1. LYMINGTON MINOR INJURY UNIT

2. Currently the 15 mins target is recorded but not reported
The Current State
Currently the 15 mins target is recorded but not reported
It will become reportable from July 2019 when we become an Urgent Treatment Centre.

4. Current Waiting Times Average booking time is 3.1 mins
Average wait for initial assessment is 9.9 mins
Average time for the initial assessment is 11.7 mins
Total ‘work time’ is therefore 24.7 mins

8. Booking in at Reception
CURRENT STATE VALUE STREAM MAP
Refer – NP
Wait
Booking in at Reception
Treatment Room –
NP + - HCSW
Wait
Discharge
IX-ray
Wait
Radiology discharge
Wait
Wait
Book to x-ray
IInitial Assessment - NP
Wait
Treatment Room - HCSW
Wait
Refer - NP
Wait
Refer – NP
Discharge
Discharge /
redirect

9. MIU Standard Operating Procedure
See and Treat
Within 15 mins of checking in at reception the patient will be called to be assessed by a Nurse Practitioner (see “See and Treat Protocol”)
If there is more than a 15 minute wait the Nurse Practitioner will implement triage using the Manchester Triage System.

10. Ideas and key themes for improvement
130 ideas for improvement generated by participants to enable achieving 15 minute initial assessment
Key themes identified; Environment, Staffing, Communication, Patient flow, IT
Priorities identified using a scoring system to ascertain objectives that would provide the most impact, with the lowest cost, low use of energy and with ease
These were rated and small groups formed to develop ideas including; Discharge from radiology, Role definition, amend SOP, develop patient signposting information and environmental estates works.
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Ideas Forms

12. Ideas and key themes for improvement
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Completed work
Inclusion of all staff affected e.g; staff working in MIU, radiology, estates
Patient handout developed, shared and amended.
Role play to assess the timings of the initial assessment and how this felt for patients and staff, including expert patients.

13. Proposed future state
Improving initial flow to ensure all patients reviewed within 15 minutes
Improved patient experience
Reduced risk
Improved staff satisfaction

14. Patient Flow diagram Arrival Self Redirection Registration: 3 mins
Signage indicating what we see/ patient information
Patient Flow diagram
Arrival
Self Redirection
Need to alert nurse on completion, so minimise delay time
Registration: 3 mins
Much shorter the currently
Generally no examination of patient
reduces duplication and free up nurse time
Initial Clinical Assessment (5 mins)
Define problem
Identify severe
Identify inappropriate
Clear need for x-ray
Analgesia
Obs (where necessary)
‘ simple’ treatment
Documentation
Treatmet

15. Electronic xray requesting
Initial Clinical Assessment
Redirection /signposting to more appropriate service
Analgesia prior to full assessment
Immediate full assessment
Cardiac presentation
( Chest Pain)
HI with LOC Significant MOI,
Heavy Bleeding,
Breathing difficulties,
Anaphylaxis,
Burns,
Limb Deformity,
Opthalmic emergency, chemical/blunt trauma.
Acutely unwell Adult/Child.
Suspected sepsis,
FAST Positive.
Wait for full assessment
Electronic xray requesting
Full Treatment room assessment
X-ray
Radiology discharge
Onward referral
Leaves department
Treatment

16. Proposed future state Streamlined registration process
Alert mechanism for nurse when patient is waiting for assessment
Changed environment – 2 rooms available for assessment
Patients no longer ‘examined’ during initial assessment
Electronic radiology requesting and direct radiographer discharge

17. Outline Implementation Plan
Key aspects of plan:
What has been delivered and in place now (Cardiac Monitors, New Patient facing website, Updates leaflets!)
Action initiatives developed within QI week that can be commenced as soon as next week.
Complete objectives, audit and monitoring relating to our new Booking In/Initial Assessment process over the next 30/60/90+ days

18. Implementation Plan

19. Lessons Learned Reflections
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Lessons Learned

20. Reflections and Conclusions
Barbara and Stephen – Service Users
Marion – HCSW MIU
Chris – RPIW Sponsor

21. Thank you’s Thank you to: Picture Barbara Strange Stephen Hales
Staff working in MIU this week
Team in the RPIW
Chris Brown
Clare Bundy
Liz Pusey
LoF Volunteer - Jenny
Picture