not require level-one or -two services. These centres can showcase the clinical skills and competencies of emergency nurse practitioners in managing patients who do not require the attention of an ED. At present, there is a mishmash of community services, including walk-in-centres, minor injury units and GP 8-to-8 clinics, that offer varying levels of care and support to patients. Some provide excellent and comprehensive care, and produce outcomes comparable with those of EDs; others follow rigid protocols and policies that can inhibit best practice, and can be likened to expensive signposts to other forms of care.
Professor Keogh has proposed that urgent care centres must meet national minimum standards in staffing, ensuring a consistent level of clinical skills and diagnostic reasoning. The centres must be open to all patients, whether they are referred by NHS 111, ambulance services or other community-based teams, or are self-referred. His proposals for a national standardised urgent care service should be welcomed by emergency nurses and I hope that senior emergency clinicians can give clinical commissioners examples of existing best practice. Mike Paynter is a consultant nurse at Somerset Partnership NHS Foundation Trust
At the conference, we were inspired to hear about new developments in emergency nursing and we adopted the ‘copy and steal everything’ method of spreading best practice. We were especially impressed by the expanding use of ultrasound for placing central lines and nerve blocks, looking for foreign bodies in soft tissues and eyes, reducing fractures without the need for repeated radiation, achieving peripheral venous access in patients for whom traditional methods are difficult, and checking for cardiac activity during cardiac-arrest episodes.
warmly. ED nurses the world over share a sense of humour, it seems, although not the UK’s bare-below-elbows clothing policy. Staff in the ED see 103,000 new patients a year and we envied its workforce of 30 registered nurses on duty and its 70 bed spaces, most with monitoring equipment, although our hosts were quick to report that this is not standard working practice across the US. We were surprised to find a breast-feeding room, predominantly used by staff, in the main department. The room is necessary because staff there receive at most 12 weeks’ maternity leave. This leave often begins before the baby is born, which means some nurses return to work when their babies are only two or three weeks old. In addition, emergency nurses’ annual leave allowance is only four weeks, including statutory holidays. We left the US feeling there is a universal connection between emergency nurses and that, when we network, we motivate, inspire and learn from each other, which benefits patients and nurses alike. See also board’s eye view, page 12
Janet Youd
The bigger picture THE EMERGENCY Nurses Association’s annual conference and international advisory council in Indianapolis last month gave RCN Emergency Care Association (ECA) committee members an opportunity to compare nursing issues in the UK with those in the US, Australia, Canada and mainland Europe. Undoubtedly, there are differences between these issues. The level of violence encountered by US and Australian nurses, for example, appears to outweigh that seen in the UK, to the extent that some departments have airport-style security systems with walk‑through metal detectors and guards with dogs at the door. It would also appear that the use of physical restraints is an accepted part of practice in the US, as was demonstrated in the conference exhibition hall. While acknowledging the elevated level of gun crime in the US, we wondered whether the use of security and restraints had a role in the high levels of verbal abuse and violence from patients. However, some issues, such as rising numbers of people attending emergency departments (EDs) and difficulties providing appropriate care for patients with mental health problems, are similar all over the world. EMERGENCY NURSE
Procedures for children We also heard about the administration of subcutaneous fluid augmented by the drug hyaluronidase in children with moderate dehydration, and in whom intravenous access is difficult and intraosseous placement traumatic. This reduces time to administration and the number of intravenous attempts experienced by children. I shall endeavour to provide more information on these topics at the ECA’s conference next March. The conference, last month, also involved a trip to the Methodist Hospital of Indianapolis ED, where we were met
Janet Youd is chair of the RCN Emergency Care Association, and a nurse consultant in emergency care at Calderdale and Huddersfield NHS Foundation Trust
November 2014 | Volume 22 | Number 7 13
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Letter Three-tier care IN RESPONSE to Nick Triggle’s overview of Sir Bruce Keogh’s service review in last month’s Emergency Nurse, the concept of a two-tier emergency service has been generally accepted. It is acknowledged that major centres can manage major trauma, stroke and heart attack comprehensively, and can ensure optimal clinical outcomes. Meanwhile, regular emergency departments (EDs) with on-site senior cover and supported by standard critical care services can provide the mainstay of emergency care. The third emergency service tier was not mentioned, however. It is proposed that urgent
care centres will provide the bulk of care for patients who do not require level-one or -two services. These centres can showcase the clinical skills and competencies of emergency nurse practitioners in managing patients who do not require the attention of an ED. At present, there is a mishmash of community services, including walk-in-centres, minor injury units and GP 8-to-8 clinics, that offer varying levels of care and support to patients. Some provide excellent and comprehensive care, and produce outcomes comparable with those of EDs; others follow rigid protocols and policies that can inhibit best practice, and can be likened to expensive signposts to other forms of care.
Professor Keogh has proposed that urgent care centres must meet national minimum standards in staffing, ensuring a consistent level of clinical skills and diagnostic reasoning. The centres must be open to all patients, whether they are referred by NHS 111, ambulance services or other community-based teams, or are self-referred. His proposals for a national standardised urgent care service should be welcomed by emergency nurses and I hope that senior emergency clinicians can give clinical commissioners examples of existing best practice. Mike Paynter is a consultant nurse at Somerset Partnership NHS Foundation Trust
At the conference, we were inspired to hear about new developments in emergency nursing and we adopted the ‘copy and steal everything’ method of spreading best practice. We were especially impressed by the expanding use of ultrasound for placing central lines and nerve blocks, looking for foreign bodies in soft tissues and eyes, reducing fractures without the need for repeated radiation, achieving peripheral venous access in patients for whom traditional methods are difficult, and checking for cardiac activity during cardiac-arrest episodes.
warmly. ED nurses the world over share a sense of humour, it seems, although not the UK’s bare-below-elbows clothing policy. Staff in the ED see 103,000 new patients a year and we envied its workforce of 30 registered nurses on duty and its 70 bed spaces, most with monitoring equipment, although our hosts were quick to report that this is not standard working practice across the US. We were surprised to find a breast-feeding room, predominantly used by staff, in the main department. The room is necessary because staff there receive at most 12 weeks’ maternity leave. This leave often begins before the baby is born, which means some nurses return to work when their babies are only two or three weeks old. In addition, emergency nurses’ annual leave allowance is only four weeks, including statutory holidays. We left the US feeling there is a universal connection between emergency nurses and that, when we network, we motivate, inspire and learn from each other, which benefits patients and nurses alike. See also board’s eye view, page 12
Janet Youd
The bigger picture THE EMERGENCY Nurses Association’s annual conference and international advisory council in Indianapolis last month gave RCN Emergency Care Association (ECA) committee members an opportunity to compare nursing issues in the UK with those in the US, Australia, Canada and mainland Europe. Undoubtedly, there are differences between these issues. The level of violence encountered by US and Australian nurses, for example, appears to outweigh that seen in the UK, to the extent that some departments have airport-style security systems with walk‑through metal detectors and guards with dogs at the door. It would also appear that the use of physical restraints is an accepted part of practice in the US, as was demonstrated in the conference exhibition hall. While acknowledging the elevated level of gun crime in the US, we wondered whether the use of security and restraints had a role in the high levels of verbal abuse and violence from patients. However, some issues, such as rising numbers of people attending emergency departments (EDs) and difficulties providing appropriate care for patients with mental health problems, are similar all over the world. EMERGENCY NURSE
Procedures for children We also heard about the administration of subcutaneous fluid augmented by the drug hyaluronidase in children with moderate dehydration, and in whom intravenous access is difficult and intraosseous placement traumatic. This reduces time to administration and the number of intravenous attempts experienced by children. I shall endeavour to provide more information on these topics at the ECA’s conference next March. The conference, last month, also involved a trip to the Methodist Hospital of Indianapolis ED, where we were met
Janet Youd is chair of the RCN Emergency Care Association, and a nurse consultant in emergency care at Calderdale and Huddersfield NHS Foundation Trust
November 2014 | Volume 22 | Number 7 13
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 06, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
