I am working a week of nights. The first 2 have been fine from my mental health point of view, but there have been a number of worrying occurences. The NHS 'Hospital@Night' Plan needs some serious work...
At the end of the night, the Consultant in charge comes in at 8am and does a ward round seeing all of the patients admitted (about 50). Today we were going round as usual, and one of the patients we saw had been sitting there for 15 hours. His blood tests and ECG confirmed that he had suffered a heart attack. This could have been picked up 10 hours earlier and he could have had some treatment. As it was, his heart continued to infarct (die) whilst he slept peacefully and the nurses checked his blood pressure and the doctors ignored him because no-one had thought to mention him to them.
Another patient had been sitting there all night with chest pain, having been admitted the previous day. The consultant had requested some tests and a further review. Again no-one told us (the night doctors) so by the time I saw him (when it was his 'turn') it was obvious he needed to be moved straight to the coronary care unit for urgent treatment.
The icing on the cake was when we arrived at the bed of an elderly lady. She hadn't been seen by any doctors since her arrival in hospital several hours previously, because it wasn't her 'turn' yet. We were sifting through the referral letter from her GP, and checking her observations on the chart. It was then that we realised she was dead. And she had been dead for up to 2 hours. Here eyes were open but her heart had stopped beating some time ago. Her observations (temperature, blood pressure, heart rate, etc) had been recorded at 6am. It was now 8.30am, and the Consultant astutely observed that her last recorded observations were at 8.15am so she must have died within the last few minutes. We made an immediate decision not to attempt to resuscitate the lady as it would have been futile. And then I looked at the observation chart again and realised that the observations at 8.15am consisted only of a temperature and nothing else. So someone had come to the lady to check her observations routinely, recorded the temperature and then was unable to record a pulse or a blood pressure. This was because she was dead. And was anyone told? No. She was left there, sitting with her eyes open looking 'comfortable at rest' whilst the breakfast trolley trundled around dishing out tea and toast.
Throughout the whole night, we had been under pressure as usual due to a lack of staff and a lack of beds. As soon as patients came up from A+E (ED), we were trying to ship them out to any available beds in the hospital. It got to the stage where the nurse manager in charge asked me to only see female patients for the whole shift as we only had 4 female beds and no male beds available. I almost told him to f*ck off. Furthermore, patients are put on a waiting list to be seen based solely on their time of arrival. It has nothing to do with why they are in hospital or whether they are about to die or not. So we are forced to see Uncle Jim with his sore big toe whilst Granny Edna's heart dies piece by piece in the next bed, just because we don't know about it. No-one tells us who is ill and who needs to be seen first. It is pot luck. It is all about the hospital meeting government targets on waiting times so they can get more money to pay the managers. And this Hospital@Night plan is one such target.
My advice is this - if either you or someone you care about is admitted to an NHS hospital as an emergency, worry. It is a crap system and it is getting worse. And despite a team of nurses and doctors working as hard as they can to help people, lives are being lost. What a shame the NHS is so stretched. It could be wonderful. It is going to get much, much worse. The Hospital@Night is a bad place to be.
At the end of the night, the Consultant in charge comes in at 8am and does a ward round seeing all of the patients admitted (about 50). Today we were going round as usual, and one of the patients we saw had been sitting there for 15 hours. His blood tests and ECG confirmed that he had suffered a heart attack. This could have been picked up 10 hours earlier and he could have had some treatment. As it was, his heart continued to infarct (die) whilst he slept peacefully and the nurses checked his blood pressure and the doctors ignored him because no-one had thought to mention him to them.
Another patient had been sitting there all night with chest pain, having been admitted the previous day. The consultant had requested some tests and a further review. Again no-one told us (the night doctors) so by the time I saw him (when it was his 'turn') it was obvious he needed to be moved straight to the coronary care unit for urgent treatment.
The icing on the cake was when we arrived at the bed of an elderly lady. She hadn't been seen by any doctors since her arrival in hospital several hours previously, because it wasn't her 'turn' yet. We were sifting through the referral letter from her GP, and checking her observations on the chart. It was then that we realised she was dead. And she had been dead for up to 2 hours. Here eyes were open but her heart had stopped beating some time ago. Her observations (temperature, blood pressure, heart rate, etc) had been recorded at 6am. It was now 8.30am, and the Consultant astutely observed that her last recorded observations were at 8.15am so she must have died within the last few minutes. We made an immediate decision not to attempt to resuscitate the lady as it would have been futile. And then I looked at the observation chart again and realised that the observations at 8.15am consisted only of a temperature and nothing else. So someone had come to the lady to check her observations routinely, recorded the temperature and then was unable to record a pulse or a blood pressure. This was because she was dead. And was anyone told? No. She was left there, sitting with her eyes open looking 'comfortable at rest' whilst the breakfast trolley trundled around dishing out tea and toast.
Throughout the whole night, we had been under pressure as usual due to a lack of staff and a lack of beds. As soon as patients came up from A+E (ED), we were trying to ship them out to any available beds in the hospital. It got to the stage where the nurse manager in charge asked me to only see female patients for the whole shift as we only had 4 female beds and no male beds available. I almost told him to f*ck off. Furthermore, patients are put on a waiting list to be seen based solely on their time of arrival. It has nothing to do with why they are in hospital or whether they are about to die or not. So we are forced to see Uncle Jim with his sore big toe whilst Granny Edna's heart dies piece by piece in the next bed, just because we don't know about it. No-one tells us who is ill and who needs to be seen first. It is pot luck. It is all about the hospital meeting government targets on waiting times so they can get more money to pay the managers. And this Hospital@Night plan is one such target.
My advice is this - if either you or someone you care about is admitted to an NHS hospital as an emergency, worry. It is a crap system and it is getting worse. And despite a team of nurses and doctors working as hard as they can to help people, lives are being lost. What a shame the NHS is so stretched. It could be wonderful. It is going to get much, much worse. The Hospital@Night is a bad place to be.
2 comments:
The story of the elderly lady reminded me of an incident during my fourth year of medical school.
As fourth years, we are required to do the patient monitoring (not sure why--the hospital had nurses) and record this at the nurse's station. Anyhow, one 4th year had recorded all of his monitoring (heart rate, blood pressure, temp) for one patient--later that morning one of the attendings called the 4th year a liar and gave him two extra months in the ward. The patient that he had "recorded for" had died--the 4th year never checked on the patient--just wrote down stuff on the monitoring sheet.
Grreat post thank you
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