Collaborative working has allowed the NHS in north Cumbria to deliver more care closer to home, free up space in A&E and provide a better patient experience.
Thanks to being able to deliver more care in Community Hospital Day Units, there is now space in the Medical Procedures Unit at the Cumberland Infirmary to provide more complex care which previously had to be carried out in the A&E departments.
Staff have been trained in the Day Units at Maryport and Wigton hospitals to deliver infusions for Crohn’s and Colitis closer to patients’ homes instead of at the main hospitals.
This means more complex procedures, such as paracentesis, are now being provided in the Medical Procedures Unit. Paracentesis is done when a person has a swollen abdomen, discomfort or problems breathing because of too much fluid collecting in the tummy. Paracentesis removes the excess fluid.
One person who can speak first hand of the improvements this has made is 70-year-old Mr Terence O’Malley, from Carlisle. 
He said: “Having the procedure done on the Medical Procedures Unit is so much better. The staff are there for you all the time, you’re not left in a side room, and it’s far less noisy. When I had to have it in A&E it was quite noisy and such a busy environment, the staff did their best but this is so much better because they can concentrate on one thing at a time. I feel really looked after. I get my own bed, a coffee and some food, the staff are excellent.”
Previously Mr O’Malley was referred to A&E through his GP and its far busier environments so he would often need to wait to access the treatment which is not ideal for a procedure that can take up to seven hours. It also meant that space in A&E was reduced for most of the day while the procedure is undertaken. Now he calls the team directly to be booked in for his treatment at the Medical Procedures Unit.
He explained: “I go in and get prepped, the clinician carries out the procedure and afterwards I have to stay for a while to be monitored. The staff are there all the time checking my blood pressure, oxygen levels and what not, it’s a totally different environment. One of the best advantages is that you always see the same staff and that just gives you reassurance, I think that changing how it is delivered is an excellent idea and long may it last.”
Fiona Sheridan is the lead nurse in the Medical Procedures Unit (MPU) she said:
“This was a real collaboration between our colleagues in urgent care, gastroenterology and ourselves. We knew that we would be able to deliver a service that was more positive for patients if we could bring it into MPU, so that we could plan a date and time for the patient, avoiding emergency admissions.
“The feedback that we have heard from Mr O’Malley and other patients is evidence that this was the right thing to do for patients and we know that we have freed up space in A&E so those patients and staff have benefitted too. I am very pleased that we have been able to do this.”
The staff in the Medical Procedures Unit undertook training which also involved shadowing and working alongside colleagues in urgent care.
Dr Denis Burke, a former consultant gastroenterologist at the Trust supported and advised on the new way of working. He added:
”This development has been a big bonus for patients. As Mr O’Malley has said, it is undertaken in a more patient friendly environment and releases capacity for our emergency services.
“This service has been made possible, not only because of the will of our teams to improve services for patients, but was enabled by collaboration to release capacity in the MPU. We did this by enabling other patient centred care - for another group of patients - to be delivered elsewhere in the community. These patients previously had to attend MPU for infusions of drugs which can now be delivered closer to their home in the Community Hospital’s Day Units. Also because of innovations in the delivery of these treatments, some patients can now give to themselves in their own homes by injection, similar to how a diabetic would give their insulin.”