Heartbeat: Meet the team who keep the hospital running in the darkest of hours

October 18, 2019

It’s just past midnight and it’s eerily quiet on the main spine at City Hospital, with no sign of the usual hustle and bustle of the day.

Yet there are two colleagues who continue to go about their business to ensure patient safety is maintained during the later hours of the day and into the night.

Matron, Rebecca Bloore, known as Becky to her colleagues, and Paul Goodman, Clinical Nurse Practitioner, are both from the Hospital @ Night team and have the responsibility of keeping things running from both a clinical and site management perspective.

We join the team at the start of their twilight shift – beginning at 6pm in the capacity office – to find out how their roles work. From the onset it sounds like it’s going to be a busy night.

Two of their colleagues are already over at the Sandwell site, doing the equivalent job. They are able to maintain communication with them via a video link so that they could run things past each other throughout the shift.

At the 7.15pm capacity call, the team are told about a mental health patient currently in the emergency department who has been waiting a while to be seen. Paul is able to organise an assessment for the patient so that he can be treated by the right team.

Afterwards, the number of beds available is totted up – and it sounds as though there maybe a shortage if patients aren’t treated and discharged.

“It’s a common issue,” says Becky. “The bed count carried out identifies if there can be a shortage. This can be due to patients not being discharged in the day or because information isn’t recorded during the day and passed onto the capacity team. We are often chasing discharges and transport for patients in the Medically Fit for Discharge (MFFD) wards.

“When needing to book transport out of hours we review the requirements of both the emergency departments first, we then review any patients waiting for discharge or transfer to MFFD wards from the base wards. We need to prioritise the work load for the Elite transport crew. “We are here to work out what can be done to try and ease the situation and make sure patient safety isn’t compromised.”

And this is also the case when it comes to staffing levels.

After the 7.15pm capacity meeting Becky and Paul are met with an influx of calls from wards experiencing a common theme – staff shortages.

“This is an astonishing amount of calls,” Becky tells me. “We have had contact from seven wards in total saying they are short staffed and in total we are being asked to find 11 extra staff.

“It’s going to be difficult as that’s quite a high number.”

Paul and Becky set to work to solve the issues and a few seconds in, she receives a call from a healthcare assistant who had turned up for a bank shift – only to be told the ward was fully staffed.

“She wants to work a shift tonight, so I’ve assigned her to one of the wards where there is a shortage,” adds Becky. “We will work through and plan the safest options to staff the wards and department also using cross-site links with our colleagues at Sandwell. Paul will then continue to work through the plan to plug the gaps to ensure we have safe staffing levels against the activity demand on the wards and departments.”

Soon it’s time for the clinical handover where colleagues from outreach, medical registrars and SHOs – both incoming and outgoing – pass on information about seriously ill patients who will need to be monitored throughout the night. These patients should have been flagged up to the Hospital @ Night referral system earlier but are only coming to light in the meeting.

During the meeting six patients are mentioned by the registrars, including a woman who has been diagnosed with breast cancer, but may now have a brain abscess.

Meanwhile a 70-year-old man has suspected encephalitis, a deadly condition that needs diagnosing and treating urgently. “He had been driving his car and communicating very well just six weeks earlier,” one of the registrars tells the meeting.

“However there has been a huge change in his behaviour and is showing signs of dementia and delirium. We have started treatment for encephalitis.”

Other patients also with concerns include one with oedema and another with COPD. “Most of these patients are on D21,” Becky says.

And so after the meeting our next point of call is to check on them and ensure they are receiving the right care, in the right place at the right time.

Becky is well known by the night shift across both sites, having worked in the role for nine years. But it is also part of her job to know her colleagues.

“I will know the skill set that nurses have which is really important,” she said. “I will be able to determine if they are able to carry out certain treatment for patients or whether this is something my team or I will need to support them with.”

The Hospital @ Night team don’t just fit catheters or cannulas – they are the first point of contact for all wards (and specialities) for unwell or deteriorating patients. They are able to perform a full clinical assessment, prescribe medication, lead on response to and recovery from a violence and aggression incident, assess and clear patient falls, order and interpret blood tests and take on the duties of speciality doctors to allow them to support the clinical needs on the acute medical units.

“Even if we are not bleeped our aim is to attend every ward or department overnight to ensure there are no concerns. This is especially so if staffing has been a cause for concern. We like to ensure all the staff feel supported out of hours.”

Becky adds: “We have quite a few responsibilities within our site management and clinical roles. Clinically we are an integral part of the EMRT/cardiac arrest team. Whilst within our site management role, we would assume the position of tactical commander for major and critical incidents, look after patient flow react to complaints and deal with staffing shortages – both nursing and medical staffing.

“It’s safe to say that no two days are the same.”

And with that Becky receives a call to tend to a patient who needs cannulating. “Duty calls,” she tells me. It’s 2am and it’s coming to the end of my shift but Becky and Paul will continue to ensure our hospital at night remains safe for all our patients and staff into the early hours of the morning.