Staff accolades

ED colleagues recognised in Nursing Times Awards shortlist

Charlie Malcom and Sunil Mistry

University Hospitals of Derby and Burton are proud that an emergency department (ED) team and an ED sister have been recognised in two categories in this year’s Nursing Times Award.

The High Intensity User Service has been shortlisted for the Emergency and Critical Care category and emergency department sister Charlotte Malcolm-Davies (Charlie) has been shortlisted for the prestigious Nurse of the Year Award for her work as part of the High Intensity User Service, alongside her role in nursing ED.

The two-person team consisting of Dr Sunil Mistry and Sister Charlie Malcolm-Davies have been running the High Intensity User Service since 2018 and are based in the emergency department at Royal Derby Hospital. They work closely with patients who visit ED very frequently to reduce their attendances by implementing care plans or referring to more appropriate services.

Patients who are attending ED more than five times in a short period are referred to the High Intensity User Service, who work with a multidisciplinary approach when implementing care plans. They work with patients with a broad spectrum of conditions, from chronic pain, to mental health or those who are socially isolated, who otherwise could be visiting the emergency department 25-50 times a year.

Dr Mistry explained: “This is an extremely vulnerable patient group who have a high mortality rate due to their often chaotic lifestyles. What Charlie has been trying to achieve is not only to reduce their attendances but ascertain the root causes of their problems to find a positive method to engage patients and help them improve their lives not just medically but holistically. This requires massive dedication.”

Charlie Malcolm-Davies said: “I love the difference you can make. Patients are so happy with the support plan in place and it supports the staff working with them. When the patients are happier and are really clear about how to access support, it helps reduce their attendance in ED.”

“I’m a nurse, I want things to be good for the patients. The patients we see often don’t trust anyone – they have been let down in the past so I have to work really hard to build their trust.”

“The best results are when you make such a quick, abrupt end to people’s multiple attendances. We had a patient who was coming to ED all the time during the pandemic. We found it was because services they used pre-covid weren’t open, but we managed to get them into hydrotherapy which was a huge achievement. Since then they haven’t needed to attend ED again.”

Until February 2022, the service was ran by Charlie for only 15 hours a week, but has since been extended to almost full time due to the success over the first three and a half years.

In the past four and a half years, the team have provided in-depth support for over 400 patients and have approximately 130 care plans in place. They have achieved 71% reduction in unnecessary admissions with their 30 highest attending patients. Dr Mistry added: “The reduction in ED attendances are significant, but almost more importantly are the testimonials we have received from patients who have changed their lives for the better as a consequence of the input that the high intensity users team has had.”

The team also work closely with the local area co-ordination team who take referrals. These are non-medical people who are based in each ward of the city and work with referred patients to get them more appropriate support local to where they live.

The service doesn’t just reduce ED attendances, as Charlie explained: “By implementing a care plan it removes the need for a patient to repeat themselves to every member of staff when they have to come to ED, they just say they have a care plan and they can be prescribed treatment and then go home, so it’s a smoother journey for them and they can move through our hospitals faster.”

“I’m so passionate about the High Intensity User Service – I started it from nothing. There were only two other trusts doing something similar at the time, but I didn’t know about them, so set up everything from scratch. It’s been successful so far and neighbouring trusts who have launched something similar have approached and asked for advice and some have followed the model I set in place, including at Queen’s Hospital Burton.”

On being nominated, Charlie said: “It’s amazing – I didn’t expect it at all. To be nominated is great, to be shortlisted is awesome. I am just an ordinary nurse, who has found a way of doing something out of the ordinary that has helped people.”

Dr Mistry, who nominated Charlie for Nurse of the Year, said: “Charlie burdens a huge responsibility. She isn't put off from having difficult conversations with challenging patients. She has shown care and compassion to the hardest to reach people in our communities.”

Charlie wanted to remind the public that “We don’t want to stop people coming to our emergency department if they need to come – we just want people to know there are other services available to them.”

The winners will be announced at the Nursing Times Awards 2022 on 26 October – good luck Charlie and Dr Mistry!



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