Kettering General Hospital NHS Foundation Trust (KGH) took part in the CLEAR UEC programme in 2021. One of the key recommendations for the trust was the creation of an ambulatory pit stop which was implemented in July 2022.
In this second part of our blog series on the transformation project at Kettering, Rebecca Barraclough, a senior sister in the emergency department who was one of the clinicians who led the implementation, describes her experience and the impact it has had for patients and staff.
We’re seeing more mental health patients than we saw pre-COVID-19 and a lot of young people with sepsis. The number of patients we’re seeing with chest pain or palpitations is phenomenal because if someone phones their GP or 111 and mentions chest pain they’re told to go to A&E or dial 999 immediately. So everyone with chest pain comes to us but the problem might be anything from a significant heart problem or it could be a muscular problem caused by someone going too hard and fast at the gym.
Patients keep on coming through the doors and we can’t ever close those doors because we’re a 24/7 service so we just have to roll with it. We’re a general hospital in a small town and there’s nowhere else to send these patients. There are times when you just think ‘I don’t know how I’m going to get through today’.
The pit stop model has worked really well for our department. We’re now seeing people much earlier who might be one step away from serious medical problems – people with acute coronary problems, septic patients, possible strokes and people who really should have come in by ambulance but have made their own way or chosen not to wait for an ambulance. It’s not that they would have slipped through the net before but we are able to identify these patients more quickly now.
Patients who come in by ambulance have already been seen by paramedics and might have had 1:1 care for four hours. But the walk-in patients haven’t been seen by anyone and that’s why we don’t want to turn anyone away at the door without a proper assessment. I wouldn’t want to be discharging anyone at triage. The biggest thing for me is identifying people with serious problems which could be life threatening or life changing if left untreated.
We still have a trained nurse in triage, then a senior clinician with discharge rights in the pit room with either an advanced clinical practitioner or a doctor and someone dedicated to bloods and ECGs – either a nurse, advanced practitioner or healthcare assistant (HCA). We have two nurses allocated to rooms with a nurse co-ordinating the area, a treatment nurse and an HCA to take patients to and from CT scans and x-rays.
The pit stop is open 24/7 though clinician cover depletes overnight. There’s always nurse cover and patients have an assessment after triage. This means there are no delays in patients being assessed as urgent and needing a bed. That gets sorted and the triage nurse doesn’t have to worry about it.
There’s still a lot of work to be done but the pit stop has definitely made a difference and helped ease the pressure.
