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Exclusive: 'Gatekeeper' nurses stream 60 patients away from hospital A&E in one day

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Nurses at a hospital in Dorset have helped ease pressures on its emergency department this winter via a “streaming” service that saw 60 patients redirected on Sunday, a matron working on the initiative has revealed to Nursing Times.

The streaming service, which places an advanced nurse practitioner as the first port of call within the Royal Bournemouth Hospital’s accident and emergency entrance, has helped to cut waiting times by redirecting patients with non-emergency needs to alternative services.

“Patients are streamed away at the point of contact to the emergency department which reduces the number of patients coming in”

Leanne Aggas

Leanne Aggas, an emergency department matron at the hospital, told Nursing Times that 60 patients were “streamed” away from its front door on Sunday.

“Patients are streamed away at the point of contact to the emergency department, which reduces the number of patients coming in, quite significantly,” she said.

“It’s taken us a while to get to the point where we’re seeing these sorts of numbers, but we are now getting better results,” she added.

The initiative began last summer, but in wake of winter pressures, the hospital has recently started to see more of an impact.

Under the service, advanced nurse practitioners, described by the hosptial as “gatekeepers”, ask patients a series of questions, carry out a visual assessment and then decide whether that patient needs to be in the ED or whether they’re appropriate for alternative services, such as the GP-led Urgent Treatment Centre.

“No one will go unless I know they’ve got a good pathway to follow”

Tracey Turley

Patients will then be given an appointment with a GP, if deemed appropriate by the nurse. The nurse can also refer patients to their own GP practice or pharmacies, based on their individual healthcare needs. Under the policy no-one is sent home, but simply redirected if appropriate.

“Nurses are very good, especially ED nurses and experienced ED nurses, at taking a look at a patient, listening to some very key, quick questions and making an informed decision,” said Ms Aggas.

“A quick inspection is the key, while ensuring you follow a process to make sure you’re sending patients to the right place and to make sure you’re safeguarding them,” she added.

The matron also explained that if a wrong decision has been made, patients are accepted back to the ED.

She told Nursing Times: “Nurses don’t like taking risks, for the right reasons, because you don’t want any harm to come to a patient, and so this is a completely different way of working.

“Historically, you’d never send anyone away from the ED, but we have to look at this as that we’re not sending people away – we’re re-directing them,” she said.

Tracey Turley, an advanced nurse practitioner who also works on the new service has been in nursing for 22 years, with a background specifically in ED.

“It is important to bear in mind that A&E is not an alternative to a GP appointment”

Leanne Aggas

Ms Turley explained how having a nurse with a “smiley face” at the front door can make a difference to patients, particularly those who didn’t want to come to the ED in the first place.

“The fact is, we’ve got the right people at the front door. We’re not seen as this ‘so-called’ bouncer, we’re not going to bounce patients out and kick them out,” she told Nursing Times.

She added: “We’re here as an advocate, we’re there to identify the patients who can be seen more appropriately elsewhere. No one will go unless I know they’ve got a good pathway to follow,” she said.

In addition, Ms Turley told Nursing Times that she too had noticed that the service had become “more effective” recently in the middle of winter.

“We do get a spike of patients over this period and obviously over the next couple of weeks where we’re going to get this cold spell, I’m sure that the GP services around the local area are going to be overstretched,” she said.

Patients with sore throats, chest infections and colds who would ideally be seen in primary care are coming to them, she noted.

For some patients, Ms Turley explained, they aren’t even registered with a GP. “At that point you can also advocate health promotion and give them the online NHS details on how to register with a GP, because not everybody knows what to do,” she said.

ED Matron Leanne and ED Gatekeeper Tracey

ED Matron Leanne and ED Gatekeeper Tracey

Source: Royal Bournemouth Hospital

ED Matron Leanne and ED Gatekeeper Tracey

Ms Turley said that, as advanced nurse practitioners and prescribers, those running the initiative also had the added advantage of being able to treat the patients themselves too, if required.

She said: “I do think this service is helping to reduce winter pressures on the ED and I also think it’s a positive move forward for the NHS, as well as for Bournemouth.”

Speaking about the positive reception it has had at the hospital, she highlighted that she had not come across any patients who were not happy about the service.

“I enjoy the role because I think having a nurse on the front desk who’s a bit of a smiley face and is willing to listen can make a difference,” she said. “As nurses generally, it’s that care and compassion that most people want and to have somebody to listen.”

She added: “If anything, I think we’ll become a victim of our own success. Patients are going to see such a good service that people may choose it as an alternative to GPs, but what we have to do as practitioners is reiterate that this is not an alternative.”

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Readers' comments (2)

  • Marvellous initiative being shown here, Nurses being involved with management at last.

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  • very good role for nurses. was smiling from the time I started reading till the end because I could see myself doing that. good job everyone involved!

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