How does a hospital cope when it is under the unprecedented pressures of a Black Alert?
That is the situation faced by nurses, doctors and other staff at King’s Mill Hospital as it struggles to meet a huge increase in demand this winter.
Chad spent a day at the hospital to find out more about the pressures - and how staff are coping.
King’s Mill has come under the spotlight like many others around the country for failing to meet performance targets, with people kept waiting for more than four hours at A&E.
What shines through is the dedication, personal sacrifice and sheer hard work of those involved.
The situation - described as the worst since records began - has been created by a perfect storm of increased number of people arriving at the department and a bottleneck created by a lack of available beds for A&E patients. Medics are urging people to only use A&E as an emergency service.
Richard Clarkson, lead nurse in A&E, said recent weeks had been ‘busy and challenging’.
The department was admitting more patients than it was discharging and they were being kept in A&E for longer.
He said: “They need caring for and that takes more and more resources of our staff.”
“A lot of frail and elderly patients needing admission because there are not beds for them are waiting from six to 10 hours.
“They need looking after. You can have as many as 20 who should be in a bed.
“We have an increasingly elderly population, more ambulance calls, more sicker patients.”
He said staff are coping with the pressures but it was hard work. Night shifts are getting busier and there are very few discharges through the night.
“We have put an extra nurse on overnight now and an extra registered nurse on every night since December, which is now on a permanent basis,” he said.
“When demand is high extra care assistants are employed and staff from other areas will come to help A&E.”
He added: “There is a lot of work being done through the trust and the health community to improve things. I have got an extremely good team and they are working above and beyond to cope with the pressure.
“When you have no ceiling and some 200-300 patients it is so unpredictable.
“I feel confident the trust has got on board with us making A&E one of their priorities.”
Jayne Revill is discharge lounge sister. She was a duty nurse manager over Christmas as the situation unfolded.
She said: “I worked over Christmas and I could have despaired for them. It was bedlam. We had seven or eight ambulance crews waiting for handover.”
She emphasised that patients are assessed in the ambulance and serious life-threatening cases are flagged up immediately and dealt with straight away.
“People who walk in, if they look really unwell are seen as soon as they possibly can and taken somewhere they can be assessed and seen by a doctor,” she said.
“The bottleneck then is the wait for a bed. It puts staff under a massive amount of pressure. At this time of the year patients are usually very unwell and the intensive care and respiratory wards are full.
“The resus ward was full - we had seven patients there at one time really unwell. It was the party time and a lot of people were coming in intoxicated. It has been all for one and one for all. We have had to do it. It is as simple as that. The staff have worked superbly.”
When it snowed on Boxing Day, she said staff had stopped overnight at the hospital to start another 12-hour shift the day after.
“I don’t think any nurse could have worked any harder or made it any better for people,” she said.
The Discharge Lounge is used where people are medically fit enough to discharge them home.
Jayne said: “If you can get people going home quicker you can get more people through to wards. If ,for example, a patient has been signed off by a consultant and is waiting for medication or transport for two or three hours, we bring them to the discharge lounge which alleviates the pressure by releasing beds.
Before Christmas there were seven to 10 patients a day using the discharge lounge - now it is 20-25.
“We are making a conscious effort to get people moving,” said Jayne.
“The trust is trying very hard and I think they have pooled all the resources they can now.”
She said a problem with social packages was leading to well people staying in beds.
“Some patients are in hospital while they are well because social packages are not in situ,” she said. “That is being addressed, but more needs to be done urgently.”
Both nurses urged people to choose the right route to health care rather than automatically going to A&E.
They could be dealt with by their GP, pharmacist, self care for people with colds and flu, or use the Primary Care centre next door to the hospital, which offers out of hour GP services.
A ‘black alert’ was declared at King’s Mill Hospital on Monday 5th January 2015 as an unprecedented number of patients attended the emergency department - and this was still in place as of last night.
Sue Barnett, interim director of operations at Sherwood Forest Hospitals NHS Foundation Trust, said: “A black alert is ‘when all actions have failed to contain service pressure in the local health economy’.
“It is rare for the hospital to be put on black alert and, when necessary, it would usually be in place for less than 48 hours.”
Staff members are working extra shifts and all non-essential training has been cancelled.
She said the trust is continually reviewing all elective operations and outpatient clinics at the hospital, postponing appointments where necessary to enable medical, therapy and nursing staff to concentrate on frontline care for patients.
An internal control centre continues to be in place, where directors constantly review the situation to enable patient flow to be improved.
Sue Barnett added: “Activity increased throughout last year with 8.5 per cent more patients attending our hospitals.
“On both Christmas Day and Boxing Day alone we recorded a 21 per cent increase in the number of people attending our A&E Department compared to Christmas 2013. The number of people attending A&E at King’s Mill Hospital in one 24 hour period (midnight to midnight) so far in January peaked at 293.
“We are also seeing an increase in the number of people attending A&E who are seriously ill and require admission to the hospital.”