My second day on the Gynaecology Ward was spent shadowing a late shift. It begins with caring for the morning’s surgical and medical cases, most of whom will be discharged the same day. Then at 5pm when the Emergency Gynaecology Unit closes, all the EGU cases are transferred to the ward, as well as any new emergencies that come in during the evening.
The afternoon was very quiet, only three patients were still on the ward. It was a bit boring. But when 5pm arrived, everything changed.
All cases have to be seen and dealt with within 3 hours. If this is exceeded, it is recorded on the ward’s waiting time target. If the case is not seen and dealt with within 4 hours, there are financial penalties, and it all gets very serious.
At 5pm five patients were brought in from EGU, and at the same time, two emergencies came in that had to go straight to theatre. With the consultant and senior registrar both busy, the Senior House Officer was the only doctor on the two gynaecology wards, having to see all existing patients, the EGU transfers and any new emergencies, a huge responsibility for the most junior member of the medical team.
The nurses got on with the assessments, and I sat in on one for a patient who was in for an early scan following 5 miscarriages. She wanted reassurance that the pregnancy was still going well. The nurse was very kind and understanding, but the computer system ruled the interaction, and meant the nurse had frustratingly little time for real contact with the patient.
The staff kept returning to the screen that tracked the patient’s progress through the system. Some needed to be seen by the doctor before being discharged, but he was still on the other ward, and time was passing.
When the doctor was finally available, there was a lot of pressure on him to get patients out quickly. But he needed to discuss some of the cases with senior staff who were still in theatre. After examining one patient, he had to tell her that she had lost her baby. She wanted some time with her husband before deciding how to manage the miscarriage. Meanwhile, the staff watched as the clock ticked over the 4 hour deadline and into the red zone.
I felt that there was already enough pressure on the staff without the additional stress of meeting artificial deadlines. Of course patients get fed up with waiting, and perhaps there has been a culture of lethargy in the past, but there must be better ways to deal with it.
After two shifts, I know a lot more about the work of the ward, and the rhythm of their days. It is a hard place to spend time in. One of the nurses said to me, ‘there is no joy here’ – and it is true in a way. The successful deliveries take place somewhere else.
One of my difficulties is that the space is shared by women with very different agenda’s and I need to find a common point of reference for my work. My next step is to spend some time doing one to one interviews with staff and patients. I’m looking forward to seeing what comes out of that.
