Doctors: Our hospital is health risk

Published on Wednesday 17 June 2009 22:07

JUNIOR doctors at a hospital have warned bosses that patients have been put at risk by understaffing and pressures to meet NHS targets.

A group of 17 doctors from St John's Hospital in Livingston felt so strongly about the shortages they wrote to NHS Lothian officials about the dangers allegedly posed to patients.

Yesterday, the British Medical Association (BMA) said that gaps in hospital rotas were a problem across Scotland and called for action to deal with the issue.

But NHS Lothian said the concerns raised by the medics had been addressed and they had more doctors and nurses working at St John's than ever.

The letter, leaked to The Scotsman, was signed by middle-grade doctors – from two to six years out of medical school and below consultant level. It has also been forwarded to health secretary Nicola Sturgeon.

The doctors wrote: "We have concerns regarding placement of medical patients at St John's Hospital (SJH). We believe that several influences are contributing toward an unsafe clinical environment."

The doctors said the volume of admissions, including overflow from Edinburgh Royal Infirmary, frequently exceeded what could be handled by the number of staff on duty.

They said the Royal College of Physicians' guidance stated that middle-grade doctors should spend one hour dealing with a new emergency admission. "We consider our maximum safe patient load to be 33 admissions per day," they wrote. "We believe any excess upon this represents an unacceptable clinical risk."

The doctors also raised concerns about the target to admit or discharge patients within four hours of arriving at A&E.

The benchmark could mean that patients are treated so they do not breach the target, rather than on their medical needs.

"We acknowledge the pressures on the trust to meet the four-hour target, but wish to highlight that, on a busy day, it may not be feasible for the middle grader to balance these targets with the care of other acute admissions."

The letter also raises concerns about patients being moved to unsuitable parts of the hospital, making if difficult for the doctors in charge of them in the admissions ward to care for them.

"In particular this can lead to unstable patients being scattered throughout the hospital," the doctors said. They said junior doctors were being asked to make decisions about which patients to "board" – move to other parts of the hospital – and asked for this to be the responsibility of a consultant.

Dr Andrew Conway Morris, deputy chairman of the BMA's Scottish junior doctors committee, said: "We have been raising the issue of gaps in rotas on a national level for some time and have continued to warn that patient care could suffer if these gaps continue.

"The reports from St John's Hospital are concerning and we hope NHS Lothian will investigate them and resolve any problems which may compromise patient safety."

NHS Lothian associate medical director Simon MacKenzie said: "We have already met with the middle-grade doctors since this letter was written, some time ago, and all of the issues raised have been addressed."

WORST BEDSORES EVER

A WATCHDOG has criticised a Scottish health board after a patient suffered the worst bed sores a nursing advisor had ever seen.

The 79-year-old patient, referred to only as Mr A, underwent a double knee replacement at Southern General Hospital in Glasgow in March 2007.

When his condition deteriorated he was admitted to Ayrshire Central Hospital, where staff noted he had severe pressure sores. After Mr A's family complained, a nursing advisor told the Scottish Public Services Ombudsman they were the worst cases of pressure sores that she had seen. Mr A failed to recover from his surgery and died that September.

Mr A's family felt he was operated on before all the necessary tests had been run and were also worried he did not receive proper aftercare.

Ombudsman Jim Martin upheld all the complaints and made a raft of recommendations including making an apology and launching an investigation.

A spokeswoman for NHS Greater Glasgow and Clyde said:

"We recognise that the treatment this patient received fell short of the standards expected. We will make a further formal apology in light of the Ombudsman's report findings," she said.