UK: Life At The Sharp End: A Day In The Life Of A Hospital Chief Operating Officer

Last Updated: 15 October 2015
Article by Karen Taylor

Most Read Contributor in UK, August 2017

With memories of summer fading fast, the NHS's preparations for "winter pressures" are well underway. Not that the pressure has relented in any way over the summer months. Indeed, most NHS organisations are likely thinking that winter pressures are simply year-long pressures. Nevertheless, and whatever the local situation, winter does seem to precipitate a feeling of crisis and the expectation that staff will need to go the extra mile. This week, I had the privilege of interviewing a Chief Operating Officer, Gill, who has recently changed profession and  agreed to describe a typical day in her life last winter to give us all some idea of what it really feels like on the front-line. This week's blog presents the highlights of that interview, as described by Gill. 

Sunday morning, 5.45am, the phone rings: it's the hospital. "Morning, how are things?" I ask? The caller replies: "tight: 40 admissions since 9pm last night, one bed needed now, 14 later and 15 queries; no Intensive Treatment Unit (ITU) beds available, but three patients in ITU who could be moved to a ward. There are currently 20 patients in the Emergency Department (ED), with four outstanding bed requests. Multiple trauma from a Road Traffic Accident (RTA) arriving imminently." I tell them I'll be there in 20 minutes, and to call the on-call manager for a meeting in the Operations Centre at 6.30am."

So began a day-in-my life as a Chief Operating Officer on a cold Sunday morning in January. On arrival I notice that the Operational Matron looks tired. She tells me she has been on her feet all night, including talking someone down from the roof of the multi-story car park at 3.00am. Together, we pull up the desk top homepage to review the latest position. Admissions outweighed discharges over the last two days by 15 each day and we are also a ward down. Twenty-five patients are clinically fit and awaiting supported care in their home, a residential or nursing facility. Furthermore, 40 patients are recorded as having a clinically-fit date for discharge today. We agree to call the discharge planning team in early, to expedite safe discharge early, and help maintain the flow of patients from the ED.

The on-call manager joins us, an experienced nurse, I ask her to go immediately to the main medical ward and assess the patients who are clinically fit. She will then go to morning report and meet with all the doctors. We can then prioritise their rounds to the patients who may be able to go home.

"Who was the on-call medic yesterday?" I ask. It strikes me that we need to prioritise the work of the discharge planning team to improve the situation. Chris, one of our Acute Physicians was oncall yesterday. I ring him. "Sorry to bother you Chris, I know it's early but we are very tight here and I need to focus the discharge team on those patients most likely to be clinically fit for discharge, are there any names you remember?"

"Hang on a moment" he replies, "I'll just review those I think most suitable." Even though he is out walking his dog, he pulls up the patient details on his smartphone. He can review their clinical status, including nursing observations. He suggests which five patients should be prioritised. Two further patients have spiked a temperature overnight so will need consultant review, but are unlikely to go home. This informed clinical view helps guide our next steps and focus the energies of the team in the right areas.

I then think of the patients waiting to go to other hospitals. Pulling up a list of the actions already taken to assist their discharge, I can review it against their current clinical condition. Patients whose condition has not changed are those the on-call manager can review with their consultant to make sure they are still fit to go home. I get on the phone and talk to on-call directors in the other trusts. Of the three trusts I call, all are in difficult circumstances regarding bed availability. However they appreciate that unless we free some neurosciences beds, we will find it difficult to take seriously-ill patients referred from their emergency departments. We find beds for five patients later in the day, I order transport through the system and call in an extra ambulance crew to take the additional strain.

After a hectic morning, the team have really pulled together. The number of beds in the organisation has increased to 15, with 18 later and 10 queries. We have admitted 10 more people by 12 noon. Fantastic dedicated individuals, great data at our finger tips both in and outside the hospital, and sheer hard work have averted the immediate crisis.Even so, it didn't have to have been like this, if only:

....... those people who came in with exacerbations of their asthma, in the cold weather, had received a text alert to pick up a booster prescription for their inhaler......

........the ambulance crew could have a tele-conference with the trauma consultant en route to the hospital to determine the best destination for the patient......

.........the older patients who have relatives to care for them at home, could go home with a mobile vital signs sensor to alert their clinical team to changes in their conditions, supporting early intervention.

Technology won't solve all the problems. But it is the basis that will help integrate health services and provide hardworking healthcare professionals with more time to spend on patient care.

As I cycle home at 4.30pm, it begins to snow. It's beautiful, quiet and ominous. I pause, take out my phone, and call the hospital. Better make sure our snow contingency plans are ready to go.......

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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