The Medical Investigations Unit

(MIU)

‘Leading the Way in Nurse Led Services’

Geoffrey Walker OBE JP MA RGN PgDip DipEd FAETCMatron for Cardiology, Medicine, Specialist Medicine, and Specialist

Nursing ServicesPoole Hospital NHS Foundation Trust

British Journal of Nursing UK Nurse of the Year 2013

Quote

“While the intellectual foot has made a step in advance, the practical foot has remained

behind.”

Florence Nightingale 1820 - 1910

My Vision

To provide a gold standard patient focused service ,that is

Nurse Led, a direct alternative to Inpatient care and challenges

accepted practice.

The Primary Function of The MIU is as an Enabler

• To avoid inpatient stays by providing an out patient alternative to care.

• To facilitate early discharge by pathway changes.• To prevent elective medical admission cancellations by

commencing treatment before the inpatient bed is ready.

• To manage the Trust’s discharge facility to free up acute beds earlier.

• To support day case treatments and diagnostics which previously may have required an inpatient stay, as well as challenge and change previously accepted practise for admission.

Keys to success

• The Unit is Nurse led, by highly skilled and able nurses with advanced practice qualifications.

• The service embraces the MDT approach to care and is supported by the medical teams.

• The service is able to respond to individual patient treatments and requirements as needed.

• The service is seamless.• The service is menu driven.• The service can respond to urgent as well as routine

booked requests.• The service is gold standard with patient satisfaction and

experience placed high on the list of priorities.

Service Impact• 2009 – 30 patients per week 5 Day Service 8 hours per day.• 2010 = Phase 1 50/60 patient per week, 7 day service.• 2010 = Phase 2 100/110 patient per week.• 2011 = facilitated the reduction of medical inpatient beds and 135 patients

per week• 2012 = 150 patients per week and supported the opening of a similar unit

at RBH.• 2013 = extended the footprint by 50% 180/ 200 patients per week and

incorporated the Trust Discharge Lounge within,• 2014 = Looking at new areas to develop with Gynaecology and Alcohol

Detox.

Monday – Friday 12 hours per day/ Saturday and Sunday 8 hours per day

33% reduction in inpatient medical beds with improved qualityand pathways.

Quality Impact• Advanced practise nurse led service.• PICC insertion clinics and outreach ability.• 600 + blood transfusions (including one of the first in England to

have nurses prescribing blood routinely).• Biopsy’s approx. 288 per year.• Bone marrow aspirations approx. 384 per year.• Drug therapy including IV antibiotics.• Pantemadine nebuliser clinics.• Same day admission for pacemaker patients.• Elective admission service.• Heart failure Service.• Low infection risk.• CF pathway support.• Cardioversion service.

Challenges and Issues

• Recognition of the need to,’ spend to save’, and support at Trust Board Level.

• Medical Staff engagement.• MDT involvement.• Training Packages.• Client group (Who is eligible and who is not).• Funding.• Recruitment.

Cultural (Changing the patients expectations).

How to begin a Service

• Look for a Need that is Patient Focused.• Create a Vision.• Develop the Concept.• Be Entrepreneurial.• Prepare a Business Plan (Use Finance and

Managerial Support).• Don’t be Risk Averse.• Self Belief, Trust yourself, You’re the Expert!

Never Stand StillLook for new service opportunities

• Identify a suitable service.• Hyperemesis Gravidarum (Gynaecology).• 72 Patients in 2013 required hydration = 126

inpatient days.• 4-6 hours IV therapy, and daily check of bloods etc.

(Ideal for MIU) !• Cost £ 250 per bed day . (Saving £31.500 - Nursing

time 0.2 band 5 WTE = £6.200 Saving £25.300).• More importantly better quality of service to patients

who can go home to their families.

Most Importantly

Sell your VisionMarket you Concept

Publicise your Service

Quote

“ For us who nurse, our nursing is a thing, which, unless we are

making progress every year, every month, every week, take my

word for it, we are going back”

Florence Nightingale

1820 - 1910

Quote

“I attribute my success to this - I never gave or took any excuse.

Florence Nightingale 1820 - 1910

Poem

‘The Man in the Glass’.

THE MAN IN THE GLASS

“When you get what you want in your struggle for self

And the world makes you king for a day, Just go to a mirror and look at yourself

And see what that man has to say.

“For it isn’t your father or mother or wife Whose judgement upon you must pass,

The fellow whose verdict counts most in your life Is the one staring back from the glass.

“ Some people might think you’re a

Straight-shooting chum And call you a wonderful guy.

But the man in the glass says you’re only a bum If you can’t look him straight in the eye.

“He’s the fellow to please, never mind all the rest

For he’s with you clear to the end And you have passed your most dangerous test

If the guy in the glass is your friend.

“You may fool the whole world down the pathway of years And get pats on the back as you pass

But your final reward will be heartache and tears If you’ve cheated the man in the glass”.

Thank You

Questions?