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Minor Injuries Unit offers ‘smarter way to run’ A&E and reduce waiting times

Photos by Johnny Bugeja

A new Minor Injury Unit at the Accident & Emergency Department in St Bernard’s Hospital has already led to a “significant” drop in waiting times for patients with minor ailments, and in the department as a whole.

The GHA estimates that up to 50% of the patients that attend A&E can be seen in the Minor Injury Unit, which has been running on a trial basis since early April but was formally opened on Tuesday.

Traditionally, the A&E department has served as the primary point of contact for individuals seeking immediate medical attention.

Prior to the unit opening, patients attending A&E were treated on a ‘first come first served’ basis unless they were very ill, in which case they were prioritised.

But while serious cases were dealt with swiftly, the demand on the unit would often result in long waiting times and unnecessary delays for those attending with minor injuries.

That in turn had a negative impact on the public’s perception of healthcare delivery.

The new unit follows a streamlined triage system that expedites patient assessment and prioritises cases based on severity, speeding up the process of receiving care.

Patients with minor injuries are now triaged into a separate queue and seen directly by dedicated clinical staff consisting of nurse practitioners and a doctor with expertise on minor injury and illness.

This improves waiting times and reduces the pressure on the senior medical team, allowing them to concentrate on those presenting at A&E with more acute or life-threatening injuries and illnesses.

Data collected by the GHA showed that since the new unit started operating on April 3, some 440 patients spent an average of 71 minutes in hospital from the time of their arrival.

Average waiting time for those patients from arrival to triage was 31 minutes, with the wait from triage to being seen by a medical practitioner averaging 18 minutes.

The types of injuries/illnesses treated in the Minor Injuries Unit include injuries to upper and lower limbs; broken bones, sprains, bruises and wounds; bites, including human, animal and insect; burns and scalds; abscesses and wound infections; minor head injuries where there has been no loss of consciousness; broken noses and epistaxis; foreign bodies in eyes and nose; superficial foreign bodies in skin; minor illness, earaches, sore throat, etc; skin problems such as rashes; conjunctivitis; and coughs or cold symptoms.

More serious conditions excluded from the unit include problems usually dealt with by a GP; conditions likely to require hospital admission; chest pain; breathing difficulties; major injuries; stomach pains requiring investigations; gynaecological problems; pregnancy problems; severe allergic reactions; overdoses; alcohol related problems; and mental health problems.

Dr Raj Nagaraj, an A&E consultant and the unit’s clinical director, said that when he first embarked on helping set up the unit, he knew from statistics that 50% of cases who attended A&E were minor.

However, people would often wait for hours just to be seen for a minor ailment.

By setting up the unit they have extended the skills of the nurse practitioners who are now emergency nurse practitioners and additional team members were brought in.

“Nearly 50% of patients presenting at A&E have minor injuries but because of the old triage system could be waiting for a long time, sometimes hours, to be seen,” he said.

“The significance of this unit is that minor injuries and illness can now be fast-tracked and seen directly by a Nurse Practitioner.”

“This has greatly expanded the clinical services that can be provided as urgent care to patients with non-life-threatening injuries.”

Initially the unit it will be operational from 8am to 4pm Monday to Friday, but this will change in the future once it has a full staff complement.

The Director of Nursing, Sandie Garcia, formally unveiled the facility in the presence of the GHA’s Director General, Professor Patrick Geoghegan, and the team that will staff the unit.

Prof Geoghegan said that when he came to Gibraltar this was one element he wanted to change within the hospital.

“One area very close to my heart is our emergency department because that’s one of the departments most of us rely on when we are in a crisis,” he said.

“And when we need help we come here, so we want to make sure that the department is a modern department that is up to date, where people will come in, be well treated, be well looked after.”

“But even more importantly, it will save lives.”

To achieve this, the GHA has in effect split the department so that people coming in with minor injuries are separated from those having major treatment for trauma, often in life-and-death situations.

“We wanted to divide the department so people can be triaged into the best department and best looked after, because at the end of the day, we just want people to get good care and good treatment,” Pro Geoghegan added.

The Minor Injuries Unit is located in a dedicated area of A&E and consists of one consultation room, where patients are assessed, and one treatment room.

Patients arriving at A&E and assessed and given a category, with minor cases - category four and five - dealt with in the new unit.

Emergency nurse practitioner Kanchan Thapa said staff conducted a patient survey over this period asking for their views on the waiting times, the time they spent on the department, the information they received and whether the unit addressed their ailment.

She proudly stated that they got four stars out of five for these questions.

Dr Nadeem Shuju, a doctor in the unit, said the new arrangements were improving healthcare provision and reducing waiting times, as well as managing staff time more efficiently.

He said the new unit is a “smarter way to run” A&E.

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