The Royal United Hospitals Bath NHS Foundation Trust
covers a 52 acre site just over a mile from the centre of the city of Bath located in North Somerset. The hospital covers acute care provision for around 500,000 people across parts of South Gloucestershire, West Wiltshire, Bath and North East Somerset.
The purpose built Emergency Department is co-located with a GP-run Urgent Care Centre and close to Ambulatory Care services staffed by the Acute Medical team. The single reception and waiting area helps stream patients to the appropriate service.
The Emergency Department is divided into:
1) A four bed resuscitation area with a dedicated paediatric bay
2) A six bed monitored high care area with 1:2 nursing cover
3) An 18 bed majors including private examination room and isolation bay
4) A minors area with dedicated Emergency Nurse Practitioner assessment and treatment area, consisting of mixed trolley and chair cubicles and a separate paediatric assessment and treatment area with its own waiting room.
An eight bed observation unit is attached to the department as well as two mental health assessment rooms. There is a dedicated procedures room with optimal light and space for suturing and minor surgery; an eye room for thorough ophthalmological assessment and a plaster room for cast application/alteration and limb manipulation prior to casting under regional anaesthesia.
Annual attendance is over 70,000 new patients a year – over 200 per day with an admission rate of around 30%. When analysed, the case mix and population statistics demonstrate that the patients tend to be more complex and unwell or severely injured than the national average, and there is a high proportion of cases that arrive by ambulance.
The department is led by 11 Consultants (10WTE) with duties shared among 10 Middle grades (8.6 WTE) - comprising of ST4+ Higher Specialty trainees, Teaching fellows, Staff grade and Specialty doctors) and 12 Senior House Officer grades (a mix of ST3 Emergency Medicine, ACCS Core trainees, GP VTS trainees, Foundation year 2 trainees and Trust appointed doctors).
Services provided include 24 hour Emergency Care throughout the year as a level 2 Trauma Unit with close links to the Trauma Centre in Bristol.
Medical and Surgical illnesses and emergencies are tended to, as are specialty groups including Ophthalmology, Ears Nose Throat, Obstetrics and Gynaecology, Maxillofacial Surgery, Mental Health and Paediatrics.
24 hour thrombolysis cover is provided for stroke patients, with clot retrieval additional therapy options coordinated with North Bristol Trust during office hours in the week.
Primary percutaneous coronary intervention service for acute coronary syndrome management runs during the week between 0700 and 1900, with transfer of patients to the Bristol Heart Institute outside those hours.
Two ultrasound machines are available for use for clinical assessment and vascular access as well as support with portfolio completion for college sign off.
Out of hours the ophthalmology service is collocated with the ED using the eye room specialist equipment, as are ENT, using the procedures room for minor interventions.
Emergency Nurse Practitioners attend many minor injuries and illnesses working independently in parallel with the emergency medical team. There is support for developing some into Advance Care Practitioners over the next few years.
Education and Training
There is a strong culture of staff development, education and care improvement through various aspects of governance. Changes to practice are embraced following practice review, critical appraisal of evidence and discussion. All trainees are encouraged to be involved with service development through audit, guideline development and quality improvement projects.
A robust induction programme for new staff exists and there is a protected weekly teaching programme. Rotating trainees are supported via named supervisors. There are ample opportunities to achieve portfolio assessments, attended study leave and pursue career goals while working at RUH.
The department supports medical students from Bristol University as well as elective students seeking experience in a busy, well-staffed and well-equipped Emergency Department. This provides teaching experience to the ED staff which is also provided during the weekly teaching programme.