Minor injuries clinic is major asset to Capital

CAREFUL, you might want to step away from the false eyelashes, the fake fingernails and the earrings. And that superglue you're about to use to stick together some broken household object could be treacherous.

Watch out too for the fluff off your socks – for any of these seemingly innocuous everyday bits and pieces could easily land you in a bustling hospital department where staff really have seen just about everything.

Such as the patient who arrived in a state of distress at the Western General's minor injuries clinic because their arms suddenly felt odd and their fingertips had turned a disturbing shade of black, prompting fears of circulation problems.

Nurses quickly diagnosed the problem: 'newspaperitis' caused by holding open the pages of a broadsheet newspaper for too long and getting ink on their fingers. The cure, simple rest and some soapy water.

Or the elderly patient concerned that they had developed an odd fungal type problem between their toes. Again nurses were swift to get to the root of the issue – it was simply fluff from the patients' socks.

It all sounds a bit trivial – indeed, bordering on ludicrous. But curious as the cases involving eyelids frozen by glue for false eyelashes, studs from earrings becoming stuck to infected ears and broken false fingernails sound, they are just an everyday part of daily life at Lothian's unique and pioneering nurse-led Minor Injuries Clinic (MIC).

It has just marked 15 years of patching up and plastering thousands of bumps, bruises, cuts and sprains, sending grateful patients of all ages – the majority of them with very real injuries and health concerns – back home in one piece.

And even if some of the cases they deal with are certainly in the 'less serious' category, nursing chiefs insist everyone who arrives at the drop-in clinic gets the same first-class service.

That includes the patients who arrive with someone else's tooth embedded in their fist insisting it was an accident, to the worker who takes a tumble at work; from the child with a moth stuck in their ear – apparently one of the more common incidents – to the patient whose feet have turned a weird colour, not, as they think, the result of some strange health condition, but because the dye has come off their new shoes.

"The thing is that if people come here, it's because they are worried about something," insists clinical nurse manager Anne Donaldson, whose role at the Western General includes overseeing nursing staff at the unit.

"We'd much rather they came along and got checked out – even if it turns out that there's a simple reason behind it. The person with the fluff was actually very relieved to be told what it was. They were genuinely really worried."

Thankfully that case was resolved without the need for even a sticky plaster. But for the majority of patients who have turned up at the clinic in the past 15 years, the team of highly trained nurses there has had slightly more work to do.

Since it opened its doors in 1994, the MIC has dealt with well over 200,000 patients – increasing from around 10,000 a year at the start, to around 20,000 per annum now.

Some might just need a check from a highly trained eye to make sure their bump or bruise isn't worse than it looks. Others might need stitches in their cuts, x-rays to check for broken bones, minor burns treated, fractures plastered and sprains strapped.

Unlike an A&E department, the MIC is run by a range of nurse, physiotherapy and paramedic practitioners – all specially trained to deal with minor injuries.

On a typical day, around 50 patients will pass through its network of consulting rooms – at peak times, such as in September when Edinburgh was packed with tourists for the Festival Fireworks, the number of patients peaked at more than 100.

Right now they're bracing themselves for the traditional winter surge of bumps and sprains thanks to icy pavements and over-enthusiastic festive celebrations from patients who wake up after the raucous night before and realise their pain is more than just a hangover.

"Spike injuries," explains Anne, while the MIC Lead Nurse Practitioner Elaine Pollard nods knowingly. "We get them at festival time and New Year. People climb over the fence at Princes Street Gardens and hurt themselves on the spikes.

"Often they don't realise until the next day – they come in with cuts on their feet."

Elaine, who's worked at MIC for seven years, says the days leading up to Christmas are often the quietest. "Maybe everyone's too busy," she grins. "Then come Boxing Day, it really picks up."

She's seen most things since joining the unit from her previous role in Accident and Emergency, from DIY mishaps, insect bites and barbecue disasters during summer, to sledging and skating accidents in winter.

And some are more bizarre than others.

"People come in and say, 'You're not going to believe this', and we say, 'OK, try us' because chances are we've already seen it.

"Some things are pretty odd – some of the superglue ones in particular," Elaine adds with a giggle.

"We just try to make the patient relax, let them know they're probably not the first one and they won't be the last."

Indeed, the kinds of injuries the clinic has encountered in its 15 years – and the rising number of patients it deals with – provides a small snapshot of Scottish trends since the mid-90s.

Fashion slip-ups in Cheryl Cole's style of towering high heel shoes or blade-like stilettos, kids taking a tumble on their new Heelys, the rise of workplace 'health and safety' making employers fearful that workplace injuries might lead to legal action, powerful oven cleaners giving off heady fumes and even the trend for exotic pets which sometimes bite their owners – they've all added to the clinic's workload.

And nervous parents who often don't know how to treat small injuries at home added to the fear that they might be missing something more serious, have also boosted patient figures.

"In days gone by a bump might have been something Granny treated with a rub of butter," nods Elaine. "These days parents aren't really sure what to do.

"And employers are very aware of health and safety, so we do see a lot of workers coming in with often quite minor injuries.

"We're happy to treat them – and you can completely understand why they come," she adds.

As she speaks, patient Alan Hart is being tended to by clinical support worker Elaine Smith and nurse practitioner Louise Hamilton.

He's arrived at the MIC with a nasty wound on his index finger.

"I cut it with a scalpel," he explains. "Bit daft really, was making a float from polystyrene at work when the blade slipped."

It's the first time manager Alan, who works at the nearby MRC Human Genetics Unit, has needed the clinic's services. And so far, he's impressed.

"It makes sense to have something like this rather than go to Accident and Emergency," he nods. "It's not a serious injury, but it is quite deep, so best to get it looked at."

It's the kind of injury nurse practitioner Christine Lawson – the only original member of staff left – has dealt with countless times since 1994.

"There are different kinds of things now that we didn't really deal with back then," she nods. "Things like the false eyelashes – when eyelash glue dries it tightens up the eyelid. We've had people in with that. "And there have been people who have come in because they've ripped off their false nails."

Back at the start Christine and her fellow 'super nurses' were seen as pioneers of a new tier within the health service. Today health boards around the country have copied the MIC blueprint with similar clinics of their own.

"Back then it was a bit scary to be involved in something completely new," admits Christine. "But it's been great – I wouldn't have been here for 15 years if it wasn't. It's true – every day really is different."

&#149 The Minor Injuries Clinic is at the Western General Hospital. It is open seven days a week, from 9am to 9pm. If you are unsure whether to attend the MIU or A&E, call on 0131 537 1330.


THE Minor Injuries Clinic opened in November 1994 after a long debate over accident and emergency provision in Edinburgh.

The health board closed the Western General's A&E three years earlier. And suggestions that a nurse-led clinic to deal with minor injuries were radical for their time.

The clinic, however, immediately proved its worth. In the first month it had seen 1,000 patients. Since then its staff has treated well over 200,000 people from year-old tots to pensioners, for all kinds of bumps, sprains, cuts and bizarre household mishaps.

The number of patients attending the clinic has doubled since its opening, with more than 50 people a day, or 20,000 a year, now attending.

It operates as a one stop, 'no appointment necessary' clinic for all minor injuries or ailments. Staff can prescribe medicine and X-rays for over 12s.

Patients are treated by a range of staff, including nurse, physiotherapy and paramedic practitioners.

The most common injury is ankle or wrist.

The MIC is a training centre in minor injuries for other nurse and paramedic practitioners from across Scotland.