It’s 9.45am on a Monday morning in March and in the gleaming grey and white emergency department (ED) at the Princess Royal university hospital (PRUH), 40-year-old Elizabeth Harwood is deep in discussion with a consultant.
Dressed in blue scrubs, it is hard to believe that only an hour earlier the speciality doctor was on the school run – dropping off her children to nearby schools in Bromley and Beckenham (Greater London).
She is briefed on where she is working that day. Like all emergency departments in the NHS, the PRUH is under extreme pressure. Hospital staff see approximately 5,500 patients a month and another 900 under-18s are seen in the paediatric ED.
Many of the patients are elderly, arriving with conditions ranging from chest pain, asthma attacks, chronic bronchitis and heart attacks, to strokes, pneumonia, sepsis and broken hips. Over the years, the department has almost doubled in size to cope with the rise in attendances.
It is a busy day for Harwood, who started working at the PRUH four years ago, following a career break to have her children. She cares for an older woman who has had a fall, followed by a succession of other patients, before handing over to a colleague at 2.30pm, when she leaves to pick up her youngest from school.
“I love emergency medicine and feel very lucky to do my job and balance it with family life. I spent a year working full-time and then went part-time. The consultants have been very supportive and I get excellent supervision. I love the team and I love the patients. It is perfect all round.”
Despite the pressures, it is an exciting time to be working in the department that is headed by 53-year-old clinical lead Andrew Hobart. He has seen huge changes since he arrived 11 years ago. Back in 2007 there were just four consultants offering cover until 4pm: today, there are 13 consultants working from 8am until midnight.
“There has been a big rise in complexity of cases and a huge increase in staff,” he says. “We now have 100 nursing posts and 50 medical posts across the grades, although we still need more doctors. We try to be innovative and flexible in terms of working patterns and some posts are linked to education. We pride ourselves on helping people progress in their careers, if not following the traditional conveyor-belt training programme.”
Such flexibility in training also extends to the nursing staff – both junior and senior. The department is unusual in that it takes on nurses straight out of university. More commonly, managers prefer nurses to have ward experience before they move to the faster pace of the ED. At the PRUH, six newly qualified nurses have joined the department thanks to a successful mentoring scheme and receive supervised training with regular study days. Two, who joined two years ago, have since been promoted to senior staff nurses, says Lucy Twyman, clinical practice facilitator. Senior nurses have the opportunity to attend courses in advanced trauma, nurse prescribing and advanced assessment.
There is no doubt that it is a busy department. Over the years it has almost doubled in size to cope with the rise in attendances. There are now 24 cubicles, and a specialist paediatric emergency area has been created. Plans are now being drawn up to rebuild part of the ED to create a bigger resuscitation area – increasing the number of beds from four to eight.
The department is also at the centre of several initiatives aimed at reducing the number of avoidable admissions. For example, local GPs have offered out-of-hours appointments in an attempt to relieve pressures on the department. In spite of this, the numbers presenting in the ED have still risen by 8-10% in the past 12 months. The main reasons are a rising elderly population and an outbreak of winter flu.
Now other measures are being introduced to ease pressures in the department. These include working with the London ambulance service to introduce a “fit to sit” initiative, where patients whose condition is stable are taken to a special seated area and rapidly assessed within a target 40-minute timeframe. This is designed to prevent any deterioration in their condition from long periods lying on a trolley.
A new acute frailty service is aimed at supporting patients who may be able to go home the same day, and there are future plans to the increase the opening hours of the seven-day-a-week ambulatory care unit. All these are aimed at helping patients see the right person as soon as possible.
However more staff across all disciplines are needed to support the changes, according to Sarah Frankton, newly appointed clinical director in acute and emergency medicine. She spent the past 14 years working at Whipps Cross hospital in east London – a lengthy commute from her home in Beckenham, where she has lived for 17 years. Going to work now is a dream for Frankton, who lives with her husband, four children and two dogs.
“There are challenges ahead, but the local area and the hospital are fantastic. I think the PRUH is brilliant. It is a really exciting time to be working here. All the consultants are very friendly and it is a good working environment,” Frankton says.
Twyman, 30, a former senior staff nurse in the emergency department, agrees. “I love what I do. Working and living here gives me the best of both worlds. I have a great job and I have a mortgage that I wouldn’t be able to afford in central London. I can be in central London in 20 minutes or go sailing on the coast in an hour, which is one of my passions.”
