The SWISS Nurse; respiratory nursing care without any borders. An admission avoidance winter pressure initiative

Abstract

<b>Background:</b> Respiratory disease is a major factor in ‘winter pressures’ in the NHS, with twice as many respiratory admissions occurring in December compared to August. Over the last seven years across the North of England, respiratory admissions have risen over three times faster than the rate of other conditions - 36.6% vs 11.1.%. The introduction of a respiratory nurse specialist within the emergency department (ED) was proposed to provide care for patients presenting to hospital with a respiratory condition to help alleviate such pressure. <b>Aims:</b> The aim of the Swiss nurse is to: Avoid unnecessary admissions during winter pressures and support patients back into the community setting for a minimum of 3 days post discharge follow up. Prevent readmission to the hospital by providing ongoing support within the community setting irrespective of area of residence. Provide equitable care for all patients to reduce health inequalities. Organisation of long term chronic disease management follow up and optimisation of care. <b>Methods:</b> A respiratory nurse specialist was based in the ED 9am - 7pm, seven days a week. The service was operational between November 2020 and March 2021, and the nurse reviewed patients presenting to the ED with any suspected respiratory complaint. <b>Results:</b> A total of 240 prevented admissions within 4 hours of ED attendance were achieved during a 5 month period. <b>Conclusion:</b> Enabled discharges from ED to all community respiratory services irrespective of Clinical Commissioning Group. This initiative improved connections with community respiratory teams, as well as&nbsp;developing a ‘can do’ attitude and standardisation of care for shared services.