Medicine in Leicester

Acute Medical Services in Leicestershire are provided by a single Trust – University Hospitals of Leicester NHS Trust – which operates from 3 sites – Leicester Royal Infirmary (LRI), Leicester General Hospital (LGH) and Glenfield General Hospital (GGH).

Leicester Royal Infirmary is the site of the only Accident and Emergency Department in Leicestershire, and thus continues to take the largest share of acute medical emergencies, although acute admissions are also transferred from A&E to Leicester General Hospital. Since 2004, Glenfield Hospital has been committed to a ‘Cardio-Respiratory Take’ and emergencies in these disease areas may be assessed in an emergency assessment area and admitted directly to this site – however there continues to be a large and active CCU at the LRI site and chest pains and respiratory disorders continue to be two of the most common causes for admission to the Acute Medical Units at both LRI and LGH sites.

In December 2005 Stroke services for Leicestershire became centralised on the LGH site, and an acute emergency service for stroke and neurology will now become an important feature of the LGH site. Precise details for staffing of the on-call are not yet agreed.

Leicester Royal Infirmary:

Acute admissions to the Medical Unit usually take place via the Acute Medical (AMU – based on 2 30-bed wards, AMU 15 and AMU 16) or via CCU. AMU is where patients are initially assessed and managed. After assessment by the Consultant on-call, patients may be discharged, transferred to the care of an appropriate general medical ward or specialist team or remain within the AMU wards if only short admission for stabilisation or results of tests is required. In times of bed shortage, patients may also be transferred or discharged from AMU between 5pm and 8am after review by the SpR on call.

Consultants are responsible for all Admissions on AMU 15 and AMU 16 in rotation working in blocks of 2 day weekends (Sat/Sun) or 5-day week (Mon-Fri) – during which they are based on AMU throughout the working day and on-call from home at night. A daily 8AM ward round begins with the nightime on-call team and assesses patients who have been admitted overnight, or required acute management overnight. The remaining patients are then reviewed later in the morning with the daytime on-call team. The AMU ‘Core Team’ of consultants work on AMU between 1 in 5 and 1 in 8 weeks – other consultants approximately 1 in 24 weeks but 1 in 12 weekends.

Since there is no separate Medical HDU facility, patients in this category typically remain on AMU for longer than average (unless a speciality ward is considered more appropriate) and are managed by the acute team for the day.

Emergency medical admissions to LRI now range between 60-90 admissions per day. Of admissions to AMU in the past year 34% were discharged home after assessment, 2% died on AMU and the remainder were transferred on to other wards.

LRI is also the site of the Infectious Diseases Unit which takes admissions directly and from AMU

A large majority (>95%) of emergency admissions occur via the A&E department.

SpRs work on AMU as part of a full-shift rota, with a core team of AMU SpRs having more regular commitments. During some of these shifts the SpR will also be responsible for providing medical advice in other medical and non-medical wards of the hospital – including the intensive care unit.

Current on call rotas/banding:

University Hospitals of Leicester NHS Trust, is actively working to reduce junior doctors hours to comply with the 48-hour working week and to reduce banding payments to a minimum. Their aim is to develop and provisionally re-band majority of our rotas templates, for implementation before the start of these new programmes in August 2007

Leicester General Hospital

Acute admissions to LGH occur via the AMU / EMU (Emergency Medical Unit) – these represent a mixture of direct GP referrals via Bed Bureau and transfers from A&E. The case mix at LGH therefore tends to be less ‘acute’ – but still covers a wide range of general medicine.

The consultant on call is responsible for EMU and performs regular on-call ward rounds there during the week and at weekends

Emergency medical admissions to LGH now range between 20-30 admissions per day during the week, with fewer admissions at weekends.

In addition, LGH is now the site of neurology services and of the combined UHL Stroke Unit.

Current on call rotas/banding:

Glenfield General Hospital

Until late 2004, Glenfield Hospital admitted acute general emergencies in much the same way as LGH. However, since then a variety of initiatives have taken place with the aim of making Glenfield the centre of a dedicated ‘Cardio-Respiratory take’ – and SpRs training G(I)M continue to participate in this emergency process.

The emergency take and Clinical Decisions Unit (CDU) at Glenfield is run by the respiratory physicians and remaining geriatricians and general physicians working at that site. The CCU is run jointly by acute general physicians and cardiologists, with cardiologists being primarily responsible for tertiary cardiology services including acute coronary interventions.

Emergency medical admissions to GGH now range between 20-40 admissions per day during the week, with fewer admissions at weekends.

Pursuit of excellence is an apt description of the cardiorespiratory department at Glenfield Hospital which has developed a national and international reputation for its clinical and research work.

The Professorial Respiratory Medicine Unit is one of the largest in the country with a large clinical and research workload. Acute inpatient work is delivered via three dedicated respiratory wards and the Clinical Decisions Unit (CDU) through which patients are admitted in a selective cardiorespiratory take with an average of 30-35 admissions each day. The unit has a full complement of consultant staff with subspecialist interests in COPD, non invasive ventilation, asthma, lung cancer, cystic fibrosis, bronchiectasis, tuberculosis, allergy, interstitial lung disease and intensive care medicine, many of whom are national opinion leaders. We have an excellent respiratory physiology laboratory, bronchoscopy and medical thoracoscopy service. The unit has a superb specialist nursing team supporting patients with lung cancer, TB, allergy, asthma, COPD, bronchiectasis and cystic fibrosis. The department has a prolific publication record and is one of the top 10 respiratory research units in Europe with multiple research projects occurring at any one time.

All trainees working in respiratory medicine will gain generic and specialist experience on the wards, CDU, attending outpatient clinics and would be expected to achieve their competencies in the specialty.

The Professorial Cardiology and Cardiovascular Unit at Glenfield has an excellent clinical and research reputation. The unit acts as a secondary and tertiary care centre for patients with cardiovascular problems in Leicestershire and the surrounding region. The large consultant team have specialist interests in coronary artery disease, interventional cardiology, electrophysiology, congenital heart disease, non invasive cardiac imaging including transoesophageal echocardiography and cardiac MRI.

It is a national leader in coronary artery angioplasty and stenting, pulmonary vein isolation techniques and is about to undertake percutaneous valve replacement. In patient care is delivered from 5 cardiology/cardiovascular wards and a 22 bedded CCU. The department has a 5 star basic and clinical science research programme and is one of the international leaders in cardiac stem cell research.

All trainees working in cardiology and cardiovascular medicine will gain generic and specialist experience on the wards, CCU, attending outpatient clinics and would be expected to achieve their competencies in the specialty.

On all sites, the pattern of follow up after emergency admission varies widely depending on the views and speciality interests of the responsible consultant. Many consultants now consider it more appropriate to discharge patients outside their own speciality back to the GP, or onwards to the appropriate speciality service rather than running a ‘general’ follow up clinic. Some others continue to run a traditional ‘General Medicine’ follow up clinic

Current on call rotas/banding:

Pathway Project

Over the next decade, the pattern of delivery of medical services in Leicestershire will be significantly changed by a huge PFI development project. Leicester General Hospital will become a planned care and rehabilitation site, which further enhancement of the cardiorespiratory take at Glenfield Hospital and general emergency take at Leicester Royal Infirmary.