BBC goes inside hospital battling winter pressures
“Do we think that guy can sit down?” asked Dr Raj Paw, senior consultant in the emergency department at Warwick Hospital.
He was talking about a patient in his 90s who was brought in after collapsing at home and was found cold and delirious.
Now he is stable. Can the bed be turned on?
“If we can get him to sit down, then he can sit in one of the chairs and that frees up his bed,” Dr. Bao said.
This is the ongoing conversation among doctors and nurses in hospitals across the country as a severe flu season puts pressure on the NHS.
Serious incidents have been declared at more than a dozen hospitals, some considered the best in the country.
The BBC visited Warwick Hospital earlier this week. The hospital is run by South Warwickshire Trust, which is one of the highest rated trusts in the country and prides itself on the smooth running of its four hospitals.
But the caseload this week has been very high.
Warwick Hospital has 375 beds and demand was expected to be nearly 100 more beds at one point. For the first time ever, it has had to declare a serious incident – the NHS’s highest alert level.
The BBC was there when hospital administrators made the call. Declaring a serious incident is a warning to local health systems that the situation is worsening. Often, it frees up hospitals to redeploy doctors and create new temporary ward space.
Over the course of two days, the BBC saw doctors and nurses doing just that: finding stopgap solutions, treating patients in whatever safe environment could be established.
Because emergency rooms are so overcrowded, patients are being treated in chairs.
Others had to wait for hours in ambulances parked outside the emergency center before being taken inside.
One such patient was Percy, who was in his 80s and suffering from liver failure. He came to the hospital because he had been feeling unwell and losing weight in recent weeks.
Dr Arun Jeyakumar, the ward’s senior registrar, is one of the doctors sent to examine patients like Percy.
He jumped into the ambulance and had a brief consultation. He told Percy that everything was being done to get him to the hospital.
Percy smiled weakly and waited helplessly.
The paramedic who took him to hospital also resigned: he’d seen many cases like Percy’s this season.
He turned on the heater in the back of the ambulance and sat down again. Dr. Jayakumar jumped out and closed the door.
Back in the emergency room, doctors, nurses and consultants discuss how to make room for new patients.
Hospital beds are absolutely at a premium. So many patients were arriving that a room was set up near the ambulance entrance for those deemed “fit to sit”.
Every chair was occupied.
“It’s not ideal,” one doctor said. “But it’s safe.”
Porters must push beds across the open space, between patients who are being treated in chairs and nurses who are kneeling on the floor to remove intubations. The drip rack moves back and forth to make room.
We see a nurse in a wheelchair taking a patient who is still on a drip to the toilet.
She left her chair in the hallway and helped patients in. A porter came and went to move the empty wheelchair.
The nurse rushed out. “That’s my wheelchair,” she cried.
We rolled it back to her and she started laughing. “You can’t take your eyes off them for a second, or another patient will be trapped in them,” she said, only half-joking.
Elsewhere, after a three-hour wait, Percy arrived from the ambulance to the emergency room.
“It’s getting worse,” he said, closing his eyes, but it would still be 12 hours before Percy was admitted to the ward.
When we see him finally being moved, he is writhing in pain on the bed, clutching a sick bowl.
Dr. Bao’s first job during his rounds is to check the cubicles to see who can leave the bed.
There was a full waiting room outside the door, with four ambulances parked outside.
A woman in the last cubicle he visited was crying. Dr. Bao received an update from the nurse and ordered some morphine.
“You’ve come to the right place,” he told the patient. “We will take care of your pain.”
Dr. Bao told us: “People are coming in now who are sicker than before. We are here trying to get them out faster.”
He then turned to a man who had been hospitalized two days earlier for a heart attack but was no longer receiving active treatment. Dr. Bao wanted to know if he could be safely transferred.
“These are decisions we are forced to make,” he told the BBC.
“I’m considering moving a heart patient to the waiting room so I can have his cubicle.”
Another patient Dr Paw saw the day before was still waiting for a bed in the ward 24 hours later.
“This is rubbish. This is not what should be happening,” Dr. Bao said. “People shouldn’t be in the emergency room for 27, 28 hours.”
At one point while in the hospital, we were taken to a bank of screens showing statistics.
The footage showed that patients in the emergency department had been waiting for beds for nearly 30 hours, and there were six ambulances queuing outside. One of them had been there for four hours.
“This is the worst I’ve ever seen,” one doctor said.
South Warwickshire Trust subsequently canceled its critical incident declaration for Tuesday, but staff told the BBC they were still facing a similar level of pressure.
