Sunday, 13 July 2008


My ward is acute respiratory medical. By and large most of what our mission statement covers is COPD. Each of the nurses on this ward has had years of experience and training in respiratory care. The doctors on the ward are specialising in acute respiratory medicine. Our respiratory patients can rest assured that they are in the hands of experienced, highly trained specialists.

Only seven of our twenty seven beds are occupied by patients with any manner of respiratory complaint. I admitted a patient last week who was in due to central chest pain, elevated troponin level and a vast history of myocardial infarctions(heart attacks). All these things indicate the patient was both high risk for an MI and in all likelihood had probably had a minor one prior to admission.

The first thought that ran through my mind when I read this patients
emergency medical assessment unit(EMAU) report was that there cant be any spare beds on our cardiac ward. This I have come to accept, patients go where the beds are, not where the specialists are.

I later had cause to phone our cardiac ward regarding another patient. It turns out that they had five spare beds. Somewhere along the line the powers that be decided that this high risk cardiac patient didnt deserve to be on the cardiac ward.

I know all nurses recieve the same basic training. And this patient was at least admitted to an acute medical ward. Fortunately the nursing intervention for cardiac arrest and respiratory arrest is the same. Had this patient been high risk vascular patient, or a neuro patient then they would not have received the best possible level of care. Which is what the NHS claims to strive for. Most bed managers have been promoted from the clinical ranks and know more or less what they are doing. They tend to be unsuccessful due to the enormity of their task and lack of support from their clinical colleagues who become less co-operative after the bed manager has sent their surgical ward a patient with pylonephritis.

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