Work Experience at Salisbury hospital :D

Well, this might be a long one, but I've got so much to say! However, firstly and most importantly, THANKYOU so much to all of the doctors, nurses, departments and patients who made my few days so enriching, exciting and imspiring!

I spent last Monday, Tuesday and Wednesday at Salisbury District Hospital shadowing junior doctors, SpR's, consultants and nurses in various departments. It was brilliant to be able to get a grasp of all of these different positions within the healthcare system and see how important the interdepartmental teamwork really was. It was really valuable to see all of the different stages of treatment that a patient recieves in their time at hospital. Right from the first consultations after GP referral, then referral on to different specialty departments where further investigations were made, or treatment plans were formulated. Then surgery (if that was what was needed), then recovery, and finally discharge. It was really interesting to see how many healthcare professionals a single patient can potentially come into contact with during their stay in hospital.

I saw how important communication between different departments is when treating patients. If a doctor's writing in a patient's notes was too poor and a nurse administered an incorrect dosage of a specific drug, the result could be fatal. One of the SpR's I shadowed has created a system linked to Microsoft Outlook email which is like a task master. It means that anything that needs doing (for example any admin, audits, letterwriting, patients to see about somehting in particular) can be created as tasks on the system. This system is available just within the department or specific tasks can be made available on the hospital's intranet so all departments are aware of followups that are needed with certain patients if they are on different wards for example post-op tests and treatments. It means that important tasks are not forgotten and that there is an electronic document of when each task was carried out. This is useful when shift change overs in staff occur to make sure that nothing is forgotten or slips through the net when patient handovers are made.

This also helped efficiency within the department I was shadowing in too. The task manager system had a triaging option so important tasks could easily be identified by all users. This meant that nothing urgent was left too long and admin along with other lower priority jobs could be set as not urgent. Further more, the system had an "attachments" option for each taks as it is added to the system. This allowed xray images for example to be attached to the task and opened with it so that if for example the task was further inspection of an xray or MRI or CT image, the person who opened the task could do it straight away rather than having to find it in patients' files, this proved a big time saver.

On my first day, Monday I spent the day in the Emergency Department in the "minors" section. There was quite a variety of different cases that came in, broken arms, ankles, elbows, sprains and eye problems mainly. I was shadowing a consultant who talked me through each of the cases as he examined the patients and took a short history. I found it amazing how quickly he was able to come to a diagnosis or treatment plan. Within 15 minutes usually the patient was in, history taken, examined, referred on for more tests (e.g x-ray) or treated. In the ED they also had a triage system to show a) how urgent cases were b) how long the patient had been waiting and c) if they needed treating by a doctor, nurse or potentially a whole team. He explained to me that the hospital aims to have people in the ED for no longer than 4 hours in total to meet their target, and that the triaging system became such a useful tool when the department got busy or there was a local road traffic accident etc.

On my second day, Tuesday I was shadowing junior doctors and an SpR in the ENT department. This started with doing the rounds of their parients that had been in over night or for longer after operations or with more complicated ailments. Check-ups that they had been well monitored during the night, checking of there had been any change in their conditions, seeing if any treatments they were undergoing had had an effect etc. Rounds lasted about 45 minutes, then we had a day surgery slot. This was for procedures such as tonsillectomies, gromits and broken noses. First of all we went and saw the patients that were due to be operated on, some of them had concerns, mainly it was just calming nerves and making sure that they were aware of what the procedure was going to entail. Then we went and got changed into scrubs (first time I'd worn scrubs = exciting!) and went into theatre.
To start with I obeved from about 5 ft away, but as they saw that I wasn't feeling dizzy or sick they allowed me to scrub up, taught me how to put on a gown/gloves/mask and come right in close. I was talked through the procudures, it was really interesting to see the techniques they used to prevent too much bleeding, burning the ends of the cut off blood vessels, I didn't know that they used that technique. The broken nose was interesting, they literally just squashed it and pushed it with quite alot of force until they heard a click, and then it was perfectl straight! I thought it would have been more technical but it seemed as simple as that. All of the patients were under GA, therefore an anaesthetist as well as other doctors and nurses were present. The teamwork that they all used was very important, from tasks just as simple as rolling the patient onto the operating bed to judging the amount of pain relief and anaesthetic needed between the main surgeon and the anaesthetist. The scrub nurse had a very important job of making sure all that the surgeon was going to need for the procedure was present and kept sterile. I was told that "a decent scrub nurse who has a good relationship with the surgeons makes all the difference."

On my last day, Wednesday, I was shadowing a variety of anaesthetists in different surgeries. It suprised me that they have the same amount of pre surgery patient contact as the doctors do, though I don't know why I didn't consider this before, because obviously they are in charge of the patients overall welfare whilst they are in surgery. Firstly we went and saw all of the patients and explained how the operation and anaesthesia was going to work, then went to the anaesthesia room (there was one next to each theatre) and waited for the forst patient to come. They walked in, lay down on the bed and were asked questions as to their identity and did they give informed consent to the operation going ahead. Then a canula was inserted, then a variety of anaesthesia products, within 10 seconds the patient was unconcious! It amazed me how fast the drugs took effect! During the surgeries I asked about the machinery that was used to monitor the patient and was taught about how it worked and other signs that patients give other than those picked up by machines that anaesthetists have to worry about. I found learning about the procedures and drugs used by the anaesthetists and why they choose certain ones really interesting, and I think that if I could, I would love work in theatre! The atmosphere and variety of different procedures I saw just in that one day really inspired me as to what we can actually achieve, mend and solve nowadays within the human body, its amazing! There was one case where a thumb was made out of some bone from the same person's pelvis, the operation had been over 8 hours long by the time I got there and they thought that it was atleast another 4 hours to go.

Its so amazing what is possible today, how we can change somebody's life, how we can just make them a new body part, replace worn out hips and knees, give them back their health which is at he end of the day the most valuable thing a person can have. It was such a privelege to see that in action and I really hope that one day I'll be there, contributing and involved in that process too!   

Charlie x