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Night in the Life of a Bed Manager

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Name: Colin Toseland
Role: Bed manager/patient flow coordinator
Wage: Undisclosed

Now you may wonder how, during a busy night shift, I have found the time to write this. Read on and all will be revealed.

The clock shows 9pm. I have no beds in the medical/cote division, two beds in AMU and four patients waiting in A/E for admission to AMU. By my calculations, that makes minus 2. There are no patients identified to sleepout from medicine or cote and so I await the arrival of the night medical registrar.

Handover from the day staff reveals that I don’t have a night nurse practitioner working tonight. I am feeling fortunate though, as I am lucky to have a very supportive on-call administrator still here in the building and we are going to meet the on-call registrar at the 9.30pm doctor’s handover to let him know the importance of timely senior review in order to sleepout patients from AMU to the surgical wards.

It’s now 9.25pm and I am informed that ward 4 is unsafe to accept admissions as one member of staff is permanently in their HDU room with a post-op major and there is only one staff nurse and one HCSW on the main ward.

I am both aware and mindful that the ward had unsuccessfully requested additional staff for the shift. Having discussed this with the admin on call, I speak to a pleasant staff nurse who agrees to continue accepting ENT/maxillo-facial patients to the ward but not to take any sleepouts overnight.

‘We have a cardiac arrest call to ward 2. Oh no, they made a mistake, it’s ward 1’

One ward just rang to say that they are sending a trained member of staff home who is unwell. This done, we go and advise the on-call registrar as to the current situation.

It’s now 9.40pm and we have a cardiac arrest call to ward 2. Oh no they made a mistake, it’s ward 1. Chaos ensues, doctors and nurses running everywhere looking for two cardiac arrests but fortunately there is only one. All is good in time, the patient is cardioverted and the medical registrar is off to pacing theatre to put a pacing wire in.

‘Oh hell’, I think to myself, ‘no senior reviews for a while now then, but not to worry because I’ve only four patients waiting’. Midnight arrives, no sign of the medical registrar, quick phone call to CCU and I discover the pacing is proving problematic but he’s nearly done.

‘Hospital at night meeting postponed as no one’s available to come to it’

Still no senior reviews done in AMU and hence no medical patients moved from A/E to AMU or from AMU to surgical sleepout beds. Hospital at night meeting postponed as there is nobody available to come to the meeting. That’s a worry as I’ve been trying for two hours to get a senior medic to ward 7 where a patient has a ‘mews’ score of 7.

All are too busy, either in theatres or pacing. Next, a brief discussion with the SHOs with regards to their perception that they don’t have to take blood or put venthlons in at night. I point out to them that I’ve done seven venthlons and two sets of bloods already, as well as managing the hospital and trying my hardest to facilitate patient flow and avoid those damned breaches!

Time for a smoke I think. Oops, take that back it’s against trust policy. Think I will just go shout at someone instead!

Oh dear, its 1.20am now and I’ve missed the canteen, so no food for me tonight. Never mind though, more worryingly there appears to be a problem with the pacing wire so the medical registrar is off back into pacing theatres having still not been able to visit AMU.

Now I have six medical patients stuck in A&E and not a single senior doctor available to authorise sleepouts. Oh well, time to ring admin on call and ask for a consultant.

1.30am: having spoken to the consultant on call its agreed that the AMU senior houseman will look at patients for sleepout and then ring the consultant back and discuss them with him. ‘Thank God,’ I think to myself, A&E have just told me capacity is becoming limited and we have two victims of a house fire on the way in. Oh joy!

1.45am and two patients have been approved to move from AMU. That should take the pressure off A&E for a while. I feel relieved. It is during this time that I have found the time to write up this diary of events and thoughts whilst waiting for the senior reviews to take place. Oh, and grabbing a quick coffee at the same time.

I’m off to AMU now to arrange to move a couple of patients to the surgical floor and one to gynae ward; Did I mention that there is no designated porter in AMU tonight? Not to worry, there are four porters on for the whole hospital tonight and fortunately they’re a good bunch and one has come over to offer his services at the expense of some of the rubbish collection. Fair play to him, I think, it’s all about prioritising needs.

I’m back again to write a few more lines. It’s 4.20am now. Finally our overworked medical registrar returned from the pacing theatre shortly after 1.50am and has slept out a few more patients. The senior houseman did well too, I thought, and the on-call consultant was most helpful when I spoke to him; only two patients now in A&E for AMU.

‘Why do I do this bloody job?’

Time to start looking at yesterday’s breaches now. Takes about an hour to go through them all and prepare the report that gets emailed around the trust every morning and at 4pm. Not sure how many people actually read it, but who am I to ask?

Time for a coffee, I think. It’s good to sit down. We walk miles in a night and as normal I’ve visited almost every clinical area in the hospital and documented the staffing for tomorrow night, along with taking bloods and siting venthlons.

Why do I do this bloody job? I ask myself that quite often! Fact is I enjoy it very much and it pays well too. Bloody frustrating at times though. We are expected to manage the site, manage the staff, play a lead role in hospital at night and make sure nobody breaches the four-hour target – failed on that score today, but not for the want of trying, I might add.

It certainly taxes the old grey matter on a busy night and sometimes it’s a bit like giving a carpenter a block of wood and asking him to make a table but not providing him with any tools! But somehow we always get there. We always do give 100% effort. Every single one of the Patient Flow Team give that 100% every single day, and we do at times perform miracles, it’s true.

Should I mention that one of the wards cast aspersions on my good character when I asked them to take a sleepout? No probably I shouldn’t. Still I rang back and pointed out that if you’re going to make abusive comments, it’s good practice to press the mute button first! They denied it of course but I know my ears didn’t deceive me as two of my colleagues in AMU heard it too. Oh well, that’s all part of the job and we are used to it on a daily basis. Different if we ever get cross with them though. In goes the IR1 before you can take a breath. Right time to add up the breaches, back later..

Well its 5.45am now and I’m about to start the morning report. Only six breaches in the last 24 hours which, considering the lack of medical capacity, is quite an achievement I think. Hope the powers that be will agree. Nice to note that of recent times the number of breaches related to awaiting surgical specialities has dropped to almost zero.

‘The dreaded bleep is going for what seems the hundredth time tonight’

Hopefully a sign of things to come. Arghh! The dreaded bleep is going again for what seems like the hundredth time tonight. It’s one of the wards after another venthlon, so I shall wander upstairs and do that now.

It’s 6.10am now, 2 venthlons later. Oh hell I left a webpage open from checking my email earlier. Guess I will be shot for exceeding my time online! Oh well, can’t be helped. One of the two patients waiting in A/E for a bed in AMU got better and went home. Seems to happen a lot during a bed crisis. Perhaps if we kept them waiting long enough we could reduce the number of admissions? Or am I just being cynical?

Perhaps I am. I’m quite pleased with the way the night has turned out though. Only one patient left in A/E and everyone is safe and well, which at the end of the day is the most important thing. We are, after all, a health service and our priority is and always must be the patients’ best interests. Anyway, enough typing, it’s time for another coffee and report writing awaits.

I hope whoever reads this has gained an insight into a typical night in the life of a bed manager/ patient flow coordinator. Please take my sometimes sarcastic and hopefully humorous comments in the way they were intended.

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