How Downe staff deliver top class care to local community

How Downe staff deliver top class care to local community

18 November 2020

ON March 26 as the country entered lockdown, the health service across the UK and Ireland was in the depths of preparing for the arrival of Covid-19.  

At that point, there were various different scenarios that were being planned for, based on projections and models from scientists, epidemiologists and statisticians.

The South Eastern Trust consolidated its three emergency departments on to two sites. This meant we took the decision to temporarily close services provided at the Downe’s emergency department.

Fast forward to the start of August and with the first surge of Covid past, the health service in Northern Ireland moved into rebuild mode.  

At this stage, we implemented the first stage of our rebuilding services in urgent and emergency care on the Downe site, keen to start to re-provide services to the local population and to allow our staff — who have faithfully, diligently and excellently served the local community over many years — to get back to working in that department.  

The first stage of this was to re-establish the minor injury service, delivered by our skilled emergency nurse practitioners (ENPs).

We implemented a model that required telephoning first and booking of appointments to ensure the care could be delivered locally and to allow us to reduce the risk of patients with Covid-19 coming into the department.

Over the next 10 weeks, our ENPs saw over 2,000 patients from the local community, the vast majority being in the department for less than 60 minutes.  The team of ENPs, nurses and admin staff have done a fantastic job in delivering this.

On October 19, we moved into the next stage of rebuilding services within urgent and emergency care at the Downe Hospital, opening our urgent care centre which also incorporates the minor injury service. 

This is a consultant-led service, seeing a wide range of conditions, with ability to admit into the acute medical wards in the Downe Hospital.  

This is a telephone first service for two reasons.  

Firstly, it helps our clinical teams get our patients to the right place first time to receive the care they need, while secondly, it allows us to man the Downe UCC as a Covid-19 free area, as much as is possible.  

When speaking on the phone to our staff, or being checked at the door on arrival, we will assess patients against the case definition for being suspected of having Covid-19.

In the four weeks since we opened the urgent care centre, there have been about 900 calls, with approximately 75% receiving care in the Downe. For those who were directed elsewhere, this has been based on the clinical needs that were presented to the team.

We expect this number to increase through the winter as we see restrictions relax and people’s lives return to a more normal disposition.  This was our experience in March and April and we have seen lower than normal attendances at our emergency departments during these most recent restrictions.

The context of delivering urgent and emergency care is incredibly different from pre-Covid times. When we take account of those with Covid symptoms, those who are signposted elsewhere based on clinical need, we believe we are seeing the majority of what can be seen, based on the  number of patients we would expect to see.

Our team of doctors, nurses, ENPs, admin and others are here to serve 

the local community, providing access to urgent care services and directing people to the most appropriate service if that cannot be facilitated locally.

We have worked closely with our partners in the local GP community and with the Northern Ireland Ambulance Service to facilitate assessment in the urgent care centre or directly admitting patients into the hospital where appropriate.

As we continue to manage the ongoing impact of the Covid-19 pandemic, including this current second surge, our message to the community is clear — we are here for you, access to urgent and emergency is available and we will continue to build upon what has been an encouraging start over the past three months.