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Life beyond the mask

It has now been a couple of months since I wrote my last blog and life has moved on since we first had to put on our masks. It is hard to remember the last time I went out and did not see a mask. Within Salisbury Hospital where I do my clinical work, as with all healthcare environments, it is hard to imagine not having to grab a mask to put on as you move into the clinical areas. Life is moving towards the new normal.

In terms of my clinical life, how do I see this new normal? Like last time, the drive to work has changed. I now have to leave much earlier to get to the hospital. I have to take into account the traffic, including the long-forgotten traffic jams. There are also more people out and about, both individuals as well as groups. Moreover, we are now returning to a more normal flow of patients presenting to the emergency department (ED), patients with accidents and emergencies.

The ED has changed dramatically too, both physically and emotionally.

What do the physical changes in the ED mean?

If a patient comes in with a temperature, shortness of breath, a new oxygen requirement or are known to be positive for COVID-19, we senior doctors and nurses have to decide where to physically see the patient.

Could it be COVID-19? If so, those patients are now seen in the redesigned smaller Respiratory Assessment Zone (RAZ). This still means that nursing staff and doctors have to wear full Personal Protective Equipment level three (PPE3) to go into the area and to remain in full protection until all patients leave, and they can step out. For most days, due to the constant trickle of patients into the RAZ, there has to be staff in the RAZ the whole time. As a result, we rotate individuals. It is far too tiring to spend a 10- or 12-hour shift in PPE3.

The positive aspect of all this is that the patients are seen in the safest environment, reducing the risk of contracting COVID during their visit. Additionally, in the non-RAZ area, staff can wear a lower level of PPE, just an apron, surgical mask, gloves and face shield. The kit is still uncomfortable and from a personal perspective, rather than getting used to it, it seems to feel worse with each shift.

Part of this is because at the start of the pandemic, we had masks with built-in air filters. Within the first month, the stocks of these masks had become unavailable and we had to make do with non-filter masks. Although the non-filter masks provide the same level of protection, they do not easily allow airflow, resulting in being very uncomfortable to wear for any length of time. They are hot, and for those of us who wear glasses, they steam up our vision. Add a face shield on top and conditions are not good. I have learnt to hold my breath during procedures!

Of course, having seen colleagues become ill and sadly die in departments where I have previously worked, everyone accepts the discomfort with minimal complaints.

What are the emotional changes?

Patients have started to visit the ED again. The initial fear of COVID-19 has lessened to some extent. We are now seeing a range of patients starting to re-present. First, there are those who are happy to come to the ED but would rather walk out than be seen in the RAZ. This is despite telling them that the set-up is to protect both the staff and other patients.

We then have the patients who should have come to the ED during the last few weeks but did not due to fear or feeling that their symptoms and signs were not severe enough to warrant bothering us. These, unfortunately, include patients who have had heart attacks and strokes and who have missed their treatment window. The group also includes patients with fractures that are weeks old and have already started healing.

We are also seeing an increasing number of patients suffering from mental health issues. Most are as a result of the reduction in support over the last few weeks, but some are new presentations triggered directly from the effects of the lockdown measures. All are asking for help.

Regarding my clinical colleagues and I, I think the one word I would use to describe the mood is ‘tired’. We are tired of non-breathable gowns. We are tired of masks that bruise our faces. We are tired of having to continuously don on and off various levels of PPE. We are tired of the dry skin on our hands from the constant washing and alcohol rubs…tired! You can see it in everyone’s faces, read it in the body language and hear it in the voices.

Where are we going from here?

I think it will unfortunately still be months before things settle down to a new normal for us all. I wonder if this will happen before 2021. However, I do believe the a real positive over the last few weeks has been increased awareness by the clinical staff of how beneficial the right technology can be in the correct clinical setting. They notice how IT can be used to great effect to improve the care of our patients, making the workflows more efficient and cost effective. One of the biggest changes I believe is the way that we engage with our patients using tele-health solutions, or as is more commonly called by my colleagues video-calling. The concept of running clinics virtually has been well received with both clinical staff and patients alike. This has been the case for both the acute as well as the primary care/ambulatory setting. It has been a necessary step, but one with lots of safety and efficiency benefits to take forward to the new normal.

The other visible change is watching clinical colleagues appreciate the effort that has gone into making data more available, enabling them to be productive from home as well as within multiple clinical areas.

Will the changes embed? I have to think positively and believe the big steps taken by IT departments and IT suppliers across multiple healthcare organisations will continue to be supported by clinical staff. The clinicians will need to continue to work with IT in order to enable solutions to be accepted and rolled out, providing an improvement in clinical safety, an efficiency drive and a reduction in costs. I am a positive believer in technology as an enabler that can make the world a better place. I, for one, will continue to encourage individuals and organisations to make the leap and continue to embrace this new world.

Finally, I want to share that I feel very lucky. I have my job at Allscripts and I practice as a doctor. I feel I can therefore use my skills to support this world-changing situation in many ways, whether it be supporting patients, healthcare workers or Allscripts colleagues. And despite the tiredness and the stress, I personally have somewhere unique to rest: Bertie, our vintage camper, is where I stay when I am working as a doctor!

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