King George Hospital

Updated in Feb 2020

King George Hospital (KGH), Ilford is a modern local hospital providing acute and rehabilitation services for the residents of Redbridge and Barking, and a ‘planned care centre’ serving the whole catchment area. It opened on its current site in 1995 and has 450 beds. The hospital is part of the Barking, Havering and Redbridge University Hospitals NHS Trust (BHR) – one of the largest in the country, serving a diverse population of around 750,000, also operating Queen’s Hospital in Romford. Some commitments occur at Queen’s Hospital. King George has an overall CQC rating of “requires improvement” in 2019 with “good” ratings in urgent and emergency services and outpatient.

5 Respiratory trainees will be posted to BHR (usually 1 year rotation) at each time (3 in KGH and 2 in QUE). Trainees will now only need to choose to rotate to BHR rather than to King George or Queens Hospitals (QUE) separately. This will allow internal shuffles to take place between KGH and QUE. Individual SpRs may have training requirements that are best fulfilled at one or the other of these two centres and allowing the Consultants at BHR Trust to arrange movement after 6 months will facilitate their training.

There are no inpatient respiratory beds in KGH at the moment (although this seems to be changing). The KGH team is in-charge of the Bluebell B ward in QUE.

Consultant speciality interests

• Dr Rajesh Banka – lead consultant, lung cancer diagnostics (EBUS), lung cancer and sleep medicine
• Dr Manoj Menon – lung cancer diagnostics (EBUS), integrated care (COPD)
• Dr Adam Ainley – TB
• Dr Mohammad Ehsan Ul-Haq Moghal

The department is well supported with specialist nurses in TB, COPD and sleep.

Typical week for SpRs

When there are 2 SpRs on at the same time (which is rare), one will cover the Bluebell B ward in QUE and the other will follow the schedule below.

	Mon	Tue	Wed	Thu	Fri
AM	General Resp clinic	Bronch list	Lung cancer clinic	Lung cancer clinic	Bronch list
PM	Admin/ Referrals	Local Diag. MDT in QUE	TB clinic or EBUS list	Admin/ Referrals	Admin/ Referrals

Other meetings:

• Monthly radiology meeting
• Monthly Mortality and morbidity meetings

Bronchoscopy

• 3 ‘protected’ sessions a week, all supervised by consultants.
• Training in bronchoscopy is ‘excellent’, with more than adequate experience gained in diagnostic bronchoscopy, including endobronchial biopsy. There is no interventional bronchoscopy.
• This is a good place for training in bronchoscopy for an ST3 or ST4.

Estimated number of bronchoscopic procedures in 6 months per trainee: 21 – 30 (with 1 – 10 endobronchial/transbronchial biopsies)

Estimated number of EBUS/TBNA in 6 months per trainee: 1 – 10

Thoracic US and pleural procedures

• Dedicated Respiratory department machine
• Level 2 trained Consultant able to sign off trainees as Level 1 competent
• There is a pleural clinic so there is good support for sign-off with trainees reporting no problems in logging cases and being observed
• There are occasional opportunities for medical talc pleurodesis.
• There has been no report of pleural biopsy performed by trainee.

Estimated number of thoracic US in 6 months per trainee: 51 – 60

Estimated number of pleural aspirations in 6 months per trainee: 11 – 20

Estimated number of chest drain insertions in 6 months per trainee: 11 – 20

NIV/Sleep

• Adequate acute NIV experience when covering the ward in QUE
• Good sleep service available here with overnight pulse oximetry, limited and complex polysomnography services available.

Estimated number of adequate involvement in management/initiation of NIV in 6 months per trainee: 1 – 10

GIM

• GIM acute take shifts are done at Queen’s hospital, Romford. The rota is approximately 1/5.
• 3 SpRs and 5 SHOs are on call during the day and 2 SpRs at night. Staffing has been chaotic in the past with frequent rota gaps and a high number of admissions. Queens on call shifts were notorious in the past for being a ‘baptism of fire’. However, recent trainees paint a different picture of good management, much fewer rota gaps and a well supported take which is not excessively busy.
• Admissions are approximately 35 – 45 patients during the day and 20 – 30 during the night. SpRs have reported requiring to manage a cardiac arrest weekly.
• Lots of experience can be gained at Queens in decision making for acutely unwell patients, and the challenges of managing a large acute care team.

GIM experience has been rated “good” here.

Teaching

• Observed postgraduate teaching
• Contribution to PACES which is run at QUE

Management/leadership

• Rota co-ordination
• Opportunity to act as lead SpR in running PACES at Queens (quite an undertaking but rewarding and is an opportunity to demonstrate leadership and management skills)
• SpRs are also invited to departmental management meetings

Quality improvement

• Trainees are involved in BTS Audits

Specialist training opportunities

• Lung function – full lung function tests and FeNO testing available (opportunity for experience with friendly physiologists)
• TB – adequate experience
• Integrated care and pulmonary rehabilitation is available in this hospital

Trainees have reported inadequate experience in ILD, CF, occupational/genetic/developmental lung disease, allergic lung diseases, palliative care in respiratory and pulmonary hypertension.

Research

• No specific opportunities reported in this post

Stage of training best suited to this rotation

• ST3 – ST4

Recent trainee comments:

“Excellent first training post. Good exposure to respiratory. Heavy GIM on calls.“

“An excellent ST3 placement with good opportunities for learning general respiratory knowledge and skills. Particularly good for procedural sign-offs – bronchoscopy, EBUS, pleural ultrasound. General medicine experience is very busy but useful in learning how to cope with a huge patient volume.”

“Good ward experience in chest drain insertion and pleural aspiration.”

“The pleural USS list is now up and running and often gets 2-3 patients for diagnostic and therapeutic aspirates.”