Alder Hey is a specialist paediatric tertiary hospital in the North-West of England. The Trust provides care to 450,000 patients. The service treats patients ranging from minor and common illnesses to highly specialist and complex medical conditions. Emma works as an advanced clinical practitioner within the gastroenterology department within the trust.
Emma progressed to an advanced practice (AP) dietitian role after completing a master’s degree through an apprenticeship route.
As part of her role, Emma leads the parental nutrition across the hospital as well as in the gastroenterology department. Becoming an advanced practitioner has allowed Emma to provide a continuity of care to patients within the service and has been able to provide families with a one point of call to respond to the demands of complex patients.
Population
As part of Emma’s AP role within the gastroenterology department, she sees patients who have:
- Parenteral nutrition.
- Inflammatory bowel disease (IBD).
- Eosinophilic Oesophagitis.
- Functional or straight gastroenterology symptoms or conditions.
- Intestinal failure.
- Gastrointestinal dystonia.
- Long-term constipation.
- The service supports, 25 home parental patients of which Emma sees15 and around 350 IBD patients.
- Emma reports the complexity of the patients has increased across her caseload
Intervention
- Supplementary prescriber -prescribes parental nutrition & other gastrointestinal medications to patients.
- Contributes to gastroenterology ward rounds.
- Conducts an inpatient clinic.
- Attends a consultant clinic; attended by those who are highly specialist (predominantly intestinal failure) & provides continuity of care to complex patients.
- Part of the Clinical case staff presentation multidisciplinary group which allows staff across the Trust to present complex cases with a multidisciplinary view of the case and different treatment options.
- Attends histology and radiography meetings.
- Leads within MDT meetings.
- Leads on the diagnostic coding of gastroenterology inpatients.
Outcomes/Impact
Service impact:
- Reduced the risk and incidents surrounding parental nutrition.
- Improved quality of care, evidenced by a reduction in the number of complaints.
- Allows better access to healthcare from a patient perspective and allows the system to move more quickly.
- Improved income generation by improving the accuracy of the diagnostic coding of patients
Patient outcomes:
- Continuity of care in long-term complex cases.
- Provides consistent access to healthcare.
- Patient surveys have provided the service with input and direction, in relation to the above.
Emma incorporates the four pillars of practice in their role by:
Clinical
Assesses patients and can prescribe parental nutrition and a range of gastroenterology medications within her scope of practice as a supplementary prescriber.
Leadership
Leads on parenteral nutrition (including the risk and incident management), represents the Trust nationally in terms of safety and progression, leads on the coding of gastroenterology patients and links in with business managers to ensure a changed practice across the gastroenterology division.
Education
Started work providing education and training to paramedics, provides training across the dietetic department and the trust on parental nutrition, provides external company training and teaching, as well as national events such as the paediatric module.
Research
Quality improvements for total parenteral nutrition. Worked on brilliant basics which uses A3 concepts to allow benchmarking and work across the trust and take to national patient safety work. Conducts work on the use of parental nutrition in severely neurologically impaired children and work on the outcomes of patients with gastrointestinal dystonia, and whether they are being diagnosed against criteria. Produced nutritionally focused posters and presented them at conferences.
