GM /Director Oncall Log for week commencing: Oncall Log for week commencing: 1st March 2013 Completed by: Tom Ellis Director on call Suzanne Marsello
Date Time Conversation Information/message to the GM oncall Action by GM (24 with: or Dir. oncall hr)
01/03/13 22.05 Richard Turton, 365 through dept so far. Last four hours 27, 25, 28, 25. 91 in A&E currently None at this Site Manager . 23 in majors with 2.5 hour wait time. . 32 in paeds with 2 hour wait. 2 unplaced Surgery and 1 medical DTA’s in Department. 23 breaches on iCLIP, 17 validated. Long wait for assessment is having knock on effect in A&E 16 beds in AMU currently, no downstream medicine. 8 surgery + 5 on Gray. Cardiac & Neuro both full. 3 stroke + 2 CCU beds available. 10 beds on ITU. Overall, should be ok for tonight, but will become tight tomorrow if predicted admissions transpires. 02/03/13 12.10 Ian Sparkes, Site Conference call hook up unsuccessful. TE had separate conversation with Site None at this Manager Manager and relayed key points to Director on call. time
95 pts so far, 0 breaches. 44 in department with no significant waits. MAU 10 beds, Medicine 4 later, Surgery 6, Cardiac 0 (7 later), Neuro 0, Paeds 10. ITU’s 7, CCU 2, HASU 2, PICU 3. Currently – 13 in Medicine and – 13 in surgery. Gray has 19 beds full, James Hope full (mainly cardiac), and Champneys 4 escalation open and full. 02/03/13 16.45 Ian Sparkes, Site 220 so far, 2 breaches. 86 in Department. 30 in minors, 19 in majors, 14 paeds, 11 Use James Manager assessment, 6 resus. All with 2 hour wait approximate. Hope or outlay into Caroline if Surgery now – 9. Medicine has 14 beds in system including MAU. necessary
The purpose of completing a log/record of your on-call is:
1.To protect you and the decisions that you make when you are on-call. In an inquest or court of law, if it is not written down it didn’t happen!
2.To provide a learning tool for your on-call colleagues, so that others can learn from the situations you faced and the decisions you took in response to them. 02/03/13 22.00 Richard Turton, 355 pts, 9 breaches so far on iClip. Beds reasonable going into the night. Surgery None at this Bed Manager is short – use Caroline if need be for low grade patients. time
Power cut earlier in the day – SGH generators kicked in quickly. 2 theatres in St. James Wing – 3 and 6 – not come back on stream. Engineers working on them currently to resolve for tomorrow/Monday lists. 03/03/13 12.00 Ian Sparkes, Site 141 so far today, 5 breaches showing, invalidated. 65 pts between 00.01 and 08.00 Agreed to Manager so heavy during early hours. discuss again around 16.00 63 in Department currently. Majors 13, 1 hour, Resus 4, Peads, 18, 2 hours, UCC 24, 1 hour, Assessment 4. TE to raise Surgical TCI 3 unplaced Med DTA’s + 1 ENT patient. – 12 in Surgery and – 12 in Med currently lists with on predicted. Brendan Beds available – 3 AMU, 1 Med, 3 Surgery, 9 Cardiac, 0 Neuro, 7 paeds. McDermott on ITU’s – GICU 0, more later, CTITU 2, more later, Neuro 5. Monday Gray full with 2 potential discharges. DTA’s down in Medicine on what expected, surgery is real issue. Some QMH capacity available (info via SM, Director on Call), relayed to Site Manager
Engineering issues with theatres 3 and 6 resolved.
Surgery have 9 patients on TCI list – this contradicts statements at 10.00 and 16.00 escalations that there were 0 surgical elective TCI’s. 03/03/13 15.55 Ian Sparkes, Site 246 so far, 80 in Dept. 9 breaches on system currently. Agreed to use Manager Minors 25, 1.5 hour, Majors 22, 2 hour, Paeds 20, 2 hours, Resus 5, Assessment 7. Chesldeson and 2 unplaced DTA’s. Cardiac to get in Beds MAU 0, 10 later. 0 Med, 2 Surgery + 6 later. Cardiac 9 but 9 TCI’s to get in, Neuro 0. Take longest ITU’s – 10, CCU 3, HASU 1. waiting IHTs in – agreed 3 to
The purpose of completing a log/record of your on-call is:
1.To protect you and the decisions that you make when you are on-call. In an inquest or court of law, if it is not written down it didn’t happen!
2.To provide a learning tool for your on-call colleagues, so that others can learn from the situations you faced and the decisions you took in response to them. Medicine – 11 beds and Surgery – 6 currently total 9 2 Cheseldon beds available. 4 escalation nurse available, so could do both NDU and Endoscopy if needed.
Of 9 surgical TCI’s bring in urgent and cancellation re-books, roll routine.
Longest waiting cardiac IHT is from 25/2 and 26/2 – agreed to offer them beds. 03/03/13 19.00 Ian Sparkes, Site Surgical TCI’s in all bar 2. Agreed to potentially use NDU to assist neuro to None at this Manager accommodate 2 emergencies in A&E time 03/03/13 22.35 Anna Rudd, Site 399 so far, 15 unvalidated breaches. 67 in Dept currently. Waits all around 2 hours None at this Manager currently. time
7 MAU beds, 5 Surgery on Champney’s free, 2 on Gray, 2 on other wards. Cardiac 8 beds left for Med/Surgery escalation if needed. 5 stroke free – NDU not opened as agreed any neuro to be accommodated within Stroke if needed
10 ITU beds.
Other issues . 1 stabbing patient, likely to die. Gang related. Press interest potentially and also other gang members had been on site – had been persuaded to leave. . 1 patient, likely to die, suspected murder. Police not initially interested. Coroner not prepared to release organs for donation due to possible murder. Police now involved again. Agreed that Site manager should alert Comms on Call around 07.00 04/03, unless issues escalate during the night. 04/03/13 22.15 Anna Rudd, Site 429 so far today, 22 breaches (unvalidated). 85 in Department still. TE to write to Manager 18 in minors – 2.43 wait CSW 24 in majors – 2.36 wait Management 29 in paeds – 2.45 wait about issues re Resus full, assessment 17. QMH out of Ambulances held for short periods, but none that would trigger escalation or hours.
The purpose of completing a log/record of your on-call is:
1.To protect you and the decisions that you make when you are on-call. In an inquest or court of law, if it is not written down it didn’t happen!
2.To provide a learning tool for your on-call colleagues, so that others can learn from the situations you faced and the decisions you took in response to them. penalties etc.
Beds available. MAU – 7, Surgery – 5, Champney’s full, Cardiac – 1, CCU – 4, Neuro – 1, HASU – 5, NDU – 1 No unplaced DTA’s. Agreement to mix sex if necessary from patient safety perspective or to avoid other target breaches.
QMH Dementia patient Patient at QMH needs transferring to KHT as their clinical condition deteriorating. Patient refused, despite being got to the entrance of QMH to get on waiting ambulance. Ambulance staff and police not helpful. Band 6 at QMH does not know what to do. Discussed options. Escalated to on-call Director. Discussed again with Site Manager – she was going to get more clinical info on patient and risks of staying on QMH site overnight (later on another ambulance with more helpful crew came and managed to get her to go to Kingston). 05/03/13 22.30 Ian Sparkes, Site 385 so far today. 65 in Department, 30 breaches so far today. Manager Majors 30 with 2.24 wait, minors 14, 1.45, Paeds 13, 1.25, Resus 4, Assessment 9.
Last four hours 26/18/27/16
Beds Surgery – 3 on Gray, 13 other, 3 on Champney’s Medicine – 6 on AMU + 1 medicine
Enough beds to get us through the night but will be patients in ED tomorrow who need placing 06/03/13 18.45 Site Manager, Conference call, 19.00 on St. Helier divert TE to ring in Sian 06/03/13 19.00 Sian, Richard St. Heleir on divert. Message had not gone out on pagers. Divert due to end 19.00 from Sector, St. hours. No further action required at this stage
The purpose of completing a log/record of your on-call is:
1.To protect you and the decisions that you make when you are on-call. In an inquest or court of law, if it is not written down it didn’t happen!
2.To provide a learning tool for your on-call colleagues, so that others can learn from the situations you faced and the decisions you took in response to them. Helier (Karen Breen + Med Director) 06/03/13 22.20 Ian Sparkes, Bed 388 so far today. 71 in Department currently, 31 breaches so far. Nothing at this Manager Last four hours 25/28/34/19 moment in time
22 majors 2 hours, 22 minors 2 hours, 8 resus, 15 peads 1.5 hours, 4 assessment
Beds Med – 8 MAU, 1 Med Surg – 11 Neuro – 0, HASU – 1, Cardiac – 0, ITU’s 3
Enough to get through the night but will be patients in ED needing placing tomorrow a.m. 07/03/13 22.20 Ian Sparkes, Bed 364 so far today. 93 in Dept. 32 unvalidated breaches on system. No action at this Manager Last four hours 24 / 20 / 28 / 13 time.
Majors – 20 @ 2 hours Minors – 23 – zero wait Resus – 7 Paeds – 28 – 1.5 hours Assessment – 12 – 1 hour
Beds AMU 1, 8 later. Med – 0. Surgery – 6, Cardiac – 1, Neuro – 0, Paeds – 15, ITU’s 2, HASU – 2/
Shortage of beds, will impact on numbers of unplaced in A&E tomorrow.
The purpose of completing a log/record of your on-call is:
1.To protect you and the decisions that you make when you are on-call. In an inquest or court of law, if it is not written down it didn’t happen!
2.To provide a learning tool for your on-call colleagues, so that others can learn from the situations you faced and the decisions you took in response to them.