Wrexham is the biggest, and busiest ED in North Wales, seeing approximately 70,000 patients per year.
Wrexham is a border town closely situated to the cities of Liverpool and Manchester, with a number of pleasant areas to live, including North Wales, Cheshire, or Shropshire countryside.
The geographical catchment area is vast, extending into Shropshire, parts of north Powys, all the way down to parts of the Mid to North Wales western coastal areas, such as Barmouth.
The department has 36 nursed cubicles separated into 4 spacious resuscitation bays, 11 majors’ cubicles, 6 minors’ cubicles, 9 CDU spaces, 4 paediatric rooms (including a separate paediatric waiting room), and 2 interview rooms.
Following the onset of the pandemic all cubicles have been partitioned, to allow for adequate isolation of yet undetermined infectious patients, including the loss of an appropriately functioning CDU for extended stay ED patients.
Other non-nursed areas include a separate eye / ENT / O&G exam room; an ENP assessment room; 3 examination rooms that have been recently vacated by the GP OOH service; a 2nd triage room, that can be used for ambulatory non-trolley assessment of patients, and finally a Triage HCW support room to facilitate front-loading of investigations, or a true see-and-treat turn around service.
Consultants
- Dr Bhaskar Ayinaparthi – CESR Lead, and RCEM CESR assessor
- Dr Ash Basu – Dual CCT holder with ICM; Specialty Tutor; Head of School for ACCS, EM & PHEM; and EPIC iBSc. Lead
- Mrs Emma Caton – Nurse Consultant & Clinical Lead
- Dr Hywel Hughes – Interest in Sports Medicine
- Dr Sian Morgan – Paeds lead, Medical Examiner (FRCPathME)
- Mr Dilip Menon – RCEM examiner & Audit Lead
- Dr Chethan Padmanabhaiah (Locum consultant) – Pathways & Guidelines lead
- Dr Fiona Rae – Undergraduate Lead, Wrexham / Honorary Senior Lecturer, Cardiff University
- Mr Robin Roop – Clinical governance and patient safety lead, and ex-VP RCEM Wales
- Dr Asha Umrawsingh (Locum consultant) – WEDFAN lead, ED Education & Teaching Lead
- 8 x Specialty doctors
- 2 x HST doctors
- 2 x ST3 doctor
- 7 x non-training grade SHOs (combination of Senior SHO / ST3 level, and SHOs)
- 2 x ACCS trainees per 6-months
- 2 x GP trainees
- 2 x F2s
- 2 x F1s
- 1 x trainee ANP (looking at further expansion)
- Physiotherapy practitioner (minor injuries follow up)
- Looking to expand ENP service for minor injuries
Consultants cover 0800 – 2200 Monday to Thursday and 0900 – 0000 Friday to Sunday
Additionally, the midweek night shifts are covered in a hybrid model with some of these covered by Consultants, and others by Middle Grades. Seniority on weekend night shifts is provided by appropriately senior locum doctors, often regular recurring.
Middle Grades cover from 0800 – 0000 Monday to Thursday, and 0900 – 0100 Friday to Sunday.
Tier 4 doctors (Specialty doctors / HSTs) work 1-in-4 weekends, alternating between 9-5 and 5-1am weekends
Tier 3 doctors (ST3s / senior SHOs) work a 1-in-3 weekends, alternating between days, lates, and nights
Tier 2 doctors (SHOs / F2s) work a 10-person rota with a 1-in-2 weekend frequency, and again work three main shifts, days, evenings, and nights. Whilst the banding for these doctors is 1A (max 48hrs workable), the rota averages out at 40hrs worked per week, with all recommended length of shift, consecutive shifts, and no late finish on Friday before weekend off, taken into account.
Education Development Time (EDT) is factored into the rota and adhered to.
Rota co-ordinator: Jo.Curry@wales.nhs.uk
All the ED consultants have a keen interest in education, having been instructors of ‘life support courses’ and a number of consultants having undertaken educational qualifications to varying levels. All trainees and non-trainees are allocated educational supervisors, with regular meetings undertaken, and career support provided by these individuals. Consistent supervision and familiarity with curricula and the various e-portfolio platforms is ensured by the same consultant supervising the same trainees.
The ED team has revamped the ED teaching programme over the last few years, with a regular teaching programme termed 10-@-10, provided by ED consultants, middle grades, and juniors, as well as all necessary WPBAs being able to be achieved during trainees’ time in ED, supported by a new ED sharepoint homepage where educational materials as well as clinical pathways can be accessed and reviewed.
All ED Consultants have above average ultrasound skills, with the majority of these individuals “grandfathered” and are capable of providing ultrasound training support and education.
ED meetings
Regular ED governance, business, and mortality & morbidity meetings are undertaken, with encouragement for all members of the ED team to attend wherever possible, with an open and transparent reporting process encourage by all. Additionally, there is an ED junior doctors’ trainees’ forum, that also feeds into the hospital junior doctors’ and trainees’ fora, as well as an active and engaged Medical and Dental Education and Training Board group that meet regularly.
ITU
ITU provide a supportive service for ED and critical care interventions (RSIs, central access, NIV) can be commenced in the ED resuscitation room by ED in collaboration with ITU. There is also an Acute Intervention Team (a form of critical care outreach), and Critical Care Practitioners.
Medicine
All Medical specialties on site, with most of these accessed through the Acute Medical service, except for neurology, which is a visiting service from The Walton Centre in Liverpool.
Neurology provides a first seizure clinic service, and in-patient access by visiting neurologists
Cardiology PCI is in our sister hospital, Glan Clwyd, but there are excellent in-reach cardiology
Care of the elderly provide a 24-hour stroke thrombolysis service, as well as excellent frailty access
Respiratory have an established high care ward for non-invasive respiratory support
Diabetes has in-reach access to ED by diabetic specialist nurses
Renal have a separate on-call rota and are always available
Haematology, Oncology, Rheumatology and Dermatology can be accessed following admission under the medical team
The acute UGI bleed endoscopy service is provided by General Surgery.
Surgery
All surgical specialties on site except for Vascular surgery, and maxillofacial surgery, which are in Glan Clwyd.
ENT often has a cross-cover on-call system with Wrexham & Glan Clwyd.
General T&O on site, specialist T&O spines or pelvis is discussed with tertiary hospitals in Stoke or Liverpool. Wrexham is a Trauma Unit, as part of the Northwest Midlands and North Wales Trauma Network since 2012, with Royal Stoke University Hospital the adult Major Trauma Centre.
Paeds
10-11,000 paediatric attendances per year, no designated PEM consultant but several ED Consultants have PEM interest and expertise. There is a close working relationship with the paediatric team. The tertiary referral service for children is Alder Hey Children’s Hospital in Liverpool, including Major Trauma, with additional support being provided by Northwest Transfer Service (NWTS) to help advice on critically ill and injured children, and paediatric transfers.
O&G
Obstetrics and gynaecology services exist and frequently they accept direct triage streaming for well, non-shocked early pregnancy PV bleeds.
Radiology
24-hour resident CT radiography service. After 2100 on weekdays, and 1300 on weekends, the reporting service is outsourced to Everlight Radiology Reporting Online. There are also 2 interventional vascular radiologists, who provide daytime cover only.