Kettering General Hospital NHS Foundation Trust (KGH) took part in the CLEAR UEC programme in 2021. One of the key recommendations was the creation of an ambulatory pit stop which was implemented in July 2022.
In this third part of our blog series on the transformation project at Kettering, Sarina Vincitore, a senior sister in the emergency department describes how the model is giving priority patients much faster treatment.
When you’re a triage nurse it’s your responsibility to allocate a priority patient to another area within the department. That causes a delay as there’s only one person assigned to triage whereas, with the pit stop model, we have a room next door to put that patient in. We know they’ll be seen by a senior clinician, a nurse and a healthcare assistant so as a triage nurse I don’t have to walk round trying to find allocated space for them.
With the pit stop, patients are prioritised and seen quicker, our chest pain patients get ECGs within 10 minutes, mental health patients get an assessment completed in a timely manner and our KPIs (key performance indicators) have improved.
We call it a ‘sick quick’ model because it’s about identifying who’s sick in the department within 15 minutes of arrival for walk-in patients. We use the Manchester Triage System* which gives us a clinical priority matrix to decide which area a patient needs to go to. The pit stop gives us an acute area where very sick people can have their first line of treatment. It’s a pit stop not an MoT! For ambulance patients, that’s done on a trolley in an ambulance streaming area, so walk-in patients and those who come in by ambulance receive the same level of care. Some patients will be de-escalated and sent to our SDEC or ‘fit to sit’ area while others will be escalated and sent to our resuscitation area.
For urgent patients needing immediate attention, the pit stop works fantastically. Say a patient comes in with cardiac chest pain, they’ll go from triage straight to the pit stop where they’ll have an ECG. But if someone comes in with urinary retention, they won’t go to the pit stop because they’re not going to die from an overflowing catheter. The pit stop is dealing with the most urgent red and amber patients, leaving the rest of the department to care for lower priority patients.
As a triage nurse, it takes a huge weight off your shoulders because you know that a priority patient is safe going into the pit stop. We’re identifying the most unwell people quicker so it’s reduced patient risk which is brilliant.
* The Manchester Triage System is a clinical risk management tool used by clinicians worldwide to enable them to safely manage patient flow when clinical need far exceeds capacity. It emphasises the importance of patients being seen in in order of clinical priority rather than in order of attendance.