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Hospital Trust

Queens Hospital

Queens Hospital is the flagship hospital of the Barking, Havering and Redbridge University Hospitals NHS Trust and replaced both Harold Wood Hospital and Oldchurch Hospital when it opened in December 2006. It has a standard bed capacity of 939, with an additional 60 available when required (which is often). Bluebell is the Respiratory ward. Queens has had some challenges since opening, and the current CQC rating overall is “requires improvement“. Despite this, trainees’ reports of their experience here continue to improve, with recent trainees being very enthusiastic about the exposure to large number of patients, and the support and teaching received from the Consultants. Notably, the CQC rates Queens as “good” in the domain of ‘caring’.

queens

Consultant speciality interests

  • Dr Kaiser – general respiratory / pleural
  • Dr Johns – general respiratory/ interstitial lung disease
  • Dr Jubber – retired but continuing to work until a permanent replacement is found
  • Dr Choudhury – general respiratory / acute medicine / ambulatory care

Meetings

  • Weekly lung cancer MDT
  • Weekly radiology meeting
  • Weekly clinical meeting/journal club
  • Monthly M&M meetings

Bronchoscopy

  • Adequate bronchoscopy experience, including endobronchial biopsies
  • Transbronchial biopsies rarely done, and not by trainees
  • EBUS not available (only at King George)
  • Suitable for ST3/4 with limited bronchoscopy experience. Well-supported training and adequate numbers. A recent trainee achieved 100 bronchs in their year at Queen’s (although they were the solo Resp SpR at the time).
  • There are 2 bronchoscopy sessions / week – usually split between the 2 registrars.

Clinics

  • Trainees do 2 general respiratory clinics a week, seeing both new and follow-up patients.

Typical week

Monday: am clinic, lunchtime teaching, pm ward work/referrals
Tuesday: am clinic/ward work/referrals, pm MDT
Wednesday: am x-ray meeting then bronchoscopy, pm clinic or ward work / referrals
Thursday: am clinic/ward work, pm bronchoscopy
Friday: am pleural list/ward work, pm referrals/occasionally extra clinic

One of these days is typically replaced by an on call or infrequently by a lieu day each week. Clinics are not too busy and generally finish on time. There is little time for admin so it is common to stay late for this.
About 50% time is spent on ward work, about 25% referrals (although this is mostly consultant led), There is lots of supervision but also autonomous practice is encouraged.

Procedures (estimated per year done by each Resp SpR)

  • Chest drains: 15 – 20
  • NIV initiation: 20 – 25

Pleural USS

  • There is a dedicated departmental bedside ultrasound machine.
  • There are no Level 2 trained Consultants in the Respiratory department, but Dr Syed in Radiology can help with Level 1 sign-off

NIV

  • info needed on organisation of NIV service

GIM

  • The rota is 1b banding, with an average of 1 on call a week and 1 weekend in 4.
  • Acute takes are notoriously busy, with a large number of sick patients seen within each 12 hour shift (average between 40-60 in the day and 20-40 at night). Daytime is generally manageable with adequate staffing. Nights can be a real challenge.
  • There is a large take team comprising 2 registrars (one covering resus admissions), 5-6 SHOs and 3 FY1s (also cover wards). There is also a dedicated ward SpR. However, there are frequent gaps, with reliance on locum staff to fill the rota. This can be a challenge, particularly for ST3s who have previously worked in less busy, more protected roles. Medical staffing are very proactive and do their best to recruit to fill gaps.

Teaching

  • Contribution to PACES teaching
  • Simulation facilities
  • Observed undergraduate teaching

Management/leadership

  • Opportunity to run the rota for juniors.
  • In house leadership and management course available.

Specialist training opportunities

  • New pleural clinic/list adds to the already good pleural experience.
  • Very good general Respiratory training.

Research and QIP

  • Queens does not have research on site.
  • There are plenty of QIP opportunities

Stage of training best suited to this rotation

  • ST3/4 for a good grounding in general Respiratory medicine and coverage of a large number of GIM competencies.
  • May also be suitable for pre-CCT trainee before acting up, particularly due to the broad GIM experience.

 Recent trainee comments:

“Queens is an intense job, and can be exhausting. The acute medicine commitment can feel burdensome, but there are good opportunities to master the Med Reg role and see lots of GIM. Also, the general Respiratory clinics provide good exposure to lung cancer, asthma, ILD and bronchiectasis so it’s ideal for early in training.”

“Although initially hesitant about starting at Queens after hearing various horror stories about acute medicine, this has probably been the best training experience I have had to date. There is plenty of general respiratory experience, lots of bronchoscopy, a newly formed pleural clinic and a dynamic friendly consultant body. Acute medicine is busy but provides great experience for a junior registrar and presents a huge breadth of general medical conditions  “

About drlj

Respiratory Registrar in North East London

Discussion

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  1. Pingback: King George Hospital | Resp NET - April 2, 2017

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