COVID-19

 

Introductions and Links

We are curating up-to-date information on COVID-19 for medical staff, students and other healthcare workers in NHS Lothian.

On 23 March 20, Scotland and the UK entered a lockdown response to the COVID-19 pandemic. On 29 May 2020, a number of these restrictions were relaxed, although where possible, you are still urged to stay in your house and maintain good social distancing practice (2 m [6 foot] between members of different households).

As of Monday 29th June, the recommendation in NHS Lothian is for face coverings to be worn at all times in ward settings, face coverings encouraged elsewhere in the hospital, as well as maintenance of 2 m social distancing where possible.

More information on the current advice is available on the Scottish Government website.

The NHS Lothian staff test-and-protect policy is available for review here. Please also see the daily NHS Lothian Speed Read updates and NHS Lothian intranet resources.

(Last updated 29 July 2020; 10:00)

Trainee Wellbeing Feedback through COVID-19 (July 2020)

 
 

Important Updates

 
 

Internal Events

 
 

COVID-19 Webinars

 

Reskilling for COVID-19

Reskilling Sessions

As more patients became hospitalised with COVID-19, we provided regular interactive teaching sessions for NHS Lothian doctors in training as refreshers in respiratory medicine and other skills for managing COVID-19 patients.

These sessions were run daily using videoconferencing, designed by Dr James Tiernan (resp consultant) and Dr Emma Scahill (clinical teaching fellow).

Session Objectives

  • be able to perform an A-E assessment
  • discuss causes, recognition and management of respiratory failure
  • review oxygen therapy and titration
  • appreciate the role of anticipatory care planning and escalation pathways

COVID Zone Induction Pack

COVID Zone Induction Guide (16-04-20)
The Allocation section below has further details on the steps in the allocation process.

University of Edinburgh Teaching Materials

This material is available via a special log-in set up by UoE. Using your NHS account, this can be accessed here.

Turas Learn Resources

Access Turas COVID-19 resources with your NHS account.

Senior Doctor Resources

These materials are tailored toward senior clinicians toward helping with decision making in respiratory failure and COVID-19 patients.

Senior Decision Support Guide PDF (pan-Lothian 16-04-20)
Oxygen Therapy / NIV Guidance (20-03-20)

Recorded Webinar

The session below was recorded with James Tiernan and a group of interim FY1s on 17-04-20 (all infomation correct as of this time).

00:00 -- Intro
04:32 -- A-E assessment and initial management
11:00 -- ABG interpretation and Respiratory Failure
27:00 -- Cases
38:50 -- COVID management
41:00 -- Role of junior doctors
47:00 -- PPE
49:20 -- Deteriorating Patients and Escalation
1.00:30 -- FAQs


This session was recorded with James Tiernan and some of the interim FY1s (all information correct as of 17-04-20).

 

Preparation for Critical Care

Following the success of the "Reskilling for COVID-19" webinars, similar online drop-in sessions were planned for any health care worker who had been re-allocated to a critical care environment (or for those looking to prepare themselves for future changes).

These sessions were run by ICM and anaesthetic registrars covering: critical care environments and equipment, systems and processes, troubleshooting, common emergencies, and management of specific ITU conditions.

VIDEO - webinar recorded 23 April 2020

00:00 - introduction
03:52 - what is "critical care"?
06:49 - equipment
32:25 - daily assessment
41:15 - CXR interpretation
47:25 - critical care emergencies
57:22 - tracheostomy management
64:09 - specific critical care conditions
71:30 - summary

Course - COVID-19 Critical Care: Understanding and Application

The University of Edinburgh and Royal College of Physicians (Edinburgh) have created a free online course developing themes discussed in this webinar including: daily critical care practice, ventilation and organ support, COVID-19 specific care, self-care and staff wellbeing.

Free FutureLearn Access Here


Useful Resources

Critical Care Handbook (developed by UoE MSc Critical Care faculty)

NHS Lothian ICU Infusion Guide (last accessed 13-04-20; these are the "yellow sheets" in ITU)

Intubating COVID-19 patients

Video from RIE Critical Care (filmed 11-03-20)

Proning in ITU

Video from RIE Critical Care (filmed 11-03-20)

 
 

Doctors in Training

 

Interim FY1s

In April 2020, we had nearly 150 final year medical students join the number of other nursing and AHP students who graduated early to work in South East Scotland and support the NHS response.

The induction programme delivered at the end of April for our new FYs is here, including links to a number of useful induction videos on a number of useful themes for FY work.

Teaching for FY doctors, with a focus on the interim FYs, is an ongoing process which can be accrued for next year's ARCP process too.

 

Allocation and Remobilisation

Reallocation

Across the UK, doctors-in-training are at the frontline of the NHS response to COVID-19.

To facilitate this, the usual rotations and training have been suspended, and some doctors are getting allocated to areas needing increased medical support.

This situation is being closely managed by the MED team - details of this process are in this allocation document (from 01.04.20).

Remobilisation

If units are returning to normal working, then trainees should also be returned to their normal training positions. This will be coordinated by the MED team, with this guidance from NES (01-05-20). The normal rotations in August are intended to continue as planned.

If you have questions regarding your banding or payroll issues, you can contact Medical Personnel by email.

COVID unit induction guide

This is a pan-Lothian guide to working in the COVID zones in RIE, SJH and WGH. This has relevant contact numbers, information on diagnostic tests and management pathways but is constantly under review and update so please check here for the latest versions. If there is information you feel would be useful to include, please discuss with your local medical team (including the authors on the front page) or you can contact us.

INDUCTION GUIDE 16-04-20


Senior Decision Guidance

This document has been prepared by the Lothian Respiratory team to help support registrars and consultants who are moving to COVID Zones. Included is advice on escalation pathways, common respiratory conditions and PPE guidance.

SENIOR DECISION GUIDE 16-04-20
Oxygen Therapy / NIV Guidance 20-03-20


 

Anticipatory Care Planning

All adult admissions in NHS Lothian should be accompanied with a recorded Anticipatory Care Plan (a copy of the form is available here). This is a standardised document which staff will be able to refer to throughout the patient's hospital admission. It should be completed by the most senior doctor available, in consultation with the patient, family and with the responsible consultant.

The paper form is required in all admissions, and this should also be actioned on Trak within the EPR (Green C indicates full escalation, red C with line through indicates DNACPR).

Part of this process will involve discussions with patients regarding anticipated levels of care and DNACPR status. With the Palliative Care team (Dr Colette Reid, Dr Stephen Fenning) we have created the videos below as examples of conversations you may have with patients and family members around dying, particularly during this COVID-19 pandemic. They have prepared some phrases which you may find useful when having these discussions (PDF here).

EC4H (Effective Communication for Healthcare) also have a section for communication with patients and families during COVID-19, including the RED-MAP conversation approach.

ACP Introduction
ACP Discussion with Patient
ACP Discussion with Relative
 

Not On Site Working

There is a small number of doctors who due to existing health conditions or pregnancy have been advised to step back from front-line clinical work (the information regarding at-risk groups is available here).

Looking after yourself is a priority, but we know that a number of you are still wanting to support your colleagues and contribute where you can.

There are a number of ways that non-clinical work (even from home) can help, and be counted as work suitable to match the Gold Guide for trainee progression (including updates regarding Outcome 10 and COVID-19). A guide produced by some of our not-on-site doctors on what to prepare and cover is included here.

 
 

Your medical training during COVID-19

 

Documents

If you have questions about your training (Foundation or specialty programmes), visit the Scotland Deanery website or email: deanerycovid-19enquiries@nes.scot.nhs.uk or visit: foundationprogramme.nhs.uk/covid-19/ // NES also has the Professional Support Unit who can help you if you have personal wellbeing issues you feel are not being addresed directly by your trainers (psu@nes.scot.nhs.uk). // NES also runs weekly webinars on Thursdays relating to training (link the Events section).
 
 

Medical Students in NHS Lothian

 

The University of Edinburgh has made changes to the formats of year 4 and 5 to allow NHS staff to deliver clinical care to patients. More details can be read on each year's Learn discussion board and in this letter from Prof Kluth (17-03-20).

The final year (year 6) students who passed their final examinations were invited, as with other final year students across the country, to help clinically by starting interim Foundation doctor positions. Please welcome them to NHS Lothian and support them, as they will support us.

Letter from Chief Medical Officer to all Medical Students in Scotland (01-04-20)

Academic Year 2020/21

Plans are still being finalised but the future of clinical teaching in the University of Edinburgh and across NHS Lothian will look very different to what came before COVID-19.

Year 4 will follow a 10 week model of rotations, in the community and primary care, acute hospital services, and specialist / outpatient specialties.

Years 5 and 6 will also have adjustments, to broader clinical placements.

Students in all these years will have longitudinal ward based placements, including making use of hours outside 9-5, with the intentions of reducing student rotation throughout our units and increasing clinical experience. Measures will also be taken to reduce exposure to AGPs. Students will be provided with branded university scrubs; information on changing sites is available on the main hosptial pages.

 
 

Wellbeing and Support

 

Doctors in Training Drop-In

Working as a doctor is tough at the best of times, and especially when we are dealing with a scenario like COVID-19. Whether you are having a stressful time on the ward or are stuck in self-isolation at home (or anywhere in-between), you are welcome to drop-in and have a chat about anything that's on your mind.

There are on-site drop in sessions currently arranged at RIE and WGH. These take the time set aside for lunchtime Foundation teaching and give all doctors a chance to come together (with appropriate distancing) to have a sandwich and a chat. Members of the MED team (including your ADME) will be there to speak with too.

RIE: Postgraduate Education Centre, Tuesday 1200-1400

WGH: Medical Education Centre, Thursday 1200-1400

For those who can't make these sessions, or are working elsewhere, we also offer Virtual Drop-Ins on Zoom hosted by one of our Clinical Teaching Fellows, Dr Brendan Cavanagh.

The drop-in sessions run from 13:00-13:45 on Tuesdays and Thursdays, with an evening session on Thursdays at 17:30.

The link to the Zoom session is below (accessible by logging into this website; if you need access please contact your local Educational Co-ordinator or email us). The code for the zoom session can also be found on Trickle.


Our MED team are also making impromptu visits to clinical teams for those who can't make the drop in sessions.

 

Local Services

NHS Lothian Advice Line
(Monday - Friday, 0800-1800)

0131 537 8530 (ext. 88530)

Staff are not to call RIDU or our Public Health teams with queries, as both areas are under extreme pressure.

Here4U
Open to all NHS Lothian staff, confidential psychological support and guidance
T: 0131 451 7445
email: Here4U@nhslothian.scot.nhs.uk

Occupation Health Staff Counselling and Support
Self referral process to OHSCS@nhslothian.scot.nhs.uk
"self refer" as message title, and include your name, date of birth and a contact number.


STAFF LISTENING SERVICE - EDINBURGH AND LOTHIANS HEALTH FOUNDATION
T: 07888998084 (between 9am and 9pm, calls last 30 minutes and you can re-call)
email: stafflistening@nhslothian.scot.nhs.uk



Accommodation Support for NHS Staff

This is available for staff for a number of reasons including:
  • difficulty getting to / from work due to increased distance or reduced public transport
  • if shielding a high risk individual(s) at home
  • if a suspected / confirmed COVID-19 individual(s) at home

A number of local hotels and accommodation services have expressed support and interest in offering places for NHS staff between shifts or available for on-call support.

Initially please contact travel@nhslothian.scot.nhs.uk who can help arrange placement for you as required; they are updating their policies in the coming days. Out of hours, contact 0141 223 1904 quoting “front line NHS staff emergency accommodation” and provide your name, ward, hospital, and work telephone number.

More information is on the Travel Team page of the NHS Lothian intranet (including the TA01 form which can be completed retrospectively).

Edinburgh Medics' Share

A medical student led volunteer group offering childcare and support for health care professionals.

Facebook Group (sign in required)

Food and Supplies

This PDF has links to supermarket times and a number of excellent local businesses who are continuing to provide food deliveries in and around Edinburgh and the Lothians, some with special discounts for frontline NHS staff.

RIE
Canteen: Opening hours extended (now continuous 0700-1930, with extended meal times)
Project Wingman Lounge: Arthur's Seat PGEC 0630-2100
Aroma: hot and cold drinks, with sandwiches / snacks available 2100-0000 (supported by FeedNHS)

WGH
Dining Room: Open 0700-1930 - hot drinks and snacks available all day.
Cooked: breakfast 0700-1000 // lunch 1145-1400 // dinner 1630-1900
Tea/Coffee Facilities in MEC 24/7

Yoga

Twice weekly Zoom sessions - links here

 

National / Online Services

Wellbeing and Self-Care (ICS)

A PDF resource developed early by the Intensive Care Society.

The second page in particular has a number of suggestions and tips excellent for general use.


MIND

A PDF resource to help with shift work during COVID-19, including simple checklists before getting home.


If need to speak with someone:

BREATHING SPACE: breathingspace.scot - T: 0800838587

SAMARITANS: samaritans.org - T: 116 123 (free phone)

SHOUT: giveusashout.org - Text 85258

FRONTLINE 19: frontline19.com free counselling service


Headspace

Free app access for all NHS staff throughout 2020 (register with NHS email).

Unmind - use NHS email

From sleep and coping through to parenting and supporting others, we provide tools and training across the entire spectrum of mental health.


Ten Percent Happier

Free podcasts and online guides to caring and coping with the anxieties and challenges presented by COVID-19.

Ten Percent coronavirus resources

NHS complimentary access

Supermarkets

A number of stores and supermarkets have either dedicated times for NHS staff, or priority access.

This changes regularly so please check with your local supermarket / suppliers for times to shop.

BMA 24/7

(confidential and peer support line for doctors and medical students)

0330 123 1245

 

Rest Facilities

As well as the additional food and drink facilities being set up, the MED has secured funding for recliner chairs to be added in a number of locations around our acute hospitals, to provide suitable space for doctors in training to have a safe rest space.

Some beds (for short spells of rest) are also available, and other rest facilities are provided by some specialties already.

 
RIE Recliners

4 recliners in Braids Room (PGEC). Beds in Doctors' Mess (close to ward 104).

WGH Recliners

CSAC and Wellbeing Wing (former Library on South Corridor)

SJH Recliners

3 recliners in Wellbeing hub / Doctors' Mess in Education Centre

REH Recliners

Recliner for trainee doctors in CAHMS. Bed in ADC.

RHSC Recliners

3 recliners in HAN space

 

Parking

RIE Parking

All parking on the RIE site is now free-of-charge (until September 2020).

Day time: Staff are asked to park in 2C (or if directed to, 2B). This leaves 2A and 1G closest to the hospital entrances available for patients (also free-of-charge).

Night time: Staff are asked to park in the closer car parks (1G, 2A, 2B) to facilitate quicker leave times and morning arrivals to the main staff care park.

WGH Parking

As well as the existing "pass" staff car parks, parks 9 and 7 (around DCN) are now allocated to NHS staff, as is the top storey of the parking beside RVB. Passes are available (via your clinical managers) for Westwoods and Fettes spaces, and the Village Hotel at the Crewe Road roundabout has offered its car park for NHS staff too.

Parking along Carrington Road and other local streets is also available; on-street parking charges were reintroduced in by City of Edinburgh Council on 22 June.

SJH Parking

tbc

RHSC / Central Parking

Local on-street parking charges were reintroduced in by City of Edinburgh Council on 22 June.

 
 

PPE and Infection Control

Current NHS Lothian recommendations for community and hospital based PPE is available here (updated 09-04-20).

An update from PHE and NERVTAG on PPE required for early CPR procedures from 24-04-20 is available here.

As of Monday 29 June, FRSMs are to be worn on the wards at all times and face coverings elsewhere, with maintenance of 2 m social distancing. This follows recommendations from Scottish Government (24-06-20).

COVID-19 transmission (August 2020)

 
 

PPE FAQs

We are grateful to Lindsay Guthrie (Lead Infection Prevention and Control Nurse) for sitting with us and answering questions from NHS Lothian doctors in mid April.

General PPE policies (April 2020)
Face fitting and Sessional use (April 2020)
PPE for resus, nebulisers and theatres (April 2020)
PPE Summary (April 2020)
 
 

Resources and Guidelines

 
 
 
 

FAQs

Answers (as we have them) to questions from our doctors-in-training.

FAQs (26-03-20)

PPE FAQs (April 2020)

Ethics During the COVID-19 Pandemic (May 2020)

Let us know what you need to know on Trickle or by talking to your trainee reps, the ADMEs or anyone else in the MED team.

 

Ways to get in touch

Lothian Trainee and Management Forum

The LTMF is a grouping of trainees, trainers and managers in NHS Lothian, and is a great opportunity to find out what is going on at work and in training, and to raise questions via your representatives.

Please email us to be included in the LTMF mailing list and find out about future meetings. These are currently being held every other Wednesday.

Trickle

Trickle is a new feedback service we have launched for doctors-in-training earlier this year.

Downloadable as an app or through your browser you can raise issues and ask questions relating to your work and training. Trickle lets you see what people are talking about and you can upvote topics for discussion.

More details are here on the Trickle page.

NES

NHS Education for Scotland has FAQs from trainees across the country with information abotu training, exams and the ARCP process.

There is also the NES email hotline checked daily by NES lead deans/managers.

 
 

Other MED Resources

PPE Update (25-03-20)
Simon Edgar (Lothian DME; 22.03.20)
A message to NHS Lothian from Dame Kelly Holmes (08-04-20)
Jason Leitch's message to NHS Lothian doctors in training

National Clinical Advisor, Scottish Government (26-03-20)

Message from Prof Michael West for Lothian doctors in training

Michael is Senior Visiting Fellow at The King’s Fund and Professor at Lancaster University. He has worked with us in NHS Lothian before and shares here his ideas on wellbeing while dealing with COVID-19 (25-03-20)

RHSC Management of Apnoeic Patient - suspected/confirmed COVID-19 (08-04-20)

Produced early April 2020. Supported by NHS Lothian Medical Photography and Edinburgh Children's Hospital Charity. More infomation on RHSC pages.

 
Supporting doctors in training

NHS Lothian published guidance for allocation of DiTs in acute services and are making plans to remobilise to normal training before normal rotations in August.

You can find information on training as well as materials for ACP discussions, online interactive respiratory skills teaching and support sessions.

Keeping safe

The latest information for staff regarding testing and NHS Lothian PPE guidelines are published above (updated 09-04-20).

Looking after yourself

Symptomatic (new continuous cough and/or temperature 37.8° or higher): self-isolate for 7 days. Health care workers can return after this 7 day period when apyrexial for 48 hours (even if ongoing cough).

Household symptomatic: the whole house must isolate for 14 days.

Further advice in the HPS / NHS Lothian occupational health links (including for high/increased risk health conditions and staff testing) above.