Two triage nurses for walk in patients Nurse coordinator taking ambulance handover ‘Recipe book’ of investigations to be requested Intermittent nurse requesting of x-rays HCA for blood tests / ECGs 5.5 WTE Consultants (two per day) 16 Middle Grades 12 FY2
One Consultant 0900-1700 One Consultant 1400-1900 Roles: Ward rounds at 0900, 1400 and 1800 Covering majors, paeds, resus, clinical decision unit (CDU) Reviewing patients Reviewing cards in the queue Clerking patients Review clinic Supervision & training of juniors Managing the shift
Pilot… Consultant 12-16, Middle Grade 16-20 [Locum MG 12-20 – support for additional consultant ] Nurse HCA RAT mobile…
Brief history from patient / paramedic Focused examination if required RAT two team go with patient into cubicle Request blood tests / urinalysis / ECGs Request imaging Initiate treatments Stream: to specialties or other providers ‘See & Treat’ simple conditions Juggle
Pre-RATPost-RAT Time to initial assessment38% < 30 mins69% < 30 mins Time to treatment20% < one hour 55% < two hours 30% < one hour 70%
"name": "Pre-RATPost-RAT Time to initial assessment38% < 30 mins69% < 30 mins Time to treatment20% < one hour 55% < two hours 30% < one hour 70%
Time critical treatments that make a difference to quality of care Ordering scans early Starting simple treatments that could enable discharge within four hours Reducing unnecessary investigations Streaming to specialties See & treat
‘its not a good use of my skills as a consultant’ ‘we don’t have enough doctors’ ‘we don’t have enough nursing staff’ ‘we don’t have any space’ You do more than you think Are you doing this already, in a less structured way? Same work, done differently Do you need a designated area?
RAT team disappeared ‘Incentive money’ discontinued Changing ways of working within nursing team? Out of hours Middle grades struggle to keep system going Rapid assessment may lead to over- investigating Intense working – can feel like only person seeing patients
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