BAEM guidelines are at http://www.baem.org.uk/miu.htm but re also copied
below.
Contrary to previous posting, this includes the statement that << A trained
A&E consultant should have medical responsibility for any such unit>>
Matthew
BAEM Minor Injury Units
Minor Injury Units (MIUs) are those without the full facilities and support
services of true Accident and Emergency departments.
Significant numbers of such units have survived recent trends to
centralisation and in recent years there have been moves to increase their
provision as a perceived public benefit.
Minor Injury Units differ widely in their facilities and staffing and thus
in the range of emergency work that they can safely carry out. It is of
paramount importance that the local population and health commissioners
clearly understand the limitations of a given unit and use it
appropriately.
Principles:
MIUs should be set up only on grounds of medical need eg, isolated
geographical communities, large seasonal populations.
MIUs may receive ambulance-borne patients by local agreement and
within strict selection criteria, but should not receive patients who
require transfer by vehicles in emergency response mode with lights
and sirens ("blueing in") who clearly require full resuscitation
facilities.
There must be provision for the immediate recognition and safe
transfer of seriously ill patients to a major A&E department.
There must be adequate staff training and equipment to treat
complications of routine care eg, anaphylactic reactions.
A trained A&E Consultant should have medical responsibility for any
such unit.
All MIUs should have close links with their nearest A&E department.
Telemedicine or other electronic links should be encouraged, including
facilities for the transfer of ECGs and X-ray images.
There should be clear protocols specifying which patients or
conditions can be treated in the unit and which require transfer to
the major department or direct to other specialist facilities.
Nursing staff in MIUs which do not have medical staff on site at all
times must be properly trained as Emergency Nurse Practitioners.
Where units are staffed by ENPs there should be clear guidelines on
the circumstances in which medical advice is requested.
Staff should work to the same guidelines as the parent department and
should, if possible, use the same documentation.
Medical and nursing staff should rotate to the main department at
agreed intervals and for agreed periods.
There should be regular audit of the work of MIUs to the same
standards as apply to the main department.
Data on the number and nature of attendances should be kept in
accordance with national definitions.
Practical considerations:
It must be recognised that MIUs do not provide a cheap alternative for
emergency care. The cost per comparable case is likely to be higher in
small peripheral units.
Every effort should be made to educate the local population as to the
role of the MIU. Research has shown that patients can usually choose
appropriately between different facilities.
Despite protocols and patient information, emergency situations will
inevitably occur in such units, but these will be rare and maintenance
of staff skills in advanced life support is probably unrealistic.
Emphasis should be placed on BLS training, recognition of emergencies
and immediate access to paramedic services. Provision of automated
defibrillators should be considered.
Unless patients can receive immediate definitive care triage should be
carried out in accordance with the national scale.
Radiology guidelines should conform with those of the main department.
X-rays must be formally reported and recall protocols developed as in
major units. Consideration should be given to digital transfer or
telemedicine links with the main department for advice on films. The
value of units without x-ray facilities must be seriously questioned.
Full clinical records must be kept. Where possible records should be
computerised and the system used should be compatible with the parent
department to allow ready transfer of records for further care.
Nurse training should be competency based and appropriate to the range
of treatment provided in a specific unit.
Provision must be made for appropriate continuing education of medical
staff working in these units.
Where MIUs are staffed by GPs rather than hospital employees clear
lines of accountability must be established. Close liaison and joint
protocols with the major A&E department should still be required.
Where A&E consultants are directly responsible for an MIU these duties
should be adequately recognised. A minimum of one session a week is
required for administration and this will need to be increased to
cover physical presence eg, for follow-up clinics or regular
telemedicine contact.
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