ÃÛÌÒAPP

ÃÛÌÒAPP’s Hospital @ Night service has gone from strength to strength over the last 15 years.

Since its inception with one team at the Freeman Hospital covering all surgical specialties the service now supports around 1,200 beds, split into five teams supported by 17 Nurse Practitioners.

The Nurse Practitioners all bring different experience and expertise to the team ranging from:

• renal
• critical and high dependence care
• medical education,
• medical admissions,
• sepsis management.

Most of the Nurse Practitioners are Independent Nurse Prescribers – the most newly appointed practitioners will undergo training soon.

The teams are specialty based with different team members depending on patient location:

Freeman Surgery (289 beds) – Elective orthopaedic, ENT, vascular surgery, colorectal surgery, HPB, urology and transplantation (kidney, liver, pancreas, islet)

NCCC (99 beds) – Inpatient haematology, oncology and renal

Neuro/Ortho, RVI (134 beds) – Neurosurgery, trauma and orthopaedics and spinal surgery

Medicine RVI (328 beds) – All medical specialities

Freeman Medicine (245 beds) – All medical specialities

Brian Crosbie, Senior Nurse explains: “The Hospital @ Night team was implemented as part of an NHS initiative to ensure optimum patient safety during the out of hours’ period when medical cover had reduced following implementation of the European Working Time Directive. It provides a collaborative team approach and assurance of clinical prioritisation.

“During implementation it was agreed that in order to succeed the Nurse Practitioner would lead the team and practice enhanced skills such as being able to undertake a history from a patient, perform a clinical examination, formulate a plan of care, and prescribe where appropriate.

“As such, these roles were ideal for co-ordinating care in the out of hours’ period – ensuring that patients were seen by the right person at the right time with the right skills”.

So how does Hospital @ Night work?

The Hospital @ Night Team is co-ordinated by a nurse practitioner within each team. The wards call the nurse practitioner (as the first point of contact) with any patient concerns. This prevents the junior medical staff having to take numerous calls when reviewing patients. The nurse practitioner triages the calls and either deals with them or passes them on to the most appropriate member of the team.

As a contact within the team, they are a resource for other team members and also provide essential support to ward based teams out of hours.

Patient reviews can include the use of support services such as critical care outreach, physiotherapists and ensuring the most senior member of the medical team engages in the patient review.

During the month of November 2022 the teams Nurse Practitioners received over 4,500 calls, responded to over 350 deterioration alert calls – of which 100% were appropriately documented by the Nurse Practitioners – and prescribed over 1,300 medications.

Hospital @ Night team are also able to support staff members with regards to their health and wellbeing. As mental health first aiders they offer staff impartial support – listening and offering guidance.

“Receiving compliments from patients is rewarding and staff have been nominated for personal touch awards/greatix by patients” adds Brian.

“I would like to thank all the staff – medical, nursing, human resources – everyone who over the years have been involved with the development of the service.

“In particular I’d like to thank my team of Nurse Practitioners who work very hard and keep professionally updated to maintain patient safety out of hours”.

A fast, responsive service of consistently high quality

Executive Chief Nurse Maurya Cushlow says: “The Hospital @ Night time are a fantastic team providing excellent care out of hours to some of our most complex patients. Working alongside the nursing teams and with our medical staff they provide a fast, responsive and consistently high quality service.

"I know how much they are valued by all staff who work with them and it’s a testament to the work of the whole team that they are held in such high regard.

Maurya Cushlow, Executive Chief Nurse

“I want to offer my personal thanks for your 15 years of service and look forward seeing the work of the team grow from strength to strength.”

Some more supporting comments sharing how much the team is appreciated

‘Brian and the H@N team have been instrumental in maintaining safety and quality in RVI medicine for years and particularly so over the last 3 years. The team are brilliant, and I know how valuable they are to both the ward staff and the junior medical staff out of hours so that it does feel like a real team effort overnight.

‘They have been hugely supportive to us and from next week will extend their cover to Freeman medicine which is a massive step forward on the Freeman site. In the challenging and often dire situation we find ourselves, I just wanted to let you know how appreciative we are to the H@N team and highlight that even now with all that is going on, there are still some good things happening.’

Here’s to many more years of our invaluable Hospital @ Night service.