Queen’s Hospital

Updated in Dec 2020

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’ and ‘effective’.

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.

Consultant speciality interests

• Dr R Kaiser – general respiratory / pleural / TB
• Dr R Johns – general respiratory / ILD
• Dr E Hilal – general respiratory / ILD
• Dr Z Huq- general respiratory

Typical week for SpRs

	Mon	Tue	Wed	Thu	Fri
AM	Cons WR or Clinic	SpR WR or Clinic	Bronch list or SpR WR	Clinic or SpR WR	Cons WR or Pleural Clinic
Lunch	Dep. meeting	TB MDT/ M&M/ Govern.
PM	Admin/ Referrals	Local Diag. MDT	Clinic or Admin/ Referrals	Bronch list or Admin/ Referrals	Admin/ Referrals

• There is a monthly M&M meetings scheduled as above.
• Trainees do 2 general respiratory clinics a week, seeing both new and follow-up patients.
• One of the days is typically replaced by an on call or infrequently by a lieu day each week.
• All clinics are general respiratory clinics and they are not too busy and generally finish on time.
• About 50% time is spent on ward work and about 25% referrals (although this is mostly consultant led).
• There is lots of supervision but also autonomous practice is encouraged.
• There is also a local grand round happening once a week.

Bronchoscopy

• Suitable for ST3/4 with limited bronchoscopy experience. Well-supported training and adequate numbers.
• Transbronchial biopsies rarely done, and not by trainees.
• EBUS is not available here (only at King George).
• There are 2 bronchoscopy sessions / week – usually split between the 2 registrars.

Estimated number of bronchoscopic procedures in 6 months per trainee: ranging between 11 to 50 (with 0 – 10 endobronchial biopsies)

Estimated number of EBUS/TBNA in 6 months per trainee: 0

Thoracic US and pleural procedures

• Dedicated Respiratory department machine.
• There are no Level 2 trained Consultants in the Respiratory department, but Dr Johns and Dr Kaiser have been level 1 trained for many years and therefore they could help with sign off.
• There are occasional opportunities for medical talc pleurodesis.
• There has been no report of pleural biopsy and indwelling pleural catheter insertion performed by trainee.
• There is no medical thoracoscopy service available here.

Estimated number of thoracic US in 6 months per trainee: ranging between 31 – 70

Estimated number of pleural aspirations in 6 months per trainee: 21 – 30

Estimated number of chest drain insertions in 6 months per trainee: 21 – 30

NIV/Sleep

• Adequate acute NIV experience on Bluebell ward.
• There is no sleep service here.

Estimated number of adequate involvement in management/initiation of NIV in 6 months per trainee: 11 – 20

GIM

• Approximately 1 in 6 on-calls (13 hr shifts). 7 nights in total every 3 months (in 4 nights and 3 nights). Weekends are 3 or 4 days every 3 months.
• 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.
• The on-call teams are as below:
  • Day: 3 SpRs (Take, Ward and Resus), 3 full-day clerking SHOs and 1 – 2 clerking SHOs from 11 am and 3 FY1s for ward cover after 5 pm.
  • Nights: 2 SpRs (Take and Ward), 2 clerking SHOs and 1 ward cover SHO
• There are frequent gaps to fill the above required members of the teams but medical staffing is very proactive and they do their best to recruit to fill gaps.
• Most on-call shifts will have at least one cardiac arrest, peri-arrest or medical emergency, often more. It’s variable but be prepared to lead arrests especially in Resus where ED are usually not competent to do so.

GIM experience has been rated “excellent” here.

Teaching

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

Management/leadership

• Opportunity to run the rota for juniors.
• Opportunity in managing departmental educational meetings.
• In house leadership and management course available.
• SpRs are not involved in the departmental management meetings.

Specialist training opportunities

• As above, there is a pleural list for pleural training.
• There is adequate ILD and TB experience here.
• There is also adequate experience in palliative care.
• The hospital does not provide experience in allergy, sleep, CF, occupational lung diseases, pulmonary hypertension and genetic/developmental lung diseases.
• Trainees have not reported gaining experience in pulmonary rehabilitation.

Research and QIP

• Queens does not have research on site.
• There are plenty of QIP opportunities.
• SpRs are involved in the BTS Audits.

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:

“This post is excellent GIM experience however the supervision can be varied. The Consultants are friendly and often interested however there has been a culture of communication break down between SpR’s and acute medicine consultants which I think has negatively impacted some SpR’s experiences. The GIM on-calls are challenging but interesting and generally staffing is adequate. Respiratory is an excellent department- friendly and helpful department with good wards and nurses. Good opportunity for NIV and procedures. Clinic is varied and you are not expected to see a great number of patients. The secretaries are fantastic and your letters are typed very quickly which helps to stay on top of paperwork.“

“Queens is an excellent place for Respiratory ST especially those in earlier training. The consultants are very supportive and there is a huge burden of respiratory and GIM pathology that comes in. It is a busy place to work at any grade but with that comes more learning opportunities. Great for bronchoscopy and pleural experience including ultrasound and chest drain insertion. There are no specialist clinics at Queens (these are all at KGH) so all your outpatient caseload will be general respiratory medicine. The respiratory team is excellent however unfortunately many other parts of the hospital (particularly ED) are heavily dependent on locum doctors and there is a huge number of non-training overseas doctors in all areas of the hospital and at all grades from SHO to Consultant. As a result quality of care is variable and this can be incredibly frustrating as the medical SpR. The education centre are by far the best I have ever seen and extremely supportive and available to trainees. There is a decent mess and lots of food options during the day. No hot food available at night. Overall I am very pleased with my time as Respiratory SpR at Queens hospital and would highly recommend to all ST3/ST4.”

“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”