Thursday, 25 July 2013

Ante-natal clinics

Pram in a garden
Dorset, July 2013
Time passes and there is always something blogworthy going on. This week it has mostly been pregnant women - my team leader is on holiday, and my colleague RSB is facilitating a week's worth of patient empowerment (calling it 'structured education' doesn't do justice to the cult that is DAFNE - Dosing Adjustment For Normal Eating. More about that another time perhaps). So it fell to me this week to support the multi-disciplinary ante-natal clinics in both hospitals within the NHS Trust where I work. I have had my fill of pregnant women this week, what with the Royal obsession to add to the mix.

In each hospital, the ante-natal diabetes multi-disciplinary team (MDT) is allocated a room that is much too small, and the poor patients are channelled through various procedures - scans, samples, tests - before they start the proper waiting. When a clinic room is free, a patient occupies it, and various members of the team visit them until everyone who needs to see them has done so and the patients moves on to wherever else they may have to go, freeing up the room for the next victim. The team office, waiting rooms and clinic rooms are all much too hot - the radiator in one of the team offices was actually pumping out heat, with no means of switching it off on the hottest day in 30 years.

In the hospital where I normally work, the ante-natal department has just been remodelled, and the team office has been created from a room that used to be a cupboard, without any ventilation at all and with a very unpleasant lingering smell. The room is long and thin, with space for about six people all standing in a line (there is no room for a chair except at the far end where there is a computer). The MDT consists of obstetrics and gynaecology doctors, diabetes doctors, Diabetes Specialist Midwives, Nurses and Dietitians, a Healthcare Assistant and various students within all these specialities. In other words, more than six people. The other hospital has a team office that is a more convenient shape, but with little more space - except it does have a window, which even opens.

I am very new to the ante-natal clinic, having observed a couple of times and taken part just once or twice. I don't know much about what goes on during a pregnancy, what tests or scans are required and when, and I don't really understand how the patient journey is conducted, either in general throughout a pregnancy, or on a specific clinic visit. The patients' files are filled with impenetrable graphs and printouts filed in seemingly random order, and there may be several pregnancies-worth of notes in a file. I noticed that there were a couple of heavy duty electric torches in the team office, the sort that you take out of the boot of the car on a snowy night to find out what the noise in the back garden is. I was going to enquire what they were for, but then thought about what sort of clinic this was, and decided against it.

I'm not sure how the different teams operating in the ante-natal clinic fit together - reception staff, then nurses and midwives managing the routine tests, then the fetal scanning team, and then our team at the end of the line. What I do know is that in the two days of ante-natal clinics I saw more patients than in my last two weeks of clinics put together - something like 22 of them - and most of them had to wait longer than in any other of my clinics, more than an hour in some cases. The majority have Gestational Diabetes, but there were a few with Type 1 and Type 2 Diabetes. It was tiring but satisfying to be occupied so intensely, rather than sitting in a general clinic room wondering how long to wait before assuming that the scheduled patient is definitely not coming.

There are some who need interpreters - Turkish and Arabic on this occasion - and I find this quite interesting, especially Arabic. Combining my knowledge of Hebrew with my recent study session on Ramadan, I was entertaining myself by trying to anticipate some of the words used. It turns out that words for 'onion' and 'carrot' are very similar in Hebrew and Arabic, but the Arabic for 'meat' sounds like the Hebrew for 'bread'. I had met the Arabic interpreter before. She told me that she teaches Arabic at evening classes at a nearby school, and I am tempted to sign up (if my employment contract is extended).

Four more Gestational Diabetes patients are booked in for Friday afternoon, my least favourite time of the week by a long way. Two patients are booked at 1.30 p.m., who are seen by myself and a Diabetes Specialist Midwife (we swap after half an hour), and two more arrive at 2.30 p.m. In theory we are all done and dusted by 3.30 p.m., enabling me to go home at my scheduled time of 4 p.m. In practice, I'm lucky to be out of there by 4.30 p.m., and often it is later. This is on a Friday afternoon, remember, and I then have to set off down the motorway for the journey home. We are all agreed that this is unsatisfactory, but so far there has been no alternative proposal for various legitimate reasons including a key member of staff being away, and lack of clinic space and time.

I will be taking over the Dietitian role in one of the two ante-natal clinic on a regular basis starting in September, so will be making more of an effort to understand how things are done and how I fit into the team. If we can streamline the workflow a little better, it will not only improve the patient experience, but ours too.

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