A highly-successful pioneering method for dealing with walk-in patient admissions at St Mary’s Hospital is on course to provide the blueprint for many hospitals across the country.
The Beacon Centre at St Mary’s has already been featured on a BBC breakfast programme for the efficient way it deals with admissions, whether it is a 999 emergency or a 111 non-emergency.
The system has been streamlined to admit all walk-in patients through the same department where hospital staff determine the appropriate treatment required. Close by the ambulance admissions entrance again ensures fast and efficient treatment for patients in the department which incorporates not only the Beacon Centre, but Accident and Emergency (A&E) and a trauma unit.
The hospital’s A&E department has recently been revamped and remodelled to make it not only larger, but to help provide an excellent working environment for staff and improved conditions for patients.
Lisa Burtenshaw, manager of the Beacon Centre, explained: “Everybody comes into the same department at the Centre, whether they are emergency; need to see a GP; come during the day, at night or at weekends. The admissions desk will help determine who the patient needs to see.
“Basically all anyone who feels they do need treatment has to do is decide whether it is a 999 emergency or they can be dealt with by dialling 111 – we do the rest!
“Those who have been involved in accidents or incidents that have left them seriously injured or bleeding will be taken straight through to the A & E department, which is adjacent to admissions. And anyone who is not sure what treatment they require is initially seen by an A & E nurse.”
Out-of-hours at the Beacon Centre works very similarly, but unlike many areas of the mainland, the Island has a very successful 111 telephone system available for those patients seeking help and advice.
Lisa said: “The 111 system genuinely works here and does so mostly because we are co-located with this single point of access. It does not matter whether a patient rings 111 or 999, the call goes to the Hub on the St Mary’s site, and is dealt with accordingly. So basically this department ‘does what it says on the tin’!”
As far as the actual Beacon Centre is concerned, 60 per cent is owned by the Trust and 40 per cent by Island GPs, which according to Lisa has been a revelation, and is set to be copied by similar departments up and down the country. The Beacon Centre deals with around 100 patients every day, not including ‘out of hours’ while A & E, which is also integrated with the trauma unit, has some 120 admissions a day. There is 24-hour consultant cover for the department; a senior and junior member of medical staff as a minimum 24 hours a day and about half a dozen qualified nursing staff. There is also at least one GP on duty during the day, and up to seven GPs dealing with admissions and telephone enquiries. Around 50 GPs across the Island are on call to work ‘out of hours’. There are also three GPs who work in the department full-time, plus a nurse practitioner and 24-hour reception cover. Added to that there is a 75-strong nursing staff attached to the A & E department along with four consultants. Robin Beal is the consultant in emergency medicine and the clinical lead for the emergency department and medical assessment unit. He said: “The changes in the department have been orientated around how the patients arrive and are processed. The department has been arranged to deal with the efficient flow of patients.
“Patients who arrive by ambulance come in via the ambulance door, and a decision is then made whether that patient needs quite acute care, or whether the person is simply unwell and needs to be seen relatively soon. If extreme acute care is required the patient goes into the resuscitation room or ‘majors’ area.
“The department has a central area where medical, clinical and clerical staff work, and everything is accessible and visible from that area, which is arguably the biggest single improvement. And we are the only department in the country which is as close to paperless as you can get. It means staff sit in front of computers, which sometimes gives patients the wrong perception, but that is the only way to do it. Similarly we are the only department nationally using a computerised prescribing system, which again reduces paper usage.”
Robin continued: “Putting the shiny new department aside, the processes and what you do with patients is the important part, and maybe it wasn’t quite right before. We are still titivating and trying to improve, but we have already made improvements when it comes to patient investigations. For example blood tests can now be carried out in the department, and we can do X-rays in the resuscitation department. We believe the way we operate is the blueprint for the future nationwide.
“The relationship between Primary Care and Emergency Medicine is absolutely vital to us, and we need to further enhance it. We already have a model that other people think is great, but we want to go that bit further.”
Overall, the message to someone feeling ill is not to be frightened to dial 111 or even 999 to seek help or advice. But inevitably the service is sometimes misused, and only recently a ‘patient’ turned up demanding treatment for a broken finger nail! Robin added: “That is not on, because it not only wastes the person’s time, but also that of clinical staff who could be dealing with other matters. We want to make sure patients who genuinely need help come in to be treated, but we don’t want to be swamped by things that don’t need to be seen.”