Another NZ-first vascular service

A New Zealand first, mobile nurse-led vascular service from Whangārei Hospital hit the road last month, offering a two-day clinic in Kaitaia. Published by Health New Zealand | Te Whatu Ora on 12 April 2024.

Our clinic has freed up Consultants’ time for more urgent patients. Putting the patient in front of the right person, at the right time, in the right location.

Established last year, the nurse-led service helped alleviate pressure on the visiting Consultant clinic which is only offered once a fortnight in Whangārei.

Once up and running, the team wanted to take the service out into the region, closer to people at home.

“One of the challenges we had was ensuring that we could take the specialised equipment in the mobile diagnostic van,” explains Clinical Nurse Specialist Karen Devine.

“We consulted with the manufacturers to check that the machine wouldn’t be adversely affected by vibration and asked if they would give us sign-off to transport it.”

With sign-off secured, the nurses travelled to Kaitaia to offer clinics on 18 and 19 March and parked in front of the whare at Kaitaia Hospital.

“We saw eight people over the two days offering routine assessments, and if we needed treatment advice, we connected with the Vascular Service Nurse Practitioner in Auckland for advice,” noted Karen.

“Everyone we saw was extremely grateful and appreciative that they didn’t have to travel to Whangārei for what would have been a 15-minute appointment with the Consultant,” Karen said.

“Our clinic has freed up Consultants’ time for more urgent patients. Putting the patient in front of the right person, at the right time, in the right location.”

The nurse specialists in the Vascular Service have advanced clinical assessment skills, enabling a clinical decision to be made in conjunction with the patient, their whānau, and the vascular team using the information the nurses have gathered.

“The feedback from the Northland patients, whānau and the wider team has been positive, and I look forward to seeing what else they can achieve in the future,” said Nurse Practitioner Alicia Sutton.

“The nurse-led service is patient-centric and allows patients to be seen closer to home, which is improving equity in health in rural Northland.”

Another positive aspect of the service is the train-the-trainer component, developed after community partners such as Ngāti Hine Health Trust and Hauora Hokianga provided feedback.

“Colleagues in the rural communities asked for a better connection with the service, particularly a point of contact they could reach out to,” explains Karen.

“We have focused on increasing their knowledge of vascular conditions, how to recognise them and what to do when they come across them because they’re out there doing the work, not us.”

The education has proven beneficial time and time again.

Recently, a registered nurse working in rural Hokianga asked for support for a vascular patient who had presented with leg ulcers.

“We tried a few things, staying in touch every day, and in a short amount of time, his wound, which he had had for more than two years, healed,” Karen said.

“The gentleman was in the hospital recently for an unrelated matter, so I popped up to visit him. He couldn’t speak highly enough of the nurses who had cared for him in Rawene; “They have changed my life,” he said.

The role of a vascular specialist nurse extends far beyond simple dressings for unhealed ulcers or wounds. They form the bridge between the patient (usually with chronic ongoing or recurrent disease) and the rest of the clinical team.

“We take a holistic approach, often addressing lifestyle factors such as smoking cessation, adding value for the patients, which is often not possible in a fast-moving consultant clinic.”

After a patient has surgery in Auckland and is discharged, they have a follow-up vascular clinic appointment six weeks later.

“We are going to be able to offer the follow-up appointments throughout the district from the mobile diagnostic van, which also provides education and surveillance, including checking family history. This will significantly reduce the need for the consultants to provide this aspect of care.”

“We are also actively reducing the vascular clinic ‘did-not-attend’ rate by going through the patient list and assessing who the person needs to be seen by.”

The future is bright for this innovative nursing team, which has already reduced the acute patient transfer to Auckland from the weekly Consultant clinic often four a week to just four this year.

The nurse-led clinics have seen 130 patients to date and are confirming locations and clinic times for the rest of the year to expand the range of vascular services available closer to home in Te Tai Tokerau.