Innovative Ideas Register

Nurse Led Respiratory Clinics

Development of the Initiative

Before 2000, Hutt Hospital had a physician led respiratory service, providing four clinics a week, and had a 1–2 year waiting list for routine referrals. These predominantly consisted of COPD patients awaiting assessment. Following the resignation of the Respiratory Physician, a suitable replacement could not be recruited due to a lack of suitable applicants. New innovative ways of dealing with the respiratory demand and the waiting list had to be addressed in order to continue to provide a service for the local community, who on the whole could not afford the travel costs to Wellington Hospital. As a pilot initiative, nurse pre-assessment and management clinics were established under the supervision of a General Physician to pre-assess and review the 100 patients on the waiting list. This initial pilot, three years on, has expanded to 1.8 FTE (full time equivalent) nurse sessions, providing five-day (Monday to Friday) assessment and education clinics, which place on hospital wards, in outpatient clinics, and in patient’s homes.

Results

Since this innovate implementation there are many benefits to the Hutt Valley community.

• We no longer have a waiting list for respiratory patients and we can consistently meet appropriate timeframes for all triage categories.
• Nurse clinics allow time for intensive patient education. As a patient’s knowledge improves, they attain more empowerment and increased control of their medical condition.
• Nurse-led clinics provide earlier access to diagnostic tools such as blood tests, chest X-rays and scans. The availability of these tests, when patients are subsequently seen by the doctor, allows for quicker diagnosis and therefore more prompt management.
• With Iwona’s support, we can ensure that patients seen in the nurse clinics are started on appropriate treatments as early as possible, allowing for improved health outcomes.
• Nurse clinics can provide intensive management during an acute exacerbation, giving the advice and support to assist patients back to optimal health. With rapid access to the home oxygen assessment clinic, we can ensure patients can start treatment without delay.
• For complex patients, nurse clinics allows for ongoing review between medical clinics. This allows for adjustments or titrations of therapy with Iwona’s supervision. It also provides continuity of care for the patients, allowing a therapeutic relationship to develop between the nurse and the patient.
• Overall, this innovation has made respiratory services more accessible to the local community. We are increasingly receiving self-referrals from the general public, and local GPs are beginning to refer directly to nurse clinics.

Primary Contact

Dr I Stolek
Respiratory Clinic
Hutt Valley DHB
Private Bag 31907
LOWER HUTT

Tel. (04) 566 6999 ext. 8279
email: iwona.stolarek@huttvalleydhb.org.nz