GM /Director Oncall Log for week commencing:

Oncall Log for week commencing: 05/07/13

Completed by: Stephen Hall, GM Specialist Medicine

Director on call: Hugh Gostling

Date / Time (24 hr) / Conversation with: / Information/message to the GM oncall / Action by GM or Dir. oncall
05/07/13 / 22:15 / Anna Rudd / Anna confirmed there have been 337 ED attendances, with 72 in the department and 25 unvalidated breaches on the system. This is high but is not a confirmed number. Staffing is OK and there are beds available, including ITU capacity. Plastics closed totertiary referrals due to lack of operating space. This is apparently standard practice and decided by the plastics consultant on call due to safety. Anna did not have full details as to the bed state, but informed me there are 12 beds in surgery (including 3 on Grey), Gynae have 5 beds and there are beds in medicine. I therefore asked as to why there have been so many breaches. Anna stated she thought it was due to skill mix in ED. In addition, Anna stated it was difficult to get a clear picture as to the real number and reasons for ED breaches due to this information from ED not being passed to her. Anna also made me aware of a patient on Holdsworth Ward that has been sectioned, and that the patient previously jumped three floors. The patient is being transferred tonight to an appropriate facility. I confirmed that the telephone conference call tomorrow was at 14:00 and that both Hugh and Amy were aware of this. / 1. Text Hugh with an update.
06/07/13 / 09:20 / Amy Scammell / Amy called the on-call mobile to say that she could not get hold of Hugh. She wanted to inform Hugh that the switchboard had gone down at the mental health trust. She asked what I would do. I stated I would inform St George’s Hospital switchboard and try calling Hugh on the other number listed and continue to call the on call director phone. / 1.  Gave Amy Hugh’s other mobile number as listed on the on call rota.
06/07/13 / 14:00 / Rob Schwarz, Amy Scammell and Hugh Gostling / I asked Rob about the breaches in ED yesterday, as there were a high number of unvalidated breaches. Rob confirmed that there were 366 attendances with 23 unvalidated breaches on the system and that ED do not tell him any details as to whether they are real breaches or not. Rob stated I would have to speak to ED regarding this. Rob also confirmed that there were 35 DTAs yesterday against a perdiced 41 in medicine and 38 DTAs against 26 predicted in surgery. I also asked whether the mental health patient on Holdsworth Ward had been transferred. Rob confirmed they had.
Rob informed the group that there were 182 attendances in ED since midnight and that there are 4 unvalidated breaches on the system. There are 58 patients currently in ED. Attendance numbers in the last four hours has been: 13, 26, 29, 20 and the longest wait is 58 minutes. Staffing is OK and there are critical care beds. Today there is 31 predicted for medicine and so far there have been 7 DTAs. For surgery there havebeen also 7 DTAs against a predicted of 24. Surgery has 3 beds with a query 5 and Champneys has 8 beds and medicine has 4 on AMU with query 11 coming up, with a further 8 beds downstream. Rob also pointed out that Dr Jane Evans is working and this will help with discharges. Cardiac has 7 beds, Neuro has 5 and paediatrics has 9 beds. Hugh asked about the Mental Health Trust switchboard. Amy said that their security was dealing with it and has heard no further news. Amy also stated that Mary Seacole Ward is full at Queen Mary’s Hospital and that Rodney Smith House has 2 beds but also has 2 patients to admit. / -
06/07/13 / 22:44 / Anna Rudd / There have been 342 attendances in ED since midnight, with 6 unvalidated breaches on the system. A couple of long waits in ED (circa 2 hours and 24 minutes) for a couple of patients but then waiting times drop. There are 57 patients in ED with the majority in majors (28). Attendance in ED over the last four hours has been: 19, 21, 18 and 18. Of the predicted 31 medicine there has been 21 DTAs and for surgery, there has been 16 DTAs against a predicted of 24. Anna said she thought a contributory factor to yesterday’s ED performance, was due to only having 3 porters, as she felt 6 were needed. Anna stated she was working days on Monday and we should raise this as an issue. Also there were multiple major trauma, related to a car crash in Horsham, and three teenagers died and one walked away with a few scratches. Anna confirmed there has been no media interest.
Staffing is OK. There are 12 beds in AMU with further downstream beds. Surgery has 7 beds and Champneys have 9 beds. Cardiac has 6 beds and James Hope is closed. Neuro has beds and paediatrics have 12 beds. There is 1 CCU bed, 1 CTICU bed, 2 GICU bed, 4 HASU beds, 2 NICU beds but no PICU beds. However, Anna stated that more staff are being assigned to PICU to help cope with demand. / 1.  Text Hugh with an update.
2.  Discuss the lack of porters at 10:00 bed meeting on Monday.
07/07/13 / 10:44 / Siobhan Greene / Siobhan bleeped to ask if it was OK to get in an agency SHO to cover the orthopaedic ward, as no ward cover had been arranged. Siobhan stated that historically the site team had provided a nurse practitioner and had pre warned the Orthopaedic Service that this would not be arranged this weekend. Yet no cover had been arranged by the service. Siobhan asked for me to authorise for her to obtain an agency SHO, which I did and to raise it as an issue on Monday.
Siobhan said that ED was busy with 58 patients in the department, but will give a full update at the conference call. Siobhan asked what time this was, and I confirmed it was 14:00. / 1.  Authorised for Siobhan to obtain an agency SHO to cover the orthopaedic ward.
2.  Will discuss ward cover with GM for T&O on Monday.
07/07/13 / 14:00 / Siobhan Greene, Amy Scammell and Hugh Gostling / Siobhan updated the group, that there have been 173 attendances in ED since midnight and there were currently 65 in the department. Attendance in the last four hours has been; 21, 25, 18, and 15. There are 2 unvalidated breaches on the system and 2 more likely to be put on. They are a mix of clinical and bed breaches. There are 19 patients in UCC with a 2 hour wait, 18 in Majors with a 30 minute wait, 14 in paediatrics, 4 in resus and 2 waiting for majors. There are 3 patients in ED waiting to be admitted. 1 Renal patient, 1 ENT and 1 surgical. Siobhan asked permission to place a surgical patient on Tervor Howell Ward. The group agreed to this and I said I would inform Laura Badley, the GM for Oncology in the morning.
Siobhan stated that there have been 3 DTAs against the 32 medical predicted and 8 DTAs against the 24 surgical predicted. There are 10 beds in AMU with query 7. 2 beds in medicine 3, on Grey Ward with a further query 4 beds. 8 beds on Champneys, 1 on Cardiac with query 1, no beds in Neuro and 21 beds in paediatrics. There are no CCU beds but query 2 coming up. 6 CITU, 3 GICU, 2 HASU and 4 NICU beds. As surgery has -21 and high take it was asked by Siobhan and agreed by group to keep Grey open.
ED is down 2 nurses and some wards are short of nursing staff across the Trust. They have gone out for agency/bank nurses but are finding it hard to fill. I asked, as paediatrics is -21 beds could they spare staff if appropriate. Siobhan stated that although they had a lot of empty beds they were also short staffed, and could only cope as they had a high number of empty beds. However, Siobhan did say she would go back and double check.
Siobhan informed the group with regards to the problem we previously spoke about today at 10:44 regarding no SHO on the orthopaedic ward. The plan is to continue to go out to agency to try and fill, and the contingency plan is to utilise the 2 F1s and Siobhan and her colleague are prescribers and can assist. I reiterated I would speak to Sean Briggs, GM for T&O on Monday morning. / 1.  Speak to Laura on Monday morning regarding surgical patient being placed on Tervor Howell Ward.
2.  Will discuss ward cover with GM for T&O on Monday.
07/07/13 / 16:48 / Siobhan Greene / Siobhan called me as they were one registrar down in CITU. Other registrars have been asked if they know of colleagues who could cover and Siobhan had gone out to agencies to try and arrange cover. Siobhan stated that the agency person would have had to have previously worked in St George’s ITU, which would make obtaining an agency person even harder. Prof Madden is the consultant on-call for ITU and Siobhan stated she had spoken to him, and he stated he is able to come in, but has an outpatient clinic at St John’s Therapy Centre tomorrow, which has cancer patients booked into it and he would have to cancel this if he worked all night, and he did not want to do this. Siobhan also informed me that there are two ITU registrars in the hospital overnight but only having two might not be safe. I suggested she contact the senior consultant currently working in ITU and ask their opinion and ask if they can assist at arranging cover. I said I would contact Dr Adrian Draper, who is the respiratory consultant on-call and ask his opinion. I informed Siobhan that in my opinion the first priority was to make the hospital safe over night and this might require Prof Madden having to cover CITU. In addition, I advised Siobhan to continue to contact agencies. We agreed to talk again at 17:30 (NB I asked Siobhan to call the on-call mobile as opposed to bleeping me). / 1.  Contact Adrian to ascertain his clinical opinion with regards to clinical ITU cover and Prof Madden.
07/07/13 / 17:04 / Dr Adrian Draper / I explained the above situation to Adrian and he agreed that if no cover could be found, then it might be necessary to request Prof Madden work in CITU overnight. Adrian stated that Prof Madden’s clinic was in the afternoon. I stated this might allow for time to arrange cover if possible and necessary. / 1.  Inform Siobhan of my conversation with Adrian when I speak to her.
07/07/13 / 17:20 / Siobhan Greene / Siobhan called to say that following her conversation with the current consultant working on ITU, they have instructed that one night ITU registrar covers the hospital and one covers CITU. If necessary they will call in Prof Madden. Siobhan said the ITU consultant, Dr Kyle said that there was to be no surgery after 20:00 unless urgent. / 1.  Text Adrian with an update.
07/07/13 / 19:06 / Siobhan Greene / Siobhan called to provide me with an update before handover. She informed me that the previous problem with regards to being a CITU registrar down had changed as they called in stating the registrar felt better and would be attending work. There have been 15 DTAs against 32 predicted in medicine and 12 DTAs against 24 predicted in surgery. There are 8 AMU beds with a query further 5 beds, 2 in surgery and 5 on Grey Ward and 6 on Champneys. There are critical care beds, including 7 on HASU. Nursing staffing is the biggest problem and they are out to agencies. They might also be able to use paediatric staff, and although they are only trained in paediatrics they could work in adult areas and not prescribe. Also they might be able to use HASU nursing staff as they have 7 empty beds. / -
07/07/13 / 22:03 / Richard Turton / Richard called on-call mobile to update, stating that ED had 327 attendances since midnight, with 64 in the department and 26 breaches on the system but Richard, thinks this is more like 10. There is ITU capacity (3 CCU, 4 CITU (not fully staffed), 6 GITU (not fully staffed) 5 HASU, 2 NICU and 1 PICU). Medicine has beds (13 on AMU) but surgery is tight, with only 2 beds and 7 on Gray. Site team may need to useChampneys for surgical female patients and Grey for male patients. Staffing (nursing) has been a problem today and they are 15 down across the trust, of which 3 in ED, (Richard is moving staff around accordingly, e.g. taking nursing for ITU which has staff and placing in relevant ward etc). / 1.  Text Hugh with an update.
08/07/13 / 22:13 / Richard Turton / Richard called with an update. He informed me there have been 415 attendances in ED since midnight, with attendance in the last four hours as: 23, 28, 28, and 23. Currently there are 78 patients in the department (30 in UCC with 1.5 hour wait, 20 in majors with 2 hour wait, 17 in paediatrics with 1.5 hour wait, 7 in resus and 4 in assessment with a 30 minute wait). There are 24 unvalidated breaches on the system, which Richard states is more like 16 breaches.
So far there have been 28 DTAs against 38 predicted for medicine and 16 DTAs against the 25 predicted for surgery. Currently beds are very tight with 6 in AMU, 1 in medicine, 2 in surgery, 4 in Gynae, 2 on James Hope and 21 in paediatrics. There is critical care beds (CCU x 2, CITU x2 but not staffed, GICU x 4, HASU x 1, NICU x 1 and PICU x 1). Currently there are 4 stroke patients in ED; therefore capacity will need to be created in Neuro/Stroke. Richard is going to go up to 5 patients on Neuro Day Unit. Richard stated there are not enough beds for medicine and next to no beds for surgery. Amyand Annex is full. Therefore, the plan is to potentially staff Champneys for medical patients. Richard might be able to staff this from using paediatric nursing staff on other wards and taking staff to open this area. Richard said he could also use the 4 cardiac beds if needed. Richard said he might need to speak to me again at either 23:00 or 00:00. We agreed that if everything was OK then Richard would not call, but if he did need to speak to me, than he would not hesitate to call. / 1.  Called Hugh to update but no answer so sent text.
09/07/13 / 23:49 / Hugh Gostling / Text from Hugh to apologise for missing call, and asked if we needed to speak. / 1.  Texed Hugh back to say I might need to speak to Site Team again at 00:00 but should be able to deal with, but will call him if the situation needs escalating.