Rob Willmore, Senior House Officer at Whipps Cross’ Emergency Department shares his reflections on changes he’s seen introduced as a result of the Covid-19 pandemic and discusses some positives that he hopes will remain once the pandemic is over.
These changes have included the rapid introduction of new ways of working both in terms of the design and layout of parts of the hospital to ensure staff safety and improve patient flow, through to redesigned rotas to help support staff get the rest time they need. In addition, Rob observes the galvanising effect of a shared common purpose and the positive impact on morale that the health and wellbeing hubs and other staff offers have had.
Taking a break from training this year, I wanted to undertake a few personal and professional challenges to widen my experience of medicine in a variety of settings. Since August, I have been working in the Whipps Cross Emergency Department as a Senior House Officer (SHO). Working in emergency medicine offers variety like no other specialty. One minute you’ll be suturing up someone’s head wound and the next you might be diagnosing someone with anxiety.
The challenges of working in emergency medicine are complex . Often the sheer volume of patients coming into A&E make it very challenging and that pressure can be seen on the faces of the staff.
Some find the frenetic nature of A&E stressful, but it’s often the stresses that make it so lovable. The enjoyment of this atmosphere is only second to the team camaraderie – that feeling of all being in it together and still being able to smile when there is a long wait and someone has just vomited all over your shoes.
A few days before the pandemic lock down, I was due to fly to South Africa to volunteer for three months in a trauma unit in Cape Town – this wasn’t to be. Instead I decided to commit to working all the hours I could to support Whipps Cross A&E in the challenges to come.
In the early days of the pandemic, Whipps had prepared well. The department constantly evolved to respond to new challenges and rising numbers of Covid-19 patients. The flexibility of staff and managers to enact improvements overnight was remarkable. A new zone was created named RAU (Respiratory Assessment Unit), which provided an area with additional protection for staff and isolated possible Covid-19 patients from others within the department. Our major’s area also created more space to see patients. These changes have helped eliminate instances of ‘corridor medicine,’ and when taken together with other improvements really contributed to a positive culture change which will hopefully be one of the lasting legacies Covid-19 will have on our department.
The departments rigorous preparation was best highlighted in its approach to the provision of, and adherence to, strict protocols relating to PPE. From day one of the pandemic, everyone from receptionists to porters, nurses to radiographers had access to masks and protective kit. Our protection was at the forefront of our seniors concerns on a daily basis. They were always asking you to refit goggles that had slipped or change your mask after hours of wearing it. I always had the kit to allow me to safely perform my job. Credit where credit is due - thank you to senior decision makers who ensured that PPE was always in place for us.
The manner in which our staff have pulled together is a second legacy that Whipps should be proud of. The senior leadership team created a new rota for A&E staffing. A four day on, four day off team structure was developed which helped prevent staff shortages and long sets of night shifts. As a consequence this offered plenty of down time and helped avoid burnout and it boosted morale. These changes in rota design were welcomed by many in the team and also helped contribute to reducing the time it takes to be seen by a doctor.
In the first four weeks of the Covid-19 lockdown I worked 22 shifts – the majority of which were in the resuscitation room and the occasional few in RAU. As a result I saw hundreds of patients across the entire spectrum of severity that Covid-19 can involve. This familiarity with a new and largely unknown disease changed some of the traditional dynamics that can exist in hospital settings. On one shift, for example, a senior consultant in A&E requested advice from an SHO in recognition of the accrual of knowledge they had gathered over the preceding weeks.
This concept of one team with a common purpose across the whole hospital, indeed the whole NHS has been felt. This has been reflected in cross-speciality support and inter-service collaboration especially. Medical teams seeing patients quickly in A&E has created flow allowing more patients to be seen in a safe environment. Maxillofacial surgeons have been acting as runners on the shop floor. The porters have responded to the crisis with vigour and an ever infectious humour making us all smile. Radiographers and radiologists have been the unsung heroes of the A&E team and thousands of chest x-rays have been performed in the last few months. Radiographers have tirelessly done portable scans across all areas of the A&E department, helping to reduce patient movement and limiting infection risk. In addition, radiologists have been working flat out reporting scans and x-rays before patients have even been seen by the A&E team, helping offload some of our cognitive workload. Staff in all areas have stepped up because they feel part of the bigger picture and valued.
Looking after staff:
A valued workforce is an effective workforce and never has this been more important. Staff have had new health and wellbeing hubs to use, food has generously been supplied for free in the canteen and more importantly at any hour of the day or night. With more staff needing to drive into work, free parking was made available to staff and patients alike. The power of these measures has had a really positive influence and contributed towards an engaged and motivated ‘one team’ culture. We must ensure that the positive changes that have been made continue into the future as we prepare for whatever else is to come.