Scottish nurse's clinical outreach program sparks national debate in Denmark
December 31, 2013 -- Today The Southern Reporter (Selkirk, Scotland) ran a short report about the "pioneering" work of nurses at Borders General Hospital who developed a successful program to promote early recognition of at-risk patients. The piece says that the nurses' work sparked national debate in Denmark after it was described on a prominent television news program there. The TV report was a result of interest by Danish consultant anesthetist Jens Stubager Knudsen, who visited Borders General to learn about the work of "specialist nurse Ronnie Dornan (right), who set up the hospital's bespoke Critical Care Outreach service in 2000." The Southern Reporter item could certainly have used some detail about how the outreach program actually works. And the piece subtly reflects the continuing disparity in the perception of nurses and physicians by referring to the Danish physician as "Dr Stubager" but the Scottish nurse as "Ronnie." Still, Dornan himself refers to the physician as "Jens" in noting that the visitors were impressed with the work at Borders General. And Dornan offers a strong one-sentence summary of their success: "As well as having one of the lowest mortality rates in Scotland, the critical-care unit at the BGH [Borders General Hospital] has one of the lowest out-of-hours admissions, length of stay, need for ventilation and need for renal replacement therapy in Scotland." That kind of description of how nursing innovation improves patient outcomes is very helpful. We thank everyone responsible for this report.
The Southern Reporter piece emphasizes that the local hospital's program has been recognized internationally. It leads by saying that the work of the "Borders General Hospital nurses" was "broadcast to millions" on "Denmark's equivalent of the BBC Six O'Clock News" and "sparked major debate urging politicians to follow its success in improving patient care." The report suggests that a Danish TV crew followed Jens Stubager Knudsen when he visited to study the work of Dornan's team in "early recognition of patients at risk of deteriorating in hospital."
The piece also offers some indications of how the program actually improves patient outcomes. It says that "one such success was the BGH's cardiac arrest calls reducing dramatically from 465 in 2000 to 48 in 2013." That is dramatic. But a quote from "Ronnie" has even more:
Jens and his team were impressed with what we are doing in Scotland and they hope to achieve equal success in Denmark. As well as having one of the lowest mortality rates in Scotland, the critical-care unit at the BGH has one of the lowest out-of-hours admissions, length of stay, need for ventilation and need for renal replacement therapy in Scotland.
For his part, "Dr Stubager" (right) notes: "My study visit to Borders General Hospital has been truly inspirational. Since appearing on our national news, the methodology has created huge debate around the whole country and politicians are now looking to take patient safety more seriously."
On the whole, this very short piece offers a great snapshot of nursing innovation and health care leadership. The report does not just highlight the fact that nurses can be clinical pioneers and leaders (people who even physicians like Stubager might listen to!). It also gives a few specific, tangible ways in which nursing can improves patient outcomes, include the lower mortality rate, shorter hospital stays, and reduced need for aggressive interventions. Of course, the piece refers to what Stubager calls the nurses' "methodology," but it really doesn't say what that is--how the "outreach" works, who is involved, what it consists of. Is it "outreach" within the local community, or just among those who are already hospital inpatients? And there is the unfortunate reference to Dornan as "Ronnie" while Stubager is referred to by his surname and the honorific "Doctor." We know people see nurses as being more approachable, and for all we know the person who wrote this unsigned piece knows Dornan personally. But such different treatment reinforces the prevailing sense that physicians as a class are worthy of more respect than nurses are. Kudos to Ronnie Dornan himself for undercutting that sense by referring to "Jens" in his quote.
We thank those responsible for this short but generally helpful report.
See the article "Borders General takes starring role on Danish TV," posted on The Southern Reporter's website December 31, 2013. The piece is archived in pdf or webarchive formats here.