Members of the Nurse Practitioners’ Team at Blackpool Teaching Hospitals
The highly dedicated Nurse Practitioners’ Team at Blackpool Teaching Hospitals has found an innovative way of cutting the amount of time patients have to wait for a pre-operative assessment before they can be added to an operating theatre list.
To celebrate Fab Change Day – a national day of collective action for staff within the NHS on October 19 – we are featuring the team as a great example of clinicians making positive changes for patients.
Clinical Matrons, Jo Marshall and Paula Vernon, jointly lead the teams which includes orthopaedic nurse practitioners, general surgical nurse practitioners and gynaecology nurse practitioners.
Dr David Hume is the Lead Consultant Anaesthetist with the team and there are 12 qualified nurse practitioners and two trainees. Some of the nurse practitioners have a dual role and also provide a trauma co-ordination service for emergency orthopaedic patients.
After reviewing patient waiting times, the equity of workloads, training needs for the nurse practitioners as well as income generated by the team versus the cost of the service, Jo and Paula merged the two services. This has improved patient waiting times and increased income.
Paula explained: “When people are listed for surgery they are usually put on a waiting list.
“There are targets we need to meet as a Trust. If we don’t meet the targets it reflects poorly on the Trust and there are costs associated with patients breaching the targets.
“We wanted to avoid ‘peaks and troughs’ in different clinical teams and through combining the services we have managed to reduce routine waiting times to an average of three to four weeks rather than eighteen. The focus of combining the two areas was to improve the quality of care for patients.
“It has also increased our revenue by £347,000 in 2015/16 due to ensuring all the increased activity was coded.”
A pre-operative assessment ensures that patients are safe to receive an anaesthetic. Each patient requiring an anaesthetic needs a full assessment of his or her existing clinical conditions, symptoms and medications.
Plans regarding further investigations, medication changes and additional support specific to the patient are organised before surgery.
Patients are prepared for surgery by ensuring they understand the operation they are having, managing any expectations through explaining the expected clinical pathway and discussing any potential side effects that may occur.
All the qualified nurse practitioners have had additional, advanced training. The trainee nurse practitioners are supported through their training with a clinical mentor and protected training time.
Preparation for surgery is psychologically complex and the nurse practitioner team enhances the patient experience by personalising the plan for people receiving this service.
Before the pre-operative assessment service was created, patients required an admission to hospital the night before surgery. This was to enable the anaesthetist to review the patient the evening before surgery.
Patients who were not immediately fit for surgery and required further investigation needed to have their operations cancelled, causing uncertainty and stress for patients as well as wasting theatre slots.
Through providing a pre-operative assessment service, patients are now admitted on the same day as they are due to have their surgery.
Any investigations or anaesthetic input can be organised before theatre and an appropriate plan be organised. The anaesthetists are now more readily available to review more complex patients and deliver anaesthetic services.