Last updated at 14:46, Friday, 31 August 2012

FURNESS General Hospital’s Clinical Decisions Unit is responsible for making sure any patient who is able to can recover in the comfort of their own home. EMMA PRESTON finds out how it’s done

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IT doesn’t matter how hard our doctors and nurses work to keep us comfortable, safe and well looked after, the fact remains that, given the choice, very few people ever want to be in hospital.

The comfort of your own bed, having loved ones around you and the familiarity of your own home are all things we crave when we are under the weather.

That is why Furness General Hospital has a team dedicated to making sure that anyone who can possibly avoid being admitted, does so.

Julie Kendall, nurse practitioner in the FGH Clinical Decisions Unit, explains: “Generally speaking, most people want to be at home – a lot of people get really quite distressed when you say, ‘sorry, but you need to stay in’.

“It helps a patient’s mental wellbeing to be able to be at home. It’s all about being in your own bed, in a comfortable environment, in your own surroundings.

“And, quite often, if you’re mentally well, the physical side sorts itself.”

The clinical decisions unit takes patients referred from the FGH emergency department, GP surgeries and other hospital wards, whenever their colleagues feel the patient is well enough.

The hope is that, here, they can have all the tests they need, be prescribed medication and arrange future treatment while avoiding having to spend any more time in hospital than they have to.

But there are strict criteria as to when it is appropriate for a patient to come here, and Julie and her team are always ready to admit anyone they think they cannot help.

“It depends on their illness and their presenting symptoms,” Julie explains.

“If they’re well and they’re able, and their blood pressure and breathing are all stable, then we would get them up here, because they may not need to be admitted.

“For example, someone with a clot on their lung – if they’re showing no symptoms, we could deal with them here – but if their breathing is struggling and they’re coughing then they need an admission.”

These factors all have to be kept in mind when Julie is trying to help her colleagues address a regular problem faced by all hospitals – bed shortages.

Julie says: “On a day to day basis, especially when beds are under pressure, we’ll get the bed managers coming to us saying, ‘will you take this patient?’.

“And we will where we can, but only if it’s appropriate.”

The unit is open from 8am until 8.30pm daily, dealing with an average of 20 patients a day.

This includes some patients who have previously been assessed here, started on treatment, and asked to come back for follow-ups or day case treatment.

Julie tells me: “Most people are very amiable to coming back because it’s just a relief that they don’t have to stay in.

“They’re very grateful to be allowed to go home, even if they do have to come back – and we try and minimise that as much as possible.”

As we speak, Julie is busy ordering x-rays for a patient who has arrived with swelling to his leg.

Every patient who attends goes through a set of standard procedures before Julie and her team carry out further investigations.

The first step is to take blood samples, which take the longest to come back from the labs, before an ECG and other observations are carried out.

The team then take a full history, family history and a full body analysis, asking about any potential symptoms from head to toe and picking up factors a patient might have written off as coincidental but could help diagnose them.

Julie says: “It’s like doing an MOT of the human body really.”

The average time a patient will spend in this unit is around six hours.

For those who are well enough, their stay will end with Julie and the team starting them on treatment and arranging any follow-ups here or ongoing appointments they will need at home or elsewhere outside the hospital.

The clinical decisions unit works closely with various community services, such as the district nurses and the intravenous home care team, to be able to do
this.

“We try to keep it patient-centred and work around what works for each individual patient,” Julie explains.

“It’s about making that journey as quick and as smooth as possible, so by the time they’ve been in A and E and been up to us, we should hopefully have been able to do everything needed that same day and have them discharged.”

Because Julie is a prescribing practitioner, she can see an assessment through from start to finish without having to call on doctors and other specialists from different parts of the hospital.

But a consultant or registrar can always be called where her team is struggling with a tricky diagnosis or has doubts about whether to send someone home.

For Julie, the importance of getting it right cannot be underestimated.

She says: “It’s quite emotionally draining, the responsibility we have.

“Some days you’re really confident and others you’ll doubt yourself.

“We do worry sometimes that what we’ve done is right, or if we’ve missed something, because you don’t want to make people more unwell than they already are.
“All we want is what’s in a patient’s best interests.”

From what I’ve seen today, the service Julie and her team offer is second to none.

I notice one patient in particular, who was irritable and confused when he came in but is sent away smiling and laughing.

All he needed was for Julie to show him how to use his medication, which she does slowly and patiently, talking through every step and making sure everything
is as simple as she can possible make it.

As we show him out, Julie tells me: “We do get a lot of good feedback from our patients.It’s quite a relaxing atmosphere most of the time, because if you tell people what’s happening and keep them informed, you diminish a lot of that anxiety being in hospital can bring.”

First published at 15:28, Friday, 24 August 2012
Published by http://www.nwemail.co.uk