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[[NEWS
Hospital’s critical care unit overwhelmed by coronavirus patients]]
By Lawrence Dunhill20 March 2020
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A major London hospital declared a “critical incident” due to a surge in patients with coronavirus, with one senior director in the capital calling the development “petrifying”.
In a message to staff on Thursday night, Northwick Park Hospital in Harrow said it had no critical care capacity left and was contacting neighbouring hospitals about transferring patients who need critical care to other sites.
The message, seen by HSJ, said: “I am writing to let you know that we have this evening declared a ‘critical incident’ in relation to our critical care capacity at Northwick Park Hospital. This is due to an increasing number of patients with Covid-19.
“This means that we currently do not have enough space for patients requiring critical care.
“As part of our system resilience plans, we have contacted our partners in the North West London sector this evening to assist with the safe transfer of patients off of the Northwick Park site”
The trust said the incident was stood down at 4pm on Friday, as they were able to open some more critical care beds. It has not yet stated how many new beds were opened.
The hospital is run by London North West University Healthcare Trust, which has reported six deaths related to coronavirus, all at Northwick Park.
The potential lack of critical care beds in England has been the major concern around coronavirus, and trusts are currently repurposing wards and retraining staff to try and create more capacity. National leaders have suggested the number of critical care beds likely needs to rise by several times.
A senior director at another London acute trust told HSJ: “Given we’re in the low foothills of this virus, this is f*ing petrifying.
“The thing people aren’t really talking about yet is that we are going to have to quickly agree some clinical thresholds for admissions to intensive care. This is what the Italians have had to do, and whether its set at [a maximum age of] 60 or whatever, we are going to have to do something similar. There’s no way we’re going to be able to scale up to the level we need otherwise.
“The trusts in outer London seem to be hit much worse at the moment, probably about two weeks ahead of the rest of the country. Barnet, Lewisham and Greenwich, Epsom and St Helier, North Middlesex and Hillingdon are all struggling.
“I was in denial about the seriousness of this virus a couple of weeks ago, but not anymore.
“I’m now on calls with commissioners about getting more people out of hospital and into the community, and they’re saying ’yes that’ll be done in the next week’, and I’m on the verge of screaming at them. Things are going completely nuts.
“And there’s a real problem with private care homes refusing to take patients back unless they’ve been tested for covid-19. But that’s not the national guidance currently and there just aren’t enough testing kits to do it.”
A spokeswoman for LNWHT said: “Critical care capacity for patients with coronavirus is being organised on a cross-London basis so that hospitals and organisations work together to deliver the best possible care for patients.
“This kind of coordinated, flexible response is one of the NHS’s strengths but with staff pulling out all the stops they need the public to play their part too, by following the expert guidance on washing your hands, staying at home and using health services responsibly.”
Source
Information obtained by HSJ
Source Date
March 2020
Topics
CoronavirusLondonLondon North West University Healthcare NHS Trust
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Lesley Bacon
#CommentAvatarLabelCommented on:25 March 2020 14:02
Watching Parliament on TV today
The front bench were still sitting side by side......
Can someone please get serious
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M Harding
#CommentAvatarLabelCommented on:22 March 2020 17:50
In response to some of the previous comments:
(i) if NHSE were to advise providers how to prioritise ITU admission or ventilator access the relevant professional societies/clinicians would be angry that 'bean counters' were not taking any notice of their clinical opinion/expertise
(ii) cited 'death rates' are entirely dependent on national Covid-19 testing policies and the UK has been heavily criticised for the virtually non-existent population (as opposed initially to contract) testing. If this reveals as expected a cohort of relatively asymptomatic cases the supposed 'death rate' will fall
(iii) the cited 'death rate' cannot be a consequence of limited ITU capacity at this stage of the pandemic though it may become so
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Timothy Richardson
#CommentAvatarLabelCommented on:22 March 2020 15:20
Thank you author of the last comment, I appreciate your response. Also pleased regarding your comments on Rockwood and Respect in the current epidemic.
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Anonymous
#CommentAvatarLabelCommented on:21 March 2020 14:42
A moving story, and thank you for sharing it.
Junior staff are more likely to avoid initiating difficult conversations, and will tend to default to active management.
Early senior assessment and involvement of a consultant is more likely to result in early decision making.
One thing we are looking to do is to include the Rockwood Clinical Frailty Score in the COVID assessment protocol which helps trigger doctors to think about what the ceiling of care that the patient may already have decided e.g. as per RESPECT form.
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Timothy Richardson
#CommentAvatarLabelCommented on:21 March 2020 11:01
Last week my 96 year old father was admitted acutely having collapsed at home with a probable uti and chest infection. Some time previously he had complete a Respect form (replacement for DNR) with his GP requested no active treatment if he had a life threatening illness. This form accompanied him with his daughter into the acute provider.
Yet within a couple of hours he was hooked up to a drip with iv antibiotics! It took 3 days of negotiating for active treatment to be stopped and only when the consultancy eventually asked what my father wanted. His answer was an unambiguous “I don’t want to live any more”.
He was discharged home to be looked after by my sister and me and he passed away peacefully in his own bed within 48 hours.
The point of this story is that the high levels of deaths in Italy and here from Coronavirus are predominantly in the elderly and those with significant pre existing conditions. My father would not have wanted to live let alone be offered a ventilator if he had been infected.
How many potential patients have already completed a Respect form to not be actively treated who’s wishes might be lost in the stress of an acute admission. How many frail but alert elderly might wish to avoid either just being treated or remove the stress of choice making by front line staff and so consider discussing whether to complete a Respect form with their family and GP?
This doesn’t appear to have been raised anywhere In the press that I have read, perhaps it’s too sensitive a matter but I believe it’s something that should be considered.
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Anonymous
#CommentAvatarLabelCommented on:21 March 2020 05:27
The failings of a bureaucratic centralised model of healthcare based upon compliance and targets and one size fits all. Even when we knew it was coming we did nothing. Outstanding work all of you at the NHSE.
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Anonymous
#CommentAvatarLabelCommented on:21 March 2020 03:33
The looming shortages are a stark reminder of our foolish reliance on government healthcare. Successive governments have done nothing to ensure we move to a more private model for the majority of citizens. This would provide better quality and provision and leave us better placed to deal with this. We reap what we sow.
If that annoyed you somewhat, imagine how it feels to see this every time healthcare is discussed and especially in a crisis like this. Using a global catastrophe to promote one's particular views on healthcare provision is a bit annoying. Having said that, we all have our opinions although it's slightly galling to see the way this crisis is being used.
I hope as many people make it as possible and I'm sure most of us are either scared for ourselves or our loved ones. Good luck and good luck to the doctors and nurses...
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Anonymous
#CommentAvatarLabelCommented on:20 March 2020 21:38
Based on the Imperial numbers, we will need 70-100 ICU beds for an average sized hospital that currently has about 15 beds.
We have had 15 years of disinvestment in acute services - and Emergency Medicine, Ambulance and Intensive Care resilience is completely inadequate for the country’s security.
A colleague told me that there are only 16 professors of Emergency Medicine but 163 professors of Ancient Greek in the UK, and even fewer professors of Ambulance / paramedic care. While professors don’t save lives on their own, they are a marker of professional recognition and investment. I wonder if we might have got the balance wrong?
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Anonymous
#CommentAvatarLabelCommented on:20 March 2020 21:31
Just best wishes to NWL and everyone else working in health and care right now. We are going to need each other.
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Anonymous
#CommentAvatarLabelCommented on:20 March 2020 21:30
Julian Hamer
Numbers look about right to me on demand side. I think supply might be higher than you estimate given everything that is going on. But conclusion that there will be a lot of additional deaths over this period inescapable.
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