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Many haematological conditions have evolved into long-term chronic illnesses. This presents ever increasing problems both in terms of cost and capacity.
People with certain chronic haematological conditions at Belfast City Hospital were seeing the consultants at least every three months. Clinics were rushed, the time given to each patient was limited, and sessions were largely confined to addressing their pharmaceutical treatment.
Ruth established a nurse-led clinic to provide more patient-centred and holistic care, and to encourage proactive surveillance and good health and well-being. She undertook nurse prescribing and health assessment training, and developed protocols for the clinic. She now provides nurse-led services at three clinics a week, assessing and reviewing patients who require long-term follow-up and treatment.
This initiative has resulted in better use of consultant time, which is now redirected to other clinical priorities and more complex patient needs. Other outcomes include reduced waiting times and increased continuity of care. Ruth has introduced a holistic assessment process to take in social, emotional, spiritual and financial concerns. Ongoing patient education and advice on lifestyle and coping with chronic illness have helped to promote self-management.
Many of the haematological patients are elderly, frail or disabled, so Ruth established assessment protocols and criteria to identify those who may be suitable for telephone review instead. This offers patients choice and flexibility in their care and follow-up.
Around 80 patients are now reviewed in this way. This service has been well-evaluated and led to many other advantages including increased clinic capacity, decreased use of ambulances and reduced burden on families who no longer have to accompany a relative to the hospital. These comments highlight the benefits reported by patients and their carers:
- ‘Travelling to Belfast was a big problem - this service has made a real difference.’
- ‘This service is fantastic as previously getting from the hospital car park to the front door was a major operation.’
- ‘My mum can’t walk well and I work full-time so it is a relief not to have to take time off work to attend clinic with her.’
The success of the clinics has demonstrated that new models of nurse-led patient review can be both safe and also improve the patient experience.
Ruth continues to work with the wider clinical team to look at new ways of working and improving services for other areas of practice. Current projects include the development of nurse-led venesection clinics and telephone review services for patients with other haematological disorders.
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