1. Every good idea has its time Jill Windle RGN, MSc. FFEN Lecturer Practitioner in Emergency Nursing

2. Time to reflect on …. zDemonstrate achievements (spanning 20 years) zDiscuss innovations in practice zLearning from mistakes (hindsight is a wonderful thing) zSharing good practice zFuture challenges

3. Local pressures z Fast, fair and convenient access to health care z No waiting! z The right clinician to see the right patient at the right time

4. Sustaining the ED Quality Indicators z Achievement required z This level of activity is proving difficult z Capacity always an issue z If we do not work as a team we cannot succeed!

5. A brilliant team

6. Major benefits of collaboration

7. Support roles z Limited number of Band 3 HCSW z Well trained – NVQ Level 3 z Clear roles & responsibilities xTriage – venepuncture, cannulation and ECG xResus - cubicle preparedness, relatives support xTransfer facilitator role, safe & efficient transfer and improves time to ward from decision to admit

8. Developing band 5 role zCompetency based orientation programme (FEN) zStrong mentorship and clinical supervision zStructure for achievement – timeframes zTriage zPGDs zNurse requested X Rays

9. Obstacles to overcome z Radiology resistance to Nurse initiated X Rays z PID / stakeholder involvement z ENP & AP primary interpretation z AP now CT, MRI range of presentations

10. Making the most of the change zFebruary 2010 target reduction of £7.2m set for Salford Healthcare. z2011 closure of all five Walk-in centres zNew build ED and PCC co-located including GPOOH service zWhy not use MTS to signpost patients to right clinician, right place at the right time zPresentation Priority Matrix (PPM) offered creative solutions (2 nd Eds)

11. Stakeholder engagement zED Consultants zSenior ED Nurses zPrimary Care Nurses zGPs zPrimary Care Physician zEmergency Care Practitioners (ECP) BGYOR

12. 12345 Abdominal pain in adults RMa Ma P PC Abscesses and local Infections RMa Mi PC Allergy RR Ma P PC Asthma RR Ma PC Back pain RMa Mi P PC Bites and stings RR Mi P PC Chest pain RR Ma MiPC Collapsed adult RR Ma MiPC Dental problems RMa Mi Dent Diabetes RR/Ma Ma PC Diarrhoea and vomiting RR Ma P PCSC Ear problems RMa Ma P PC Eye problems RMa Mi/Eye MiPC

13. The Deflection Process zPPM developed to safely deflect patients from the ED to primary care zRun by key practitioners with additional primary care training (ECP) zShort consultation zRecording of observations but no in-depth physical exam zPatient education essential zThe discussion is more important than the action

14. ENPs: Band 6 & 7 zDeveloping Clinical Skills module zDefined presentations managing ambulatory caseload zAssess, diagnose, treat zPractice guidelines zPGDs / NMP zChoice for patients

15. ENP ad hoc practice z 2 years limited exposure (2009 – 2011) zOSCAs reveal retained competence across injury skill set zLoss of confidence not competence

16. Advanced Practitioners zA hybrid not a traditional nursing role z Masters level - Clinical Practice z Trained to high standards using a Bio- Medical model z Certainly not a junior doctor substitute z Funding? z Organisational preparedness z Clinical career pathway for Senior nurses

17. Advanced Practitioners z1999 1 st AP post 2013 = 8 NPs in ED, 6 in PANDA zA truly autonomous role zClinical expertise zManaging complex clinical case load zNon-Medical Prescribers zRole models & innovators in practice

18. Trauma Centre status Problem Lack of role clarity Lack of training Structure Team leader Team number Organisation Task allocation Horizontal / vertical activity

19. Saving lives Experienced team – train together work together 65% nursing staff TNCC trained Team allocation & organisation Inter departmental links

20. Measuring achievement zMulti skilled workforce delivering right care to right patient at point of entry zStreams of care with designated staffing and expertise z Nursing roles – improving patient journey yTime to definitive management yPatient choice & experience yStaff recruitment & retention benefits

21. Measuring achievement z Trauma team developments = improved patient outcomes z Improved time to senior clinical decision maker Drs and Aps z Continued collaboration, sharing experiences z National input across the team, shaping the future

22. The future of the ED team? zContinued political directive zDriven by a changing workforce zEmergency Nurses & Medical staff will be central to change zChallenges from NHS & private sector, to deliver treatment & care to patients zUltimately the patients right to choose will shape future healthcare