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Nurse manager credited with developing ambulatory approach

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A nurse has been credited with transforming care by leading the development of ambulatory care at her hospital trust in Oxfordshire.

Sister Linsey Davis and colleagues first created the new ambulatory team in November 2015, which she now manages at Oxford University Hospitals NHS Foundation Trust’s John Radcliffe Hospital.

“We can see and treat them quicker and they’re not taking up hospital bed space”

Linsey Davis

The service, comprising the ambulatory assessment unit (AAU) and the new acute hospital at home (AHaH) team, has “transformed how many patients are now diagnosed and treated”, said the trust.

The importance of the innovation saw Ms Davis win the “outstanding achievement” category at the trust’s staff awards in December.

She was praised not only for setting up the service but for the way she has inspired and coached the new team during a period of considerable change to deliver care in a new way.

The service sees an average of 40 patients a day and supports them in a similar way to anyone attending hospital as a potential inpatient, but they can usually return home the same day.

The same ambulatory approach has also now been adopted at the trust’s Horton General Hospital.

As well as getting patients home quickly, the service has helped to reduce the number of admissions and eased pressure on beds.

After carrying out research and feasibility studies, Ms Davis started the service “in two rooms in geratology with one and a half nurses pinched from another unit”.

Initially, they were assessing what kind of patients they could take, how the processes would work and what kind of equipment they would need.

In a short space of time, the team was occupying a whole side of the geratology department and had to move to a new improved location on the fifth floor of the John Radcliffe.

Ms Davis said: “AAU covers anybody we think we could treat, diagnose and discharge within the same day, or within 48 hours. So we can treat people much quicker.

“Instead of them going through the front door to the emergency department, they’re coming through the ‘side door’ to AAU and we can see and treat them quicker and they’re not taking up hospital bed space – but they’re still getting the best possible treatment.

“People have said they’ve noticed a difference in the number of patients that are down in the emergency department,” she said.

More than 40 nurses and doctors now work in the unit, including 13 nurses who comprise the AHaH team – the first time that acute hospital nurses in Oxfordshire have gone out in the community.

Oxford University Hospitals NHS Foundation Trust

Nurse credited with developing ambulatory approach

Linsey Davis

AHaH, set up in October 2016, has become a key component of the new service, said Ms Davis.

“AHaH is the next step of the ambulatory pathway. Patients who are nearly ready to be discharged from hospital – perhaps they need antibiotics or further treatment, such as blood tests, which they would normally stay in hospital for – can now have that in their own home through AHaH,” she said.

Most similar services around the country take nurses mainly from emergency departments, but Oxford has consciously decided to recruit from a number of teams, it said.

“We have emergency department nurses, geratology nurses trained in dementia care, nurses from gastro and renal, a stroke nurse – so we can call on a range of expertise,” said Ms Davis.

“We all share information and look at how we can improve things and everybody is happy to share their skills and expertise to make the service work better,” she said.

She added: “We even have a WhatsApp group, which keeps the team working closely together and makes everybody feel involved and supported.”

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