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Congratulations to our respiratory medicine team!

9 May 2016, Sarah Newall, Communications

Congratulations to our respiratory medicine team whose hard work and dedication has enabled a departmental overhaul in the last six months. In April last year the service was swamped with a backlog of 500 new patients waiting for first appointments and a further 1,300 follow ups without allocated slots.

Picture of Dr Andrew Barlow, respiratory consultant

The in-patient demands on the previously small team were equally challenging and the need to improve the support to acute services and managing patients with respiratory failure was recognised. This was happening during the start of a new clinical partnership with Central London Community Healthcare NHS Trust team, with whom The Trust delivers some of our out-patient services. The time for change was recognised by September’s CQC inspection.

The team, led by Dr Andrew Barlow (pictured above) and supported by key Consultant colleagues including Dr David Evans, Dr Matthew Knight and Dr Abi Jackson proposed a sequence of changes including improved coverage across the hospital and some innovative support programmes to A&E and the AAU.

One of the changes, the introduction of the Acute Respiratory Response Team, now means that a Consultant lead team is available to assess and where necessary commence non-invasive ventilation for patients with ventilatory failure. With the changes now in place, the whole hospital has benefitted from the enhanced model of care and the respiratory team expansion has also allowed consideration of sub-specialty services including a new sleep service for patients with suspected obstructive sleep apnoea.

New Consultants take time to recruit so we’re grateful to the dedicated team of locum consultants who have covered specialist clinics during this time. None of these changes would have been possible without a fantastic management team lead by Elaine Odlum.

The department now runs two separate ward-based Rotas; one for the specialist respiratory ward at Watford Hospital and one for all the respiratory referrals across the hospital, which includes the Acute Respiratory Response Team. At night the Consultants also provide a telephone advice service for the acute medical teams managing patients with respiratory failure. From June 2016 there will be daily input to urgent respiratory cases on Saturdays and Sundays with the same overnight advice available. This means there is now a clinically robust out-of-hours, consultant-lead rota providing on-call support to medical teams across the hospital; 24 hours a day, seven days a week.

Dr Andrew Barlow has worked at Watford Hospital for 11 years and is delighted with the changes.

He said: “The turnaround has taken an immense amount of hard work which has been a genuine team effort. We recognised what needed to be done and the senior management team supported us at every stage. We have been empowered to take control and get on with the necessary changes; which is great for our patients.”

“In October last year we also introduced an outpatient based pleural service offering assessments, diagnostic procedures and treatments for patients with pleural disease, so patients can now come to a one-stop clinic rather than spend days in hospital. This will take 1,000’s of bed days out of the system so there are benefits to the whole healthcare economy, but most importantly our patients.

“The main problem was not having enough people to deliver specialist respiratory care, so job number one was to expand and reconfigure the department to increase the time spent by senior clinicians in direct contact with sick patients. With two posts funded by CLCH and two additional posts supported by the pleural service business case, the department now has nine Consultants.”

The new Acute Respiratory Response Team, mentioned earlier, comprises a Consultant, an SpR and a specialist nurse. The team carries a bleep and expects to be called for all new cases of acute type 2 respiratory failure thought to be candidates for NIV. There is also an out of hours nominated Consultant available to discuss any case where clinical doubt or difficulties arise. The day time and out of hour’s rota is held by switchboard and the clinical teams on AAU and A&E.

Over the last six months the team has also implemented:

  • Improved governance arrangements with monthly M&M meetings
  • A new Medical Thoracoscopy
  • service (to commence in September/October 2016)
  • Reviewed booking system for Respiratory out-patients
  • A new training programme and register for nurse competencies in NIV
  • Re-written the Trust Non Invasive Ventilation protocol
  • Developed new protocols for pleural intervention, bronchoscopy, community acquired pneumonia, hospital acquired pneumonia and thrombolysis for sub-massive pulmonary embolus
  • Introduction of accurate demand-capacity modelling for Respiratory Medicine with department-level job planning

Dr Barlow added: “I am relishing the challenges and opportunities that come with this sort of expansion and that with the new Consultants on-board, there will be many more years of innovation and clinical excellence to come.”


  1. For more information, please contact Sarah Newall, Communications in the Trust’s Communications department on telephone: 01923 436 280 or email: info@whht.nhs.uk. Out of hours, please call 07900 228 031.
  2. West Hertfordshire Hospitals NHS Trust is a large acute trust serving people from across Hertfordshire, north London and further afield. It operates from three sites at Watford, St Albans and Hemel Hempstead hospitals and sees about 600,000 patients a year. We are one of the largest employers locally, with around 4,500 staff and volunteers.