How the hospital as a whole is organised and works (Part 1)

I thought it would be useful to share with you the map of the hospital that I've made and explain how patients move through it on their 'journey'. But first I thought I'd have a bash at highlighting the different groups of people within the hospital.

At this point I'm going to declare a conflict of interest (as I understand from Private Eye that this is now a legal requirement). Whilst I will try to be balanced and not too controversial, I have to accept that however hard I try I will always be biased in favour of Surgeons. So no doubt you would get a slightly different view if you asked someone else!

I've decided to start with Anaesthetists. Pretty much everyone else in Theatres thinks the Anaesthetist has a cushy job (in the UK at least). All they have to do is give a couple of injections, link the patient to the machines, sit down and start doing the crossword. In the unlikely event of something going untoward, the mad beeping of the machine will alert them whilst they think about 6 down. [Out here it's a little different without the machines to keep an eye on the patient!]. The Anaesthetist would point out that a) you can't really do any surgery without them and b) they might look like they are doing nothing but actually they are keeping an eye on the crazy surgeons who are out to 'cut' [cut is used to mean operate on as in 'how much cutting time have you had?] anything that passes by, even if it can't be anaesthetised safely.

Funnily enough, pretty much anyone who isn't a surgeon, thinks that they are crazy and on some sort of mission to 'cut' anything that moves. If it can't be cut or it's been cut then it's not really worth worrying about and clearly is a problem for the Medics! Of course, the surgeons would tell you that there's a lot of skill in knowing where to cut and how not to let the patient bleed to death and that really, they don't want to operate on everything but they really enjoy it when they get the chance to save a life. The positive impact of a surgical operation often being delivered faster than improvements in complex medical cases.

The exception to this is orthopaedic surgery. This is not for the intellectual or highly dextrous individual. This is carpentry by another name. However, out here Geoff's having to embrace it!! To no noticeable detriment to his IQ.

The other type of surgeon that isn't included in the above is the Obs and Gynae team. They tend to be quieter (probably making up for the noise their patients make!) and concentrated on their specialist area. They get a real enjoyment from bringing new people into the world! However covered in slime they might be :)

Finally, the Medics (I'm including the Paeds guys here). Arguably the Medics have a the most difficult job. Their patients are sick in very non-specific ways. There are lots of possible diagnoses for any set of symptoms (especially out here where half the diagnostic tests you'd do at home aren't available). They also, unlike the surgical patients, tend to be chronically sick rather than acutely unwell. And whenever the surgeons can't work out what's wrong with their patient (i.e. it's not immediately cutable) they ping it over to the Medics to palliate!

Map of St Francis'

I have done a basic map of the hospital for new joiners. There was nothing, which made learning the place a little tricky! And I thought it would be useful for you to see how things are laid out. All buildings are single storey. The blue lines are paths that might or might not be covered with a sunshade.  It's possible to get to Theatres under cover from pretty much all wards but the route to X ray is uncovered, which will be fun in rainy season! Augustine and Monica are the Medical Wards for adults, Kizito and Mukasa the Surgical wards, where adult is anyone over c.10 years.

Patient Recruitment

When Geoff said he wanted me to understand patient recruitment in OPD (Outpatients Department, top left), I headed off happily envisaging plates of nibbles, a free glass of bubbly and some flags with silly messages on. I actually found a massive queue that often extends the whole way along the path to the junction with the path to 'York'.

OPD isn't really just Outpatients, it's also A&E and a GP surgery rolled into one. Apart from extreme cases and ladies in labour, all patients must first go to OPD before being admitted to the hospital (if they need to be). The doctors go to OPD when they've finished the ward rounds (on days when they aren't in theatre if they are surgeons). There they sit in small rooms that might have 2 or 3 consultations going on concurrently!! There isn't much in the way of privacy, apart from one screen.

Patients come through the door as soon as the last one leaves or in great bundles towards the end of the day if they are desperate to be seen. For a few days, Nat had no idea how patients came to arrive outside room 15 (General OPD), so I was despatched to find out!

The key questions were: how does anyone know how many patients there are in the OPD? is there a triage system (ie is someone acutely unwell seen faster than someone coming for a regular diabetes check?)? who is sent to sit outside room 15, as opposed to going to another doctor or the clinical officers (COs have basic training and can deal with minor cases but refer anything complicated to a doctor)?

So, I fought my way through the door, found a quietish corner, where I could stand out of the way and watched. If there was a system, surely I'd work it out.

All patients are holding green pieces of paper - this is their notes. Unlike at home, they take their OPD notes away with them (and reliably bring them back!). When they arrive they register at Room 1, if they are new patient they get given green paper.

Next they queue to be weighed and have their blood pressure taken. They either queue down the middle corridor of the room (see the pictures below) or sit on a bench. When I was there the queue in the middle of the room was for the weighing then they sat on the bench to have blood pressure taken. If people weren't concentrating and moving along the bench quickly then there was a tendency for queue jumping, which seemed to be tolerated with a shrug!

OPD at a busy time. The weigh scales are to the left in the foreground. Room 15 is in the far left corner

When the queue is a little less hectic - note the people all focused around Room 15

After that it wasn't obvious so I asked one of the nurses on the blood pressure machine. They ask the patient what is wrong then direct them to wait outside the correct room. I look around, mostly at the throng of people sat on crossways benches outside room 15. How do they know when it's their turn? 'They are queuing, look!' She points towards room 12 where there is a bizarre orderly queue all stood up. Just like at home but with one small difference, each person is pressed up, literally, against the person in front and behind! So many things go through my mind but mostly - surely it's way too hot to be pressed up against some ill stranger??

I point to room 15 - there's no queue there, I say. 'They just know!'. I watch, clearly they don't know, arguments are rife. But there is a cute prioritising system - if you've bagged a wheelchair at the entrance to the hospital then you can just go straight to the front - mostly because you can run everyone else over! I hear that the only thing trumping the wheelchair is if you come in on a hospital trolley! Though quite how you even get one of those to the door, let alone inside the box room I have no idea. I shall return to take a photo of the feat!

So, in summary, in theory all patients are recorded on the sophisticated patient management software (more about this later!). There is some very basic triage but it is likely that many very sick people queue for hours behind diabetes patients. Nurses tell everyone where to wait. If you want to jump the queue - grab a wheelchair!