Urgent care services at Singleton and Neath Port Talbot hospitals have changed to provide more care for patients during the busiest times.
The Minor Injury Unit at Neath Port Talbot will now close overnight - between midnight and 7.30am - because only around three patients a night had been attending during these times. Instead, night staff will switch to working earlier in the day when the unit is much busier, so more patients will get seen more quickly.
At Singleton Hospital, a confusing system of several different urgent care services will be brought together into a single integrated service. Opening times will be expanded into the evening and weekend for urgent care patients who are referred directly by a GP, or other health care professionals. Walk-in minor injury patients will still be seen, but opening times for this group will be a little shorter. Instead of 8am- 8pm seven days a week, the hours will remain the same Monday to Friday but change to 8am-1pm on weekends.
The redesign is aimed at helping patients who are not 999 emergencies, but who still need care straight away. These include Minor Injury Unit patients; patients referred urgently to hospital by their GP, and other patients who need an assessment to decide if they should be admitted to a ward or cared for in another way.
The changes, aimed at better meeting demand and improving patient experience, follow a formal public engagement exercise carried out by ABMU Health Board and ABM Community Health Council between December and February. The plans were given formal approval at the March meeting of ABMU Health Board and supported by the Community Health Council.
This new system is also supported by the new 111 service, which launched in the ABMU area in October. Patients who are not emergency cases but who need urgent care can ring the free 111 number to get advice if they are not sure what to do or where to go. 111 has dealt with around 70,000 calls over the last five months, with most being answered in under 90 seconds.
Senior staff at Singleton and Neath Port Talbot hospitals designed the overhaul of their services to make the best use of evolving clinical teams and staff, and reduce the time patients wait for urgent care. Clinicians and managers at both hospitals came up with ideas of how to streamline and improve services.
The changes at Singleton Hospital pull together four different services, the Acute GP Unit (AGPU), the Singleton Assessment Unit (SAU), the Minor Injury Unit (MIU) and Ambulatory Emergency Care (AEC)
The main benefit of merging these four teams are longer opening hours for services when the demand is highest, including later into the evenings and weekends. This will allow more patients to be assessed more quickly.
Singleton will also continue to provide as assessment clinic for eye patients.
Other changes include:
" As well as two additional advanced nurse practitioners joining the new centre; the AEC part of the service will have a dedicated consultant.
" At present, patients accessing the four services go to different reception desks. In the new centre there will be just one, along with one triage area.
" No-one is currently on reception after 8pm. The new centre's reception desk will be manned until midnight, seven days a week.
Dr Chris Hudson, ABMU Clinical Director of Medicine and Unscheduled Care, said:
"We believe these are common sense changes we can make which will really make an improvement to the service we can offer, particularly around managing times of peak demand.
"Working together in one team will provide a more timely service and a much improved experience for patients. It will also have a positive effect for patients at other hospitals like Morriston, because it will reduce pressure on that hospital."
Singleton Hospital's service changes are also in line with the ARCH (A Regional Collaboration for Health) programme's longer term plans for Singleton Hospital. Singleton is earmarked to become a centre of excellence for ambulatory care. Ambulatory care can be described as care that through advanced intervention, technology and modern care, avoids the need for hospital admission.
Neath Port Talbot Hospital
The MIU is led by a consultant nurse, and the service is delivered by emergency nurse practitioners; triage nurses and healthcare support workers.
It has a reputation for seeing and treating patients quickly and effectively, but has now become a victim of its own success. So many patients have been attending the MIU between 9am and 8pm (around 120) per day, that waiting times started to grow.
Conversely, after midnight, very few patients were turning up - about three per night.
Now the MIU will book in the last patient by 11pm, close at midnight and then re-open the MIU at 7.30am. Overnight staff will switch to earlier shifts, so many more patients would be seen faster.
Some quick facts and figures:
" Between 9am and 8pm the MIU is at its busiest with around nine patients attending each hour; circa 120.
" That rate drops to three patients per hour between 10pm and midnight.
" Between midnight and 7am, the MIU normally only sees 3 patients - throughout the whole period.
Overall demand for the MIU is increasing year on year. Between September 2012 and August 2013 there were 31,300 new attendances, but by the same period in 2016 they had increased to over 40,700; the vast majority during the day and early evening.
This demand has meant an increase in waiting times, with the MIU sometimes even breaching four-hour target times. There has also been an increase in the numbers of patients who don't wait when the department is busy and leave.
However, it is expected that redeploying staff to busy times will mean the majority of patients treated and discharged in under an hour, and 95% within two hours.
Overnight minor injury patients will be able to use Morriston or the Princess of Wales emergency departments (EDs), or can call the new 111 service for advice. As patient numbers are so low, this will not impact adversely on the EDs. In fact, the quicker service provided by the MIU during the day and evenings is expected to help take pressure off both Morriston and the Princess of Wales EDs overall.
Claire Birchall, Neath Port Talbot Hospital's Unit Service Director, said:
"As the patient numbers are increasing this means that people who are waiting to be seen can also wait longer, and we appreciate that this can be frustrating.
"We want to improve the quality of our service by making sure we have more staff available when we know more people will be attending.
"Added to this, our emergency nurse practitioners are highly specialised which means they are not easy to recruit and take a long time to train up. It is important to make the best use of these highly skilled staff by asking them to work when most people need to be seen."