What where and who is St.Emlyn’s?
I have recently been asked about St.Emlyn’s and Virchester. Many people have suggested that this is a mythical place, but whilst the standard of care is indeed magical at times it is an institution of international repute with an illustrious history.
St Emlyn’s is a large virtual hospital situated in the centre of the regenerating post-industrial city of Virchester. St Emlyn’s biggest local rival is the “new” teaching hospital of Abandon, located some 4 miles to the East. Many smaller hospitals lie in its’ not so post-industrial virtual hinterland – the towns of Lonchester, Oilingham, Newmingham and Lingport being some of the biggest. These surrounding hospitals provide a flow of tertiary referral patients. They are sent back with ‘challenging’ discharge letters from the lofty towers of the virtual University Departments of St E’s.
St.Emlyn’s was originally built by the department of health and remains the only NHS hospital built on time and to budget. In recent years central funding has waned. Local directors of services are constantly on the look out for new opportunities and sources of income.
Facilities and services
Most specialties are on site and most procedures can be performed in house. As is always the case one or two vital services have been placed elsewhere both in the interests of “equity” and also (more importantly as far as the commissioners of services are concerned) to ensure the hospital never gets a stranglehold on the health economy or “gets above itself” as they put it. The fact that some patients may have problems in more than one body system is a constant source of angst to many clinicians. Despite suggestions from some quarters it remains technically difficult to separate the head from the body of patients (to allow care for the same patient in different hospitals) in a way that is compatible with a good functional outcome.
Virchester has excellent tertiary level services for many conditions. This attracts many patients to its emergency departments with the result that the numbers of attendances to emergency services seem to rise year on year. It is not uncommon to find a patient in the ED at 0300 on a Saturday night asking why you need to ask them questions when they are well know to Mr/Dr/Prof X (who is probably asleep in bed at this point). Bed occupancy is high and despite the option to produce as many virtual beds as possible at the click of a mouse there are many difficulties in achieving centrally directed targets.
Both the adult and paediatric departments are approved for training and function as trauma centres for the region.
The Emergency Departments
The Emergency Department is the overworked “front door” of St Emlyn’s and provides a 24/7 service to the relatively small (but growing) local resident population, to the large (and growing) numbers of term-time students, to the considerable day-time commuting workforce and to the fun-seeking 24-hour-city virtual revellers and virtual clubbers. Combined, the adult and paeds departments saw some 150,000 new patients last year and has a review rate of 6%.
St.Emlyn’s maintains an online virtual hospital filled with hundreds of cases available to all. These can be accessed online at stemlyns.org.uk.
Mr Roy Royce, Clinical Director, and a consulting staff of 12 wte lead a team of middle grades (SpR, StR and “Career”) and juniors (StR 1 and 2 and FY2) across adult and paediatric departments. Together with Joan Rolex, the Lead Nurse, and her team and the burnt out Directorate Manager Iyam Charge they strive to feed all the pigs and make them ready to fly. Effie Cient, the young and capable PA, sits in the middle of everything and makes it work. The medical team works closely with the nursing team, admin team and support staff to do the best job they can. The department is active in teaching with many medical students seeking to join the team from the University of Virchester and also as elective students from around the world.
St. Emlyn (OK this bit is made up – there is no real St.Emlyn that we can find, but if there was……)
Saint Emlyn is the (not real!) patron saint of Emergency department overcrowding. Working as a English physician in the 13th Century during the Hundred Years’ War he is said to have brought calm to the chaos of the battlefield, treating all before him (friend or foe) and inspiring others to strive forward in the delivery of health care in extremely challenging conditions. It was claimed that St.Emlyn was able to work for long periods without sleep and minimal sustenance save for the extract of the Coffea tree which was brought to Europe 2 centuries later (Ed – Eh??!!).
St.Emlyn inspires many emergency physicians to this day, primarily through his hard work and diligence, but also by his ability to diagnose anything without getting a CRP or D-dimer result first.
No pictures and few records of St.Emlyn survive and so his appearance and characteristics are unknown. For all we know he might very well have been a lady.
Teaching and research
St.Emlyn’s reputation for teaching is well known with a reputation for innovation and creativity. The emergency department is linked to several universities and has an extensive research program with a particular interest in the teaching and understanding of both the art and science of emergency medicine. It seemingly always has medical students around who rate it very highly as a place to learn ‘real’ medicine. Whilst existing on the web the ED facilitates much of it’s learning through online resources such as the bestbets site and the stemlyns classroom.
Similarities to past present and future hospitals
St.Emlyn’s is typical of many city centre hospitals in the UK and around the world although some problems are specific to the UK health service. However, as it exists in cyberspace it is possible to reconfigure the hospital very quickly, and without the involvement of the private sector and PFI. Any specific similarity to real hospitals in the past, present or future is unintentional.
The future of Emergency Medicine at St.Emlyn’s
Roy Royce (clinical director) sees many challenges ahead for the department and trust in general. Although well positioned financially and geographically the changing landscape of the NHS means that services are always under threat and new challenges arise almost weekly. The only certainty is change, but if he (like all of us) follow in the footsteps of St.Emlyn we will continue to the best for our patients, our colleagues and ourselves.