Ilkeston Community Hospital Minor Injuries Unit
Main contactLynn Walshaw, Clinical Services Manager and Simon Griffiths, Deputy Director Provider Development
OrganisationIlkeston Community Hospital
Improvement project titleIlkeston Community Hospital Minor Injuries Unit
Key wordsCommunity Hospital, Minor Injuries Unit, Multidisciplinary, local provision
Short descriptionIlkeston Community Hospital wanted to maximise the potential of the community sites and ensure service delivery was in line with national policies which included having a plurality of providers. It was also noted that the public needed a local emergency service with ease of access and rapid return back to primary care as otherwise they would have to travel to Derby or Nottingham. This project describes a Minor Injuries Unit which was established to expand the type of conditions that could be managed at Ilkeston. They now see both adult and children who in the main self present, although they have also had a number of ambulance presentations. The service deals with any undifferentiated diagnosis and trauma; do not ordinarily see coughs and cold as this is usually dealt with primary care and the Out of Hours (OOH) service. They are linked to the emergency care network in Nottingham and Derby and can triage patients to them and vice versa. The clinical algorithms include transfer protocols.
Date submittedMarch 2007
AimProvision of a high quality local minor injuries service.
Approach used, methods and improvement toolsThey have not used specific improvement tools and techniques, but have had access to the service improvement team for help. They worked with commissioners, public health and clinical representatives to identify areas where there would be health gain such as substance misuse, younger adults, fracture clinic etc.
There was a lack of understanding from the clinical staff perspective about what the MIU could offer, so staff had to make sure that the role and scope of the service was clearly defined. Availability of diagnostics out of hours led to the development of a pathway for access to diagnostics that has now been agreed.
Over the last few years they have developed patient group directives: pathway presentation for a range of conditions. They also provide a soft injury service with therapy input and a fracture clinic and a needle exchange and contraceptive advice to young people. The clinical practice facilitator identifies training and development needs. They have also supported a member of staff in training and developing skills to equip nurses with the skills to deal with mental health problems.
They view improvement as a continuous process and work with consultants in acute trusts and the PCT clinical lead for MIU, to identify new ways of working. This has included how to deal with burns, with the development of pathways that covers assessment in MIU and IP care.
With respect to medical cover, the MIU has the support of a lead GP who works with staff re protocol development etc. There is also a medical on call system available each day. OOH support is provided by a separate contractor. They also run 3 GP review clinics per week, into which nursing staff can refer patients. Nurses can also access medical telephone advice via the acute trust.
Evaluation methodsThe MIU is part of the acute trust portfolio and as such is audited by the Audit Commission which takes into account type of presentation, activity, skill mix etc. There is a monthly report on activity and waiting time. Additionally, there are weekly reports from the patient experience tracker, which can include issues of privacy and dignity, responsiveness and injury management. It is an electronic system of gathering patient feedback about the service. It provides an objective way to look at staff processes and culture; this system can be adjusted to get the answers to specific issues and gives a “bulk” of positive comments. Because a score is given, improvement can also be monitored.
Some of their services are considered as part of the acute hospital portfolio and are assessed by the Audit Commission on an annual basis
‘Essence of care’ is monitored and this is benchmarked with other facilities. They also undertake a patient survey twice a year.
Risks identifiedIn order to make sure that the patients seen in the MIU were safely managed, they had to identify “what if” scenarios and worked with the risk manager on a number of these issues e.g. management of head injuries.
ChangesThe service now sees between 30,000 and 32,000 new patients each year and has a weekly fracture clinic, a needle exchange scheme, contraceptive advice for young people and ENP nurse practitioners. Although there was an MIU on site for a number of years, the service was limited by the type of presentation it could manage. The expansion of services at the MIU has improved access to care for local patients who otherwise would have had to travel approximately 10 miles..
Summary of results, lessons learnedIt was assumed that there might not be good understanding about what services could be provided in an MIU and the role of the nurse practitioner in the MIU. Explicit information, therefore, was developed and shared with other organisations and the public.
The work is in partnership with all stakeholders so it is about continuous improvement and not a one off project.