Mobile units used as a ‘cold’ site at Shrewsbury and Telford Hospital NHS Trust

Vanguard installed a mobile theatre and ward, at the Princess Royal Hospital in Telford, in December 2019.  The Shrewsbury and Telford Hospital NHS Trust wanted to add additional theatre capacity to the hospital and, with a staff team of four, and the unit provided fully equipped by Vanguard, it provided a fast-paced and busy environment, seeing between eight and 10 patients a day, on average.

Prior to Covid-19, the average patient journey would see the person arrive to the eight-bedded ward, where they would be admitted by the host ward staff and are assessed by both the anaesthetic and surgical teams. Then a team brief would take place, consisting of all theatre members, and this would be led by the named team leader before receiving any patient.

The unit previously carried out both local and general anaesthetic procedures with lists both morning and afternoon. The pace has slowed as a result of Covid-19, but the unit has been successfully operating as a ‘cold’ site for the Trust, allowing key procedures to continue.

Neil Rogers , Assistant Chief Operating Officer – Scheduled Care at The Shrewsbury and Telford Hospital NHS Trust, said: “Before Covid-19 we were using the unit for oral surgery, an area where we had some patients who had been waiting for a very long time for procedures such as wisdom teeth extractions and other treatments but is specialist work that couldn’t be done in a family dental practice.

“That was about 50% of the work and the other half was ENT and urology.  We could also treat children on the unit as it was segregated from the rest of the hospital.

“The procedures carried out there were very focused on those with long waiting lists and to give us extra capacity.

“During Covid-19 we didn’t want to let it go – the unit was due to go back at Easter -but we have extended the contract so we can use it as a ‘cold’ site through to the beginning of 2020/21.

“Having the unit has been a real asset as it can be ring-fenced as a service, it’s segregated from the main hospital and the staff are their own individual team, not working elsewhere within the hospital. They were ready and available to begin procedures again when we needed them to.

“The team have provided a range of day case procedures such as  skin cancers, ENT and  a broader range of oral surgery, and  now general cases are beginning again. The unit is ideal as it has its own staff team, and we have a dedicated team of our own surgeons and anaesthetists who only work on the Vanguard unit. The unit has its own recovery area and it’s  has its own anaesthetic room.

“So, we continue to use it as a ‘cold’ site taking appropriate additional precautions. We’re running a process of pre-operative swabbing. Patients are swabbed 2-3 days before they come for their procedure.

“All patients are temperature checked before they come onto the unit and should have self-isolated for an appropriate period before their procedure to further reduce risk.

“We’ve treated around 150 patients since the beginning of Covid-19. The focus really is on safety for everyone - as many of the procedures carried out on the unit are aerosol generating, all of the  team members have been fit tested for FFP3 masks and they wear all of the appropriate PPE. There are 15-minute gaps between cases and previously we might have seen up to 10 people a day, now it is at four or five.

“This is a safe environment to continue with the skin cancer work and we are looking to add non-urgent cancer work too. Having the unit separate to the hospital is key for patient safety and the patients have been very happy to attend because of that separation and the ring-fenced group of staff.

We’ve been extremely pleased that the Vanguard unit will continue to add to our capacity through into the  restoration and recovery phase of responding to, and living with Covid-19.

“The team have been really helpful, they are really part of our collective team and it has been great to have that additional resource and expertise on site. Even when the unit was on downtime, we knew we could turn to them if they were needed.”