13 July 2010

Hospital walk-in centres seeing 30 odd patients every day

| johnboy
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Walk-in poster

At 4am this morning Katy Gallagher mailled out a media release celebrating the first two months of the nurse-operated walk-in centre at Canberra Hospital:

ACT Minister for Health, Katy Gallagher, said today that Australia’s first public nurse-led Walk-in Centre had been well received by the Canberra community, with more than 2000 people seeking advice or treatment in the eight weeks since it opened.

The Walk-in Centre at Canberra Hospital opened to the public on the 18th of May, offering fast, free, one-off advice and treatment for a range of minor illnesses and injuries.

“The greatest users of the Walk-in Centre service so far have been people aged 18 to 35 years.

“People with respiratory tract infections have been the most common type of presentation to the centre, followed by people seeking treatment for minor wounds.

The Walk-in Centre is open 7am- 11pm, seven days a week with no appointment necessary, and is staffed by trained Receptionists, Nurse Practitioners and Advanced Practice Nurses.

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I-filed said :

Did I hear right? I could have sworn the 6 pm ABC news bulletin just then quoted Gallagher saying the new centre was getting “2,000 visits a week”.

Accidentally posted!

Did I hear right? I could have sworn the 6 pm ABC news bulletin just then quoted Gallagher saying the new centre was getting “2,000 visits a week”.

JumpingTurkey1:23 pm 21 Jul 10

Generally drs are very accepting of ‘their own’ (including medical students) – e.g. unwritten rule that drs do not charge other drs (and medical students, and dr’s families). So a nurse-turned dr or a nurse-turned medical student will be very acceptable to drs.

JumpingTurkey1:18 pm 21 Jul 10

Well I think drs would be okay with this – I am sure that no one would doubt that nursing experience will enable them to shave off a few years off medical school, also recognising that nurses will be giving up substantial income to embark on such a program of study.
Maybe even more I think – $45K per year scholarship.

justin heywood12:59 pm 21 Jul 10

JumpingTurkey said :

…..Perhaps a better solution to shortage of drs and recognising some experience that nurses have is to establish a fast track path for experienced nurses to graduate as a doctor – since they already have communication skills, and have experience dealing with patients and have nursing knowledge, why can’t they be admitted into a fully paid (say $35K per year salary) intensive (48 weeks per year) graduate course in Medicine for 2.5 years?….

That’s not a bad idea JT. (but imagine the outcry from the doctor’s unions)

JumpingTurkey12:49 pm 21 Jul 10

You need to look at how nurses are trained. They are trained to be very good at ‘nursing’ the patients back to health. Their training focuses on improving patient’s health once the diagnosis is clear. Their training focuses on administering medications, taking observations, identifying and managing wounds, etc. They are trained to know when there are deviations from the expected course of recovery of illnesses.

However doctors are trained to be diagnosticians. As I am sure that many of us realise, diagnosis is not straightforward, as there are many many rare conditions that can mimic each other, and it is often not reasonable to subject people to hundreds of tests (many of which are invasive) to rule out all possibilities. Some degree of ‘educated guessing’ is inevitable.

It takes medicos around 10 years to train up as a GP. This involves extensive training in the art of taking a history, examination, and ordering and interpreting of investigations. This also means extensive studies on clinical features and laboratory features of different diseases, as well as studies about medications and their modes of action, common side effects and dosages.

Because of these differences in training and key focus between nurses and doctors, even when nurses undergo further training, and even if they have 20 years experience as nurses, such experience often is not ‘doctor’ experiences or ‘doctor’ training. It is same as asking a kidney specialist who has been around the wards for 30 years that because he has been around the wards long enough that he would know how to do an experienced nurse’s job in effectively nursing people back to health, or administering medications in a safe and efficient manner. 20 years of experience as nurse does not suddenly make them experts in diagnosis – simply because their every day work does not involve diagnosis! Whereas a GP in training will be actively looking at people’s throats, and consulting with their senior colleagues on what it is, and how to treat it, and gain experience by doing that, your every day nurses will not be doing the same.

Even if a nurse undertakes further studies and gains extra experience as nurse practitioners, this is usually limited to the field of their choice. They do not simply gain an all round experience and training that a typical doctor receives by spending time looking at patients from all sorts of different fields – e.g. cardiology for few months, renal medicine for few months, surgery for few months – you get the drift.

The reason for all of this is not to say that doctors are superior to nurses. Simply that their jobs are different. And 20 years experience as a nurse does not make them better than even a junior doctor at diagnosis (the most important part of doctoring) – just as a lawyer with 30 years experience is no better in accounting than a fresh accounting graduate straight from uni. Therefore it is no surprise that these walk in clinics should be limited in scope – they need to be protocol driven in order to protect both the nurse clinicians and the patients. If an illness deviates away from their protocol or what is common then they may not have the core knowledge / diagnostic skills / broad medical knowledge to fall back on to.

Perhaps a better solution to shortage of drs and recognising some experience that nurses have is to establish a fast track path for experienced nurses to graduate as a doctor – since they already have communication skills, and have experience dealing with patients and have nursing knowledge, why can’t they be admitted into a fully paid (say $35K per year salary) intensive (48 weeks per year) graduate course in Medicine for 2.5 years?

You would assume that demand for the clinic is still in the ramp-up phase, and is expected to, let’s say, increase about six to eightfold, within a reasonable period, to get the cost per visit down to something more reasonable, or else after a few months, they intend to scale it back to something matching the demand.

But this is the government, so that’s probably too much to expect, and they’ll have an expensive bunch of nurses under-employed forever.

That’s $220.00 PER VISIT!

Frankly, that’s way too much for the ACT ratepayer to be spending “advising” someone with the sniffles.

How does it stack up against the forecasts?

Are the visitor stats increasing over time?

Maybe it’s just me, but I find the costs for this clinic absolutely staggering. The clinic costs $10 million over 4 years to run, plus $2.175 million in capital costs to get it started.

Averaged over 4 years that’s $3 million a year to treat ambulant patients (i.e, not requiring acute emergency care). Surely it would have been much more cost effective to employ a single GP who could have seen the same volume of patients for a fraction of the cost??

Been on two separate occasions, both in the evening – excellent. Waited 10 mins on on occasion, nil on the other. The nurses were thorough and were able to provide antibiotics there and then for tonsillitis. Had to refer for a kidney infection though – we thought it was a UTI which IS treatable.

These rules and limits are a bit silly and they have to ask 1001 questions first to see if they are allowed to treat you. I expect this is to appease GPs, who probably feel threatened by a nurse prac clinic (and no wonder – it’s top notch, free, and open from 7am to 11pm, unlike my GP).

PS, I believe it’s a Cth (not ACT govt) funded initiative.

I struck the promo materials ages ago in a cafe (poster and card). Typically crap govt marketing dolts: no indication of where the centre was! Now I know, thanks!

I thought nurse practitioners have been able to prescribe for a couple of years.

MrNurseRatchet8:03 am 14 Jul 10

As a side note, I find it interesting that conversations are centric on quantity as opposed to quality of throughput. I suppose there’s a healthy balance between the two…

The hospital is such a disaster at the moment with all the construction I’m surprised people can even find the ED, let alone the walk in centre :-/

justin heywood10:27 pm 13 Jul 10

JessP said :

Me thinks it might be a better use of staff NOT to have 5 nurses seeing 30 -40 people a day – a 6 to 8 each!

Given that the place is open for 16 hours a day 7 days a week, wouldn’t that be at least 2 shifts (i.e. 10 staff) to see the 30-40 people per day? I hope that isn’t right.

There might be a slight hope of the place taking pressure off the Emergency department next door if there were sufficient signs pointing people to where the clinic actually is.

It’s hidden behind some trees in a bit of a gully somewhat near the the Emergency department. The 2 hour parking lot is oddly close but there are no signs saying this is the closest parking for the walk in centre, nor are there any signs pointing you from the parking lot to the walk in centre.

Signage, people.

Me thinks it might be a better use of staff NOT to have 5 nurses seeing 30 -40 people a day – a 6 to 8 each!!! HOLY WASTE OF MONEY YOUR CHIEFLYNESS!!

They aren’t really capable of treating serious injury or illness, so they’re more of an alternative to primary care than emergency. It might be worth Katy’s time to check if the nearby medical centres have seen a couple of percent decrease.

Do they remove things from fat rolls?

p1 said :

I wonder if they are same odd people who post on RA?

No, oddly enough I haven’t been yet…

justin heywood4:33 pm 13 Jul 10

By my calculation of Katy’s figures, that equates to around 43 patients a day. If there are 2 shifts for 5 staffers (post #3) for a 16 hour day, how many patients does each nurse see in a shift?

I applaud the ACT government for trying to do something about A&E at Canberra Hospital. My main problem with the walk-in centre solution is that most people attend Accident and Emergency because they consider their condition to BE an emergency (rightly or wrongly). If the walk-in centre can only treat non-urgent matters, how will this solution reduce waiting times at A&E?

I wonder if they are same odd people who post on RA?

MrNurseRatchet4:07 pm 13 Jul 10

Furry Jesus said :

Hospital walk-in centres seeing 30 odd patients every day.

No normal people? Eccentrics are renowned for their strange resistance to seeking medical treatment, along with variable hygiene practices and unusual dress sense, so hats off to ACT Health for its success in engaging this underserviced group. Who said social inclusion was just a feel-good sop to bleeding-heart liberals?

LOL!

Hospital walk-in centres seeing 30 odd patients every day.

No normal people? Eccentrics are renowned for their strange resistance to seeking medical treatment, along with variable hygiene practices and unusual dress sense, so hats off to ACT Health for its success in engaging this underserviced group. Who said social inclusion was just a feel-good sop to bleeding-heart liberals?

MrNurseRatchet3:10 pm 13 Jul 10

As far as I understand it, the nurses there have been given strict protocols through which they have been allowed to practice, which may have been why they were unable to prescribe a medication for a certain illness or provide wound care. The nurse there told me they will only provide care and/or medications as long as it fits within the guidelines established by ACT Health. I went there for a really bad case of strep throat and had received antibiotics and a really good thorough examination. On the other hand my mate had to go there for a minor infected spider bite and they couldn’t give him antibiotics. Had to be sent to his GP for that. Overall pretty happy with the service, just wished simple things like infected spider bites could be taken care of there too.

Woody Mann-Caruso2:19 pm 13 Jul 10

Katy was on the radio this morning saying there’d been no change in A&E attendance figures. She wasn’t sure why this was the case.

Nurses are such a funny culture. It seems that if you get their attention and they know they are required to do their job they will do it, and do it well, But until that point, they seem to be top of the “not my job” class. Whenever I visit someone at hospital there are always nurses a thteir station, and you feel like the rudest person in the world interputing their conversations to ask for directions or confirm what room someone is in.

Please don’t get me wrong I really appreciate how hard nurses work and think they do a wonderful job, better than doctors in many cases… This is just an observation of the culture of the industry.

Waiting For Godot12:41 pm 13 Jul 10

Fiona said :

Anyone know what the wait time is like?

If you get there before 8:30AM you can usually be seen immediately. I’ve been there twice so far and I’ve got no complaints. The only problem is that the nurses there cannot prescribe medication. I thought Kate had changed the law so they could. Something to look into, methinks…

I attended one Saturday – no wait time as the place was deserted except for about five or so on staff. BTW – very poorly signposted and I ended up having to go to emergency to even find out where the clinic was. Was astonished to find 100+ people in Emergency but the walk-in absolutely no patients.

Despite this, I had to undergo the third degree about who had referred me (even though I gave them letter with all possible details from my GP)as apparently the walk in service does not include wound dressing changes (recent minor op required me to have daily wound dressing so GP thought this would be the logical place for me to go over the weekend as her practice was closed).

After a large amount of unnecessary bagging out of my GP for ‘incorrectly’ referring me to the clinic they decided that they would actually change the dressing for me. Following that, the service was good.

However, surely basic dressing change is just the sort of thing they should be doing. I was told that, in future, this was the role of the Community nurse who should have been arranged to come to my home to do this dressing change. I was astounded! There were at least five nurses standing around doing nothing! I was more than able and willing to get to the clinic and certainly did not need a home visit from what I imagine are very busy community nurses. I was told not to come back to the clinic the next day for dressing change as they would not do it.

amarooresident312:15 pm 13 Jul 10

The real measure will be if the Emergency Department is seeing any reduction in people presenting there.

Anyone know what the wait time is like?

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