W W W 

Pit stops that don’t stop – a blog by Dr Richard Preece

10th April 2017

As part of #HomeForEaster week, Richard Preece, Executive Lead for Quality for the Greater Manchester Health and Social Care Partnership, looks at his afternoon spent with a local AMU team.

Dr_Richard_Preece2 (1)

Calm kindness is the enduring impression I took away from my afternoon with the AMU team. I was there to support #HomeforEaster. I hoped to learn more about what it’s like to work in a busy hospital ward and possibly give one or two insights in return. Being there on Sunday would also be a way to see progress with seven day working.

The Acute Medical Unit (AMU) is the first point of entry for patients referred to hospital as emergencies by GPs or other health professionals, and those referred from the Emergency Department. Patients will be initially seen by a nurse who will record vital signs such as temperature, pulse and blood pressure. Other tests, such as blood tests and x-rays, may also be needed. After being seen by medical staff and a consultant the patient may be discharged or sent to a medical ward to continue their treatment.

In the morning I’d watched Lewis Hamilton win the Grand Prix in China. The AMU team and Lewis’s pit crew are similar. Patients, like racing cars, arrive at relatively short notice, are attended to swiftly, and as soon as possible are underway again. The pit crew and ward team share many attributes. Both are passionate multi-disciplinary teams and both disguise intense activity with calm and highly choreographed teamwork. If part of the pit stop service is missing or doesn’t happen on time Lewis’s departure is seriously delayed and so it is on AMU.

There are more than fifty patients on AMU and they are continually being admitted and discharged. Just creating a list of who was in which each bed and where the team were up to in terms of meeting care needs challenged my novice ward liaison ability. (Rather inconveniently patients can have very similar names!) In the few minutes it took to get from the ward to the 15:00 briefing a patient expected from the Emergency Department was being moved to the AMU and he was temporarily not an inpatient in one or the other.

It was good to see so many visitors to patients on a Sunday afternoon. Some patients didn’t get any which reminded me how isolated people can feel in hospital (and at home) and how important it is for the team to talk to patients even though they are very busy.

About half the patients on AMU were waiting to move to a bed on another unit, including Cardiology, Respiratory Medicine, and Medicine for Older People. These patients were receiving great care on AMU but that’s not quite the same as the focused care they might get on the specialty ward. The delays in discharge from those specialty wards my fellow Ward Liaison Officers reported at the 15:00 briefing meant a delay in transfer to those wards for the AMU patients. Those specialty ward patients would be #BetteratHome and the AMU ones better on the specialty ward. The most important thing we do when we improve flow in, through, and out of hospital is improve the focus and appropriateness of care or patients experience.

The focus of the AMU team is stabilising acutely ill patients and getting them firmly established on the road to recovery. The focus of the specialty wards is on optimising their care and the road home. Delay in transfer means delay in the shift of focus. Delay breeds delay.

Seven day working has always been a reality for ward teams but it’s not been a reality for all teams providing care and support to patients. In a short time on AMU I had three separate conversations along the lines of ‘we can’t do anything about that on a Sunday’. Commenting on the Liaison role, Helen, my Partnership colleague, said “I think it would be busier on a weekday”. I’m sure she’s right. We still have more to do to create a full seven day service.

As I left the hospital at 4 o’clock I remembered colleagues on a ‘long day’ shift had already been at work for eight hours and still had a few to go. Lewis and his pit crew had long since finished their day’s work. The pit stops in AMU don’t stop.

I had observed a few things that might help and shared these at the briefing. The AMU team were kind and welcoming. They and their patients richly deserve our support.

  • Follow Dr Richard Preece on Twitter @drrichardp