Pioneers in patient care: consultants leading change
North East
Innovation: A UK on-site neonatal service provided solely by advanced neonatal nurse practitioners
Dr Unni Wariyar
Royal Victoria Infirmary, Newcastle and Ashington General Hospital, Ashington, Northumberland
Job title: Consultant paediatrician and honarary clinical senior lecturer in child health
Specialty: Neonatology
Newcastle consultant paediatrician Unni Wariyar has been instrumental in setting up and supporting a nurse-led baby unit that has enabled a consultant led, but low risk, maternity service to continue 18 miles north of Newcastle at Ashington General Hospital. This hospital serves most of Northumberland’s population and delivers around 2000 babies a year.
Ashington Hospital has never had an inpatient paediatric unit and in 1996 the service offered to newborn babies was withdrawn.
Realising this was an opportunity to support the local community Dr Unni Wariyar, a consultant neonatologist, and his colleagues at the Royal Victoria Infirmary and Ashington General Hospital trained appropriately skilled Advanced Neonatal Nurse Practitioners (ANNPs) to take care of all the newborn babies under his supervision as the lead clinician based at the regonal unit in Newcastle.
Dr Wariyar says: “Eight experienced neonatal nurses, who we have specially trained, provide all neonatal care including neonatal resuscitation, stabilisation of ill babies, and the care of small, frail, but otherwise well babies. They help, support and advise parents, perform neonatal baby examinations and ascertain fitness to discharge the babies home.”
“Clear guidelines and protocols were developed and appropriate support services such as radiology and laboratory services were negotiated so that now we can offer a high standard, holistic, baby and family-centred care for the majority of the population in one of the largest districts in the country.”
Dr Wariyar says that he and his team can now care for patients properly. “Previously doctors based at Ashington had virtually no proper supervision and the nurses were under severe strain having to deal with emergencies without enough support and guidance.
“Now highly trained, motivated staff run the unit with immediate access to advice and support from four neonatal consultants at the regional unit 24 hours a day. They also have regular training updates from the regional team. This has improved morale, motivation and confidence amongst the staff at Ashington and patient care has improved dramatically,” he says.
The public, GPs, local councillors and MPs in Northumberland have supported the innovation and are generally delighted. A patient satisfaction survey is underway and so far shows a very high scoring. A survey of the stakeholders other than the public also showed a high rating.”
Training for this NHS funded scheme began in 1995 and the scheme has been introduced in stages since early 1996. “A comprehensive evaluation programme is in progress and a report is expected by early 2002. The available results are “extremely encouraging”, says Dr Wariyar.
“I spend significantly more time at work than expected to give good care to my patients. If I had more time I could communicate with families better and support them even more which would help the public and the NHS. I enjoy my work and have no regrets for choosing medicine as a career but it is a profession which should be chosen because you want it come what may.”