Major London hospitals are running short of equipment in intensive care wards, including pumps and blood dialysis machines, according to a leaked memo to senior hospital doctors.
The shortages, which go beyond concerns about the shortage of ventilators and protective equipment, emerged from a conference call of some 80 senior NHS doctors. The call highlighted the growing pressure from the influx of coronavirus patients on hospitals in the capital, which so far is the hardest hit part of the UK.
The 1,000-word memo, seen by the Financial Times, is written by Professor Daniel Martin, the head of intensive care for serious infectious diseases at the Royal Free Hospital. It paints a picture of doctors and nurses still scrambling to develop treatments for the virus as the shortages bite.
The summary of the call, which was designed to share information about how best to treat coronavirus patients, warned nurse-to-patient ratios are at six-to-one in intensive care wards with hospitals using everyone “from med students to dental hygienists” to absorb the overload.
The note also revealed Covid-19 is not simply a “one organ” disease that attacks the lungs, but is also causing “high rates” of acute kidney failure.
Dr Martin warned “over zealous” use of diuretics such as Frusemide were leading to leading “unnecessary” kidney complications and related blood clotting issues.
He also flagged the “higher than predicted need” for kidney treatments, while noting that several London hospitals, including Kings College Hospital, are running short of blood filtration machines.
He wrote Kings College was “running out of” the “CVVHF” blood filtration machines and an unnamed centre had “run out of pumps” used to administer some drugs.
The note, designed to share insights and develop best practice among colleagues, painted a picture of the pressure on the NHS as hospitals race to train sufficient doctors and staff wards already facing shortages.
“Most centres now getting towards 1:6 nursing ratio with high level of support workers on ICU [Intensive Care Unit],” Dr Martin wrote. “Training has largely fallen by the wayside as it is too large a task. People are being trained on the job,” he added.
He also chided colleagues that they need to catch up with other hospitals in seconding staff, and noted some “non-medical staff” were refusing to enter intensive care wards — a practice that needed to end.
“We need one support worker per patient. Other centres are using everyone they have. From med students to dental hygienists. We are behind the curve ‘++’ with this,” he wrote.
“Last time I was on a night shift, theatres were full of non-medical staff refusing to help ICU — this is unacceptable,” he added.
The account of the call emerged as the NHS across London braced itself for the “peak” of Covid-19 admissions, around Easter time, with government models expecting this in the next seven to 10 days.
Dr Martin’s note to colleagues also revealed the extent to which doctors are still learning about treatments for the virus, despite all the information being passed back from hotspots hit earlier in the pandemic in Europe, such as Lombardy in northern Italy.
He warned, for example, to avoid ventilation too early in the intensive care process as this “may be harmful”, while noting patients were having to go back on to ventilators if taken off too early.
“Not many patients have reached extubation yet in London,” he wrote, before adding “re-intubation seems to be common” and his doctors should “wait longer than usual before extubating”. “An extubation protocol is needed immediately,” he added.
Another evolving area of coronavirus care is the question of “fluid balance” among patients, and how far they should be hydrated. “All centres agreed that we are getting this wrong,” he wrote.
Dr Martin concluded with a final note of uncertainty, arguing that colleagues “desperately need to look at our own data to understand whether we are getting this [treatment] right or not”.
A spokesman for the Royal Free Hospital declined to comment on the communication. A request for an interview with Dr Martin was declined, citing his work commitments in managing the response to the virus.