Annex A > Chapter 15 - Post-operative Care > Involvement of clinical staff
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Involvement of clinical staff
Cardiologists
93 Dr Jordan, consultant cardiologist, in his written statement to the Inquiry stated that:
`It was difficult to maintain any continuing liaison between the surgeons and anaesthetists at the BRI and the cardiologists at the Children's Hospital. This actually became more of a problem as the number of adult patients increased and with this the actual number of anaesthetists and of cardiac ITU nurses, so that the role of the paediatric cardiologists inevitably appeared less important.' [122]
94 Dr Jordan did not regard the fact that the cardiologists were based at the BRHSC as being a problem in itself. Rather:
`The main problem as I saw it was that the system had grown up as being managed by the surgeons and anaesthetists and we were not routinely involved in post-operative care. Another problem was that for much of the time there was no regular time for the surgeons and anaesthetists to carry out their visits, and these seldom coincided, so it was impossible to co-ordinate the visits which I did make with their attendance on the ward. The situation was actually better at weekends when I was able to at least make an effort to get there when the surgeons or anaesthetists were expected.' [123]
95 However, as Dr Joffe, consultant cardiologist, told the Inquiry:
`Dr Jordan specifically made a point of going to the BRI every day and often twice a day, so it was not as if there was no presence whatsoever at the BRI. He found it slightly easier than I could because earlier on he was still involved in adult cardiology, had an office at the BRI, and needed to be there anyway, and indeed, he and later Dr Martin [consultant cardiologist, BRHSC] were running an outpatient clinic for adolescents and adults who had grown from the childhood period, usually post-surgery, at the BRI. Therefore, they had some time when they had to go. So, apart from the weekends, I would say that on a daily basis there was at least one call by a paediatric cardiologist who would look at all the patients, not only his or her own, but all paediatric cardiac cases, and make recommendations about management, if necessary. In addition, we, or certainly I, tried, I think on two occasions, to establish a regular routine ward round at the BRI, twice or three times a week, and discussed this with Mr Wisheart at the time, and the intention was there, on both sides, but with all our other demands and the variation between timetables of surgeons and paediatricians, et cetera, it was just not possible to organise.' [124]
96 As to his own input, Dr Joffe said that he regretted that he had not had the available time on every occasion to go to the BRI, from the BRHSC where he was based, in order to see his patients post-operatively. He told the Inquiry:
`I do regret it. I think we may have made a difference to the overall outcomes, but it is very hard to put hard figures on to that, so it is an impression. But I wish we had the time to have spent in the BRI for that purpose. Unfortunately, we did not.' [125]
`The physical separation was real, although of course not insurmountable. The distance between the two hospitals was really quite small: 150, 200 metres, maybe. But the hill, when you were walking up it, felt as if it was almost half a mile, rather than 200 metres. It was extremely steep, so it was difficult coming back up; it was easy going down. This may sound trite, but it does make a difference, and it also makes a difference in terms of the ordinary communication that exists in a unit where consultants and various doctors can meet with each other and bump into each other in a corridor, and so on, which facilitates overall management.' [126]
98 Dr Robin Martin's evidence to the Inquiry included this exchange:
`I personally found it difficult to get actively involved in the care of the patients down there [at the BRI]. Patients were under the care of the surgeons, the surgical team were looking after the patients in conjunction with the anaesthetic team. It was very difficult to arrange a time when you could be there when other people were there to discuss the individual case, so usually when I went down I would find there was no one else actually physically there that I could talk to about the case and -
`Q. The communication between yourself and the surgeon would necessarily have particular difficulties because of that?
`A. It would be difficult, yes. There would be occasions when surgeons or anaesthetists might specifically ask for an opinion about this or that and of course we would give that opinion and there would be some discussion. But just in the day-to-day management it was very difficult to get very actively involved.' [127]
`The paediatric cardiologists visited their patients on the Unit on a regular basis. They would be contacted in an emergency. They would often come into the Unit to assess the child, give advice, or perform an echocardiogram.' [128]
`There was a definite failure to involve the cardiologists enough. When they were called, they came down from the Children's Hospital and they were very helpful, but they were not called as a routine, and they were not there as a routine.' [129]
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Footnotes
[122] WIT 0099 0045 Dr Jordan
[123] WIT 0099 0045 - 0046 Dr Jordan
[128] WIT 0213 0041 Julia Thomas