The heart of the hospital

Dr Chris McKenna, Acute Admissions - Victoria Hospital, Kirkcaldy
Dr Chris McKenna, Acute Admissions - Victoria Hospital, Kirkcaldy

Working in one of the busiest hospital wards in the country does not come without its pressures, as the staff in acute admissions 1 at Kirkcaldy’s Victoria Hospital are the first to admit.

But when they get the job done and do it well, it brings with it huge job satisfaction – and that is something they are striving to improve on, with results already being noticed.

Staff Nurse Sam Coull takes patient Asif Rana's blood pressure

Staff Nurse Sam Coull takes patient Asif Rana's blood pressure

It’s just nine months since the service moved from being spread over two hospital sites to the new wing at the Vic, and although initial teething troubles, coupled with a busier than usual winter caused some problems for staff and patients, the existing 80 staff say things have now settled down and feedback from patients and relatives over the past few months has been very encouraging.

The 44-bed ward, which is divided into two sections, deals with between 250 and 300 seriously ill patients each week, and that doesn’t take into account the 10 people a day seen in the ward’s assessment bay.


Dr Chris McKenna (34), one of the unit’s consultant acute physicians, is currently undertaking a year long course through the Institute for Healthcare Improvement in Boston to help quality improvement in his field, and is already implementing some of his ideas.

One of the main areas of improvement has been in GP referrals, where, if a doctor believes his patient’s ailment needs urgent investigation, they will call and speak to a clinical co-ordinator who will take details of the patient and the reason for referral.

If they meet criteria they will be brought into the admissions unit’s assessment area, otherwise they are admitted directly into the ward.

There they are met by a staff nurse like Sam Coull (pictured), one of the dedicated team, who will carry out initial observations such as blood pressure and heart rate and take routine blood tests.


Patients are then reviewed by a senior doctor who will perform a thorough assessment, arrange further tests and, where needed, prescribe treatment.

“We are here to ensure that patients who need further investigation and treatment are given it in a timely manner and in the most appropriate environment – so that they are not kept in hospital any longer than they need to be,” explained Dr McKenna.

“For example if someone comes in with a serious skin infection such as cellulitis they can be given antibiotics intravenously then sent home to come back over the next few days for further treatment.”

Some of the most common reasons for GP referrals to the medical assessment area include chest pains or palpitations, respiratory difficulties, blood clots and severe headaches.

“Sometimes we will not know immediately what is wrong with a person and it can take some time for us to diagnose their condition, so our job is a bit like a detective where we have to put the pieces of the puzzle together to work out what is wrong with someone, and that can often require specialist help,” said Dr McKenna.

“We have an excellent service from our ECG, radiology and laboratory departments here at the Victoria which makes it easier to run a smooth, efficient and patient-centred department, allowing the team of consultants to make informed decisions.”

Dr Laura Clark (35), a consultant acute physician and kidney specialist, said the assessment unit was striving to meet national guidelines and see and manage patients within four hours.

“Two consultant physicians are available all day every day on the admissions unit with one consultant on call overnight, ensuring that patients receive early senior clinical review and decision-making,” she explained.