The following is a note from an intensive care consultant about a visit they made this week to a district general hospital in the home counties to transfer a patient to a larger hospital with more capacity further away from London. 

HSJ publishes anonymous pieces very rarely, but we believe the following account from a reputable and reliable source paints an accurate picture of what is going on in critical care at some of the nation’s smaller hospitals, where they are under severe pressure from covid-19. All names and locations have been anonymised. Alastair McLellan, editor, HSJ.

Dr X and I have just transferred a covid+ patient from [smaller hospital A] to [larger hospital B].

When we arrived at [hospital A] we were taken to the orthopaedic department, which has been turned into an overspill ward of covid+ ventilated patients. Outside was a coordinator managing staff and transfers. Empty boxes and PPE lined the corridor.

At this time [the unit] was waiting for four patients to leave, and had seven patients waiting in A&E to come in. The entrance and exit to the department was through the same double door. Between the double doors staff donned and doffed together.

A huge pile of PPE lay next to the waste bin at the entrance. A doctor came out of the department, doffed, gave us the details of the patient we were collecting and then left. Dr X and I donned and were then directed to a small bay, no bigger than a small theatre which had four ventilated patients, one of which was the one we were transferring.

You could stand in the middle of the room and touch all four beds. The patients were being looked after by one nurse, and a runner. There were four bays each with four ventilated patients just in this department.

Dr X and I had to transfer the patient to the transfer trolley by ourselves, no help was available. This included deciphering each syringe driver and drugs. At each bay they had pre-filled 50ml syringes of remi, propofol and norad, which the nurse just replaced in each driver when their alarm went off. Another staff member drew the replacement drugs up and replenished the box. They did that for every box in every bay of the department.

Opposite us was a male on dialysis. He was saturating at 45 per cent and I noticed his airway pressures were over 45 and alarming. A doctor walked in, looked at the machine then said to the nurse, ‘he hasn’t got long left, call his family and let them know’, then left. We were there for approximately one hour, during that time two arrest alarms were sounded. We were delayed leaving as there was only one patslide [for moving patients] being shared.

The nurse looking after the four patients in our bay had done an external transfer to us yesterday… She arrived back in [place of hospital A] late last night and then had to come in early today to start this shift in full PPE.

All the staff looked tired and overworked. When we left with our ventilated patient we were quickly ushered over to one side. A middle aged male on a ward bed struggling to breath through a 100 per cent non rebreather mask was hurtled into the bed space we were just in. They were waiting in the corridor for us to leave.

[Hospital A] is massively overwhelmed and struggling. It was horrendous, and really has opened my eyes.