F Guide to Cheltenham General Hospital by MikeJenny

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									                 F2 Guide to Cheltenham General Hospital 2009


F2 Guide to Cheltenham General Hospital



A bit of general info….

Hi and welcome to Cheltenham General Hospital, this is a very brief guide to most of the different
specialties in which F2s work.



The mess is located to the right of the college road entrance (the one with the pillars), or near to the
oncology unit if you’re in the hospital, near to the library. The code for the door is 315, and this also
opens the door in from the outside. Normally quite a few mess meals, balls etc on top of the usual
monthly mess party, which generally ends up at Subtone, even if it doesn’t start there!

On call rooms are located through the mess, but there’s a lot of change happening at the moment,
so they may not exist for long next year. There is an on call room for the ortho/surgical SHO and the
oncology SHO overnight, but not the MAU SHO (who’s generally tied up on MAU all night anyway!)

The code for the library is (we think) C642Y, but in case it changes, it’s always written up on the
board in the mess. Computers available 24/7.

To bleep… 80 – number to bleep – number calling from

Bleep for haematology technician = 1551

Bleep for biochemistry technician = 1589

The blood gas machine is situated in A&E resus. You won’t get a code unless you work in A&E, so you
have to find a friendly looking nurse and ask them to run it for you. You can also ask a passing porter
to take it downstairs for you, or from MAU the HCAs often have codes and will take them down for
you also.

XR is located on the first floor (above a&E, below mau) so take all requests for USS/XR/MRI etc here
to the secretaries. CT is in the A&E x-ray department on the ground floor, so take CT requests here. If
urgent, find an on call radiologist (wither in CT dept, or in the offices at the back of main XR) and
discuss, otherwise, there’s a slot in the CT room where you can put requests.

The intranet is great for local policies, especially the antibiotic and other drug guidelines. Look under
the A to Z for antibiotic guidelines, and you can access all of the other guidelines
(DKA/hyperkalaemia etc.) through here or the pharmacy website.

There are night nurse practitioners on overnight and they act to support the F1s on medical ward
cover, and take a lot of the workload off of you, especially if you’re on orthopaedic/surgical nights
when in theory all calls from the wards should be triaged by the night nurse practitioner first.

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                  F2 Guide to Cheltenham General Hospital 2009


SPECIALTIES/JOBS

A&E (Or the ‘ED’ as it’s now officially called)

There’s a brilliant 2 day course for induction at the start of every 3 month placement in A&E, run by
the consultants and registrars. It will give you all you need to know to start off in the ED, especially
Xrays, paediatrics, trauma, head injury guidelines and the common conditions seen, as well as giving
you a chance to ask about anything you’re worried about. Lots of interactive and hands on sessions,
and a great lunch both days! It’s normally held in the Sandford Education Centre, but you’ll be
emailed with details. You can also find the CGH ED guidelines on most of the computers in the ED,
and on the intranet. Sam (Dr Loffhagens secretary) is a great port of call if you have any rota/leave
probs – she’ll be found at the back of A&E in the office near to the staff room. Code for the staff
room 12340.

The shifts can be pretty antisocial – lots of evenings and weekends, and nights about once every 6
weeks (shift vary, 8-6/3-12/6-2/10-8, with longer shifts at the weekend). Last year we were alone
over night from 2-8, but from August there should be a middle grade on with you. If you’re ever on
your own over night, the sisters and nurses are a great source of information as they’ve seen just
about everything once, or you can call the registrar at Gloucester. If you need to arrange a CT head
for a head injury patient (that’s the only thing you CT from the ED, everything else goes to the
medics), you need to have consultant approval, so this may mean calling them in the middle of the
night (see NICE guidelines for head injuries). Listen to the sisters on this – if they’re worried about
someone with a head injury, its worth calling the reg at GRH and/or the consultant to talk this
through. Consultants are around during office hours , and are ‘on the shop floor’ so will keep
checking that you’re sorting your patients out properly! They’re all very nice, and keen to teach, so
ask if you’re not sure (which will be frequently at first).

The ED is split into resus, majors and minors (including an eye room and a paeds room). CAS cards
from both majors and minors are triaged by one of the nurses and placed in order of severity/time
on the rack in the doctors office. Traffic light system of orange (eg chest pain – see urgently), yellow
and green to guide you. If there’s a patient expected in resus, one of the nurses will let you know
and you normally wait in resus for the patient to arrive. To refer to MAU bleep 1617, bleep held by
the sister so you’ll need to tell them only presenting complaint and patient details. To refer to any
other specialty, bleep the SHO/F1 – list of numbers up on the wall in the doctors offive.

It’s a really friendly team of doctors and nurses, and the emphasis is on learning/teaching. If you’re
uncertain of a diagnosis, just ask someone to review your patient. There’s a weekly teaching session
for all juniors on Fridays at 4pm – varied topics, and you can put in requests if you want a particular
topic. You’re expected to go to this even if you’re on the 6-2 shift, but won’t have to start work until
6pm. It’s a great place to have a go at lots of practical procedures e.g. joint manipulations/ suturing/
local anaesthetics if you’re keen!

GP


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                 F2 Guide to Cheltenham General Hospital 2009


This rotation very much varies on the practise that you are placed at, but you’re supernumerary, so
should be working normal office hours.

As an F2 with prescribing rights, you generally have your own clinics after a few days of sitting in
with the partners and work your consultation time down to 15-20 minutes per patient. You may also
be asked to do telephone triage, home visits or swine flu triage, but usually at a pace to suit you.

You’ll be informed of you placement, and its best to phone the surgery a few weeks ahead of time to
organise the first day and if you have any particular requests for your time with the GP.

ITU

TO FOLLOW

MAU

From August 2009 ‘Utopia’ is planned, which will change the medical and surgical admissions
process, but we’ve included the old system in case utopia isn’t quite up and running.

On day 1 go to MAU and make yourself known to the nursing staff/consultants. If you’re starting on
days arrive for 8am, twilights for 3pm and nights 9pm at MAU reception. Handovers are 9am and
9pm.

There are 6 MAU SHOs, so you work a 1 in 3 rota of days or twilights/nights/week off. There are 2
consultants who run the unit, Dr Hauser and Dr Kerry. Days run from 8-4 and begin with a ward
round initially covering the night take patients, before a handover at 9 in the staffroom on MAU. You
then finish the ward round or clerk new admissions (either from GP or from A&E directly) with
registrar support on hand if you need it. You also cover the DVT service, which just involves clerking
?DVT patients and then following the DVT algorithm re. treatment and further investigation, packs
are found on the desk at reception. There are also 1 or 2 F1s on during the day, and an evening SHO
from 5pm. Twilights run from 3pm to 9.30pm.

As an F2 on nights you cover either MAU for admissions and ward work, or you cover orthopaedics
and surgery for all admissions and ward cover. If you’re on MAU, nights run from 9-9.30 and you
hold the crash bleep. If you’re on surgical nights, they run from 9-8.30. You need to handover to the
surgical registrar, and then attend the trauma meeting from orthopaedics from 8am in orthopaedic
theatres recovery.

This is a good job to get your DOPS/MiniCEX etc done if you can find a few minutes free with a
registrar, as you get to do a few procedures e.g. LPs/chest drains/ascetic drains etc.

MAU Useful Bits

Hope this is helpful – it’s just a few things I found useful to know when I started. Some sound
obvious but are things commonly missed (and therefore we get our ears chewed off – very kindly- by
the bosses!)
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                  F2 Guide to Cheltenham General Hospital 2009


The Unit

It is busy and chaotic but people are very friendly and will help. There’s lots of support – just ask. It
can feel like you have been thrown into the deep end at first but it really is just a case of finding your
feet and ignoring the chaos– and I hope this will help. This is a great place to learn – but you will
have to be proactive in getting everything you can out of it.

F1 Shifts

8 – 3.00        Post Take ward round. In the first few weeks you’ll start off clerking during this shift
                until you find your feet.

1.30 – 9.00     Clerking

3.30 – 9.00     Clerking. Take crash bleep at 5pm

9.00 – 5.00     Short Stay Unit. Carry Crash Bleep

F2 Shifts

8 – 4.00        Post Take ward Round for first few weeks then Clerking after that

3.00 – 9.00     Clerking

And also the night shift – they are honestly not too bad!

Post Take Ward Round – like any other WR

1) Ensure Take list updated with where patients are. Make a list of the Post Post take patients i.e
those on MAU that will not be seen on the PTWR – give to Day SpR to see

2) There is a handover meeting at 9am for In reach/ Diabetes input/ resp input and so night team
can handover any pts not yet seen on PTWR and go to bed!

3) Fill in all parts to the PTWR sheet esp diagnosis and investigations seen helps when doing d/c
                    summary’s.

4) Do jobs generated from PTWR. Please mark with a when things are requested and fill in
                completely when you’ve seen the result. With the high turn-over in the department
                it’s important everyone knows what’s been done and what’s left to do – one patient
                had 2 CTs for same question!

5) Take all request forms on light box in Bay A to appropriate departments. If possible do this before
                 10am.

6) If there are any outstanding requests/jobs you have been unable to complete before the patient
moves to the ward let the team on the receiving ward know so that they can chase these up.


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                F2 Guide to Cheltenham General Hospital 2009


Clerking

   1) Patients are referred to the lead nurse. Some come via the SpR on call.
      They get written in the purple book which lives at the ward clerk’s desk.

   2) It is your responsibility to transfer their names from the purple book to the white paper take
      list and to write their arrival time so check the book regularly. This is the only way you know
      who is waiting to be seen, who is expected and in what order

   3) Clerk in order of EWS then admission time unless someone has been highlighted to you as
      being unwell. Write your name on the white take sheet next to the patient you are seeing
      so nursing staff know who to direct questions at.

   4) Use the Acute Assessment proforma (JAMAR) to clerk patients except when there is a
      suspected GI bleed then fill in the GI proforma.

   5) For stroke fill in stroke proforma. This only contains the neuro exam and risk factors, so rest
      of clerking needs to go in Acute Assessment Proforma.

   6) There is a white board which should tell you where the pt is and what their EWS is. It has not
      been 100% successful so far so if you note it has not been updated inform the lead nurse
      kindly. This is where we should be able to see who is sick by their EWS.

   7) Again mark what things have been requested and what has been seen             within the
      clerking to prevent duplication. Put requests on the light box in A bay and they will be taken
      down the next day.

   8) Write down on take sheets patients that may be suitable for In-Reach/ diabetes specialist
      nurse/ COPD outreach review so that they can be flagger up to relevant nurses at handover
      the next day.

   9) Also on the white take sheet mark when bloods and CXR have been requested and seen
      using the same format. Put a cross through these if they are not needed so that the night
      team knows not to chase up these results.

   10) Endoscopy referrals need to be faxed to endoscopy (number at the bottom of the request
       sheet). The patient needs to be consented at the same time as you fax the referral as they
       move quickly and you won’t want them to miss their slot.

   11) Carotid dopplers go on a yellow form and get faxed to 2901. On each form that you fax write
       date and time of fax and then put on light box so that form can go down to appropriate
       department.


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                 F2 Guide to Cheltenham General Hospital 2009


    12) All F1 clerkings get reviewed by an SpR.
        If a patient is moved off the ward or to be d/c home they need to be seen by a Consultant or
        SpR first.

    13) There is a MAU technician available during the day (Carole / Gill / Teresa). They do all the
        obs and ECGs for new patients. They can all take blood and insert cannulas if asked nicely
        however their priority is to do obs and ECGs so if they are too busy they will refuse.

    14) If you start a new drug you want the patient to have prior to the next drug round you need
        to let the nurse looking after them know especially with antibiotics which your should write
        up and ask to be given ASAP

    15) You need to check bloods and CXRs ordered for the patients you have clerked. Hand over
        any that need chasing to a member of the team that is staying on. The night team will check
        any remaining bloods still not back from the day however this will only be when they get a
        chance so if you are worried about a patient pass it on to a colleague for more urgent
        review.


Night Shift
Handover at 9pm – this when you should be told about sick patients and jobs that are left over to do
– (trop T after Trop T after Trop T plus the odd set of bloods and CXR to review)

At 7 ish Fill in white take sheet with patient location ready for PTWR

Post Take WR from 8-9am

9am attend handover meeting – handover any pts not seen on PTWR /jobs/ concerns – and a bit of
work related chit chat!

9.30am Home to bed

One F2 covers Medicine. The other ortho and surg. Decide amongst yourselves who does what
when. See the MAU induction pack for more info on night cover for ortho/surg. (ortho isn’t too bad
either – most things A&E sort – and most things can go in a plaster/ NBM/ fragmin [not for spinal
injuries] and wait til the morning to be sorted. I’ve been told – trauma’s/open injuries/ dislocations
that A&E cannot get back in position and young hip fractures – then call SpR – but ask them what
they want to be called about when you start your shift. Ortho are not on site but the SpR’s are all
very nice and approachable – and like everything else – if you are not sure – look in a book and ask!)

Other Bits

Bioconneters need to go on all cannulas

X ray requests are placed in the blue box located on the nursing station. Write the time of request
for the ongoing audit. They are done when the nurses and A&E are free to do them. If you need one


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                 F2 Guide to Cheltenham General Hospital 2009


done more urgently than “when they can” tell the nurse in charge and they will arrange a shorter
wait.

ABG’s – fill in a biochem request form and put a sticky around the ABG syringe and then call a porter
using the radio and kindly ask them to take an ABG down to A+E. Some of the HCA’s are able to use
the ABG machine so you can ask them too.

There is weekly teaching every Monday – look at email to find out when you are presenting.

Discharge Summeries and TTO’s

If you don’t hate them already you will do by the end of MAU.

Good news - A full TTO does not need to be done! If a patient is going home with new meds just sign
the TTO part on the drug chart so that the chart can go to pharmacy and be completed.

The turnover is high so there are always endless summeries to do. We still need to meet the three
day rule.
D/C summeries waiting to be done are kept on a shelf in A bay
Please look at drug chart as well to see if there are any changes to meds. If so please complete a
TTO just writing which drugs are new and which have been stopped and why.
Request investigations and o/p appointment if not already done so.
Once done please save, generate and SEND summary.

Obs & Gynae

A really friendly and supportive specialty – the main port of call is Karen Longmate (ext 2361), Mr
Hayman’s secretary. There are also 2 gynae nurse practitioners who’ll guide you through early
pregnancy clinic, guidelines and gynae on call.

On day one go to see Karen (in the admin corridor of St Pauls wing) at 8.30am where you’ll be given
details of departmental induction (lots more info in this pack!)

Your time is divided up as gynae on call, early pregnancy clinic (variable per week), delivery suite and
gynae reg review, antenatal and gynae clinics.

On calls as an F2 are about 1:5 but no night shifts (hooray!). When you’re on call you start with the
consultant lead gynae ward round (8.30 am – currently Avening, but this will change as the
department moves around), with the rest of the day spent covering the gynae inpatients and any
admissions. You don’t cover delivery suite when on day on call and have a covering registrar. If you
are on call in the evening, you cover both obs and gynae, again with a covering registrar.

Early pregnancy clinic (EPA) starts at 8am in the antenatal clinic. You need to collect the EPA folder
from the gynae nurse practitioners office prior to this. Initially you’ll be doing joint clinics with the
nurse practitioners, just until you find your feet. You are also responsible for doing the EPA discharge
summaries on infoflex (there is a tick box system to make this easier).

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                 F2 Guide to Cheltenham General Hospital 2009


Gynae reg review clinic starts at 2-3pm and usually follows on from your EPA mornings. You are
responsible for holding the EPA bleep during this time. The on call gynae registrar will see all patients
either with you or after you.

Delivery suite (‘CDS’)duties start with doing the post natal reviews. Not all post natal patients need
review, but those that do will have a red tag in the notes identifying them from the midwives. At any
time you may be called to assist with the C-sections so it’s worth being in scrubs whilst you’re on for
delivery suite. You will be assisting during all elective C-sections, which usually occur in the
mornings, but may run late dependent on extra emergency slots. You may also be called by the
maternity assessment centre (MAC) which is on the antenatal ward and is midwife lead (seeing
women for antenatal reviews).

Oncology

There is a 1 day oncology induction at the start of your rotation to explain rotas/duties etc. Induction
was previously in Sandford Education Centre, but you’ll be e-mailed to confirm.

As an F2 you’re assigned to either Lillybrook or Rencombe ward for 2-3 week blocks at a time. You’re
responsible (with an F1/F2/SHO – variable on a weekly basis) for day to day running of the ward
including elective admissions e.g. chemotherapy.

Every morning there is a morning meeting starting at 9am (location has recently changed – check at
induction) where a duty consultant will run through all of the patients with you to
troubleshoot/handover.

Consultant ward rounds are very variable – you’ll go round with them if you’re on the ward, or they
may do ward rounds on their own. Consultants are all really approachable, so you can feel
comfortable in approaching them about any issue regarding patient management. There are a few
registrars attached to the oncology team, but they’re rarely on the wards as they cover clinics
instead.

On calls mainly revolve around the (oncology and haematology) chemotherapy helpline, to which
patients have open access. This is staffed by a senior nurse on the wards and they may bring people
in for you to see and assess if they have any concerns. The most common presenting complaint is
pyrexia in patients on chemotherapy, but you will also see people admitted from clinic/a&e. You
usually do 1 on call per week, but every 6 weeks you’ll do Tuesday, then Friday/Saturday/Sunday on
call. There are no days off in lieu after this.

Around once per week you’re on call for radiotherapy. This covers all the outpatient radiotherapy
patients in the hospital that day and you’ll be called to assess them if they become unwell or require
analgesia etc.

On nights you cover both of the wards and the helpline, and see any new admissions. There is no
registrar overnight, so your senior cover is a consultant working from home.


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                  F2 Guide to Cheltenham General Hospital 2009


Strict rules over touching/taking bloods from lines – nursing only tasks, you need appropriate
training before you’re allowed near any lines and as a rule you won’t get onto a training course in
your 3 month block. You don’t normally have any role in prescribing or giving the chemo to patients,
as this again is consultant/nurse lead.

Orthopaedics

Again, there should be an induction on the first day, but watch out for an e-mail for directions of
where to go on day 1.

Every morning begins with a trauma meeting at 8am in orthopaedic theatres recovery. Cases from
the previous day are discussed and it’s useful to have a record of any ‘left over’
emergencies/traumas from the previous days on call which are yet to go to theatre. You’re expected
to know about them and give the trauma meeting a summary of the case.

You’re also supposed to go to orthopaedic admissions suite around the same time (split the team) to
begin marking patients and to write drug charts. In reality, teams often wait until the patients come
up to the wards to do this.

All of the junior doctors (F1-ST2) are on the same rota and perform the same level of duties. You’re
split into 3 teams, A, B and C. Each team does 1-2 on calls per week (9am to 9.30pm) but your on call
days are split into an early and late shift, so two people from the team will cover each on call day
(e.g. morning/evening, with afternoon overlap). When you finish your on call at 9pm, you need to go
to MAU to hand over to the night SHO. You do get quite a few afternoons off for theatre
time/clinics/private study, but you have to organise these yourself, so be as keen as you want to!

You do 1:6 weekends on call and no nights, as these are covered by the night MAU SHO.

When you’re on call, you take GP calls (tell them to send them to A&E as an orthopaedic expected
patient) and see referred from A&E.

The rest of the week is taken up with SHO ward rounds (consultants/registrars will do ward rounds
once or twice a week). Most of orthopaedics is routine elective surgery, with the occasional trauma
from on calls. There’s always a registrar on call for orthopaedic cover, but medical problems arising
on the wards are normally dealt with at the SHO level.




Paediatrics

A very well supervised job with teaching most mornings before ward rounds. You’re based mainly in
Gloucester, but will have occasional days in CGH on Battledown ward (open in the daytime only).

There is an induction day early in the rotation which you’ll be sent details of prior to starting.

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                 F2 Guide to Cheltenham General Hospital 2009


In Gloucester there will always be one SHO on a long day and one or more on a short day with an
additional SHO coming in for a twilight shift. When on a short day, you may need to carry the
paediatric assessment unit (PAU) bleep and are responsible for seeing new patients before registrar
review. The registrars then decide if the patient requires admission.

Nights are in blocks of 3 or 4 and you have 2 or 3 sets during your 3 months rotation.

There is a strong team work ethic and everybody cross covers various roles to get the jobs done.

You’ll learn to take bloods and cannulate children and are responsible for all of the discharge
summaries (and there’s a high turnover of children)

Psychiatry

As ever, a nice friendly rotation based at Wotton Lawn Hospital on the GRH site. You’ll be working in
a firm for one specific consultant on 1 or 2 wards and may or may not have a registrar linked to your
team.

On day 1 (and some of 2!) there is an induction session where you’ll be told about your rota, duties
etc. but in summary…

Get in touch with your consultants secretary early on – they will be able to help you with lots of
paperwork issues e.g. discharge summaries (every consultant has they’re own likes and dislikes on
these) and also tracking down your seniors when you have a problem!

During the day you’ll be based on your own ward (nb Kingsholm and Dean are now male and female
segregated, so if you work for one of these consultants (Dr Fear or Dr Undrill) then you’ll be split
between the two) and cover day-to-day running of the ward, as well as clerking any of your own new
patients. There are generally ward rounds with the consultant (or registrar) two to three times a
week. These are ‘paper’ ward rounds only, and tend to be informal and involve a lot of tea and
biscuits. As you only have 6-12 quite long stay patients, you can get to know they’re histories quite
well so no excuses for not being clued up on the ward rounds.

Day to day problems on the psych wards tend to be quite minor, and you act more as a GP for your
patients, although you’ll also be called for medical or psychiatric emergencies, but in the latter your
role is post restraint checks rather than involvement in the ‘C&R’ (control and restraint) itself. You
may also have patients on the psychiatric intensive care unit (PICU). This is a locked ward and covers
the more unwell or high risk patients. If you do have a patient on there, it’s worth going once every
day, or a phone call at least, as there are no dedicated doctors on PICU.

On call is split into days and nights. Day on call covers inpatients only for emergencies, and cover of
wards where they’re own team doctor is not on site that day. You also cover Montpelier, the
forensic unit, as they often have no junior cover, but you aren’t called here often. Handover at 9 am
and 5 pm is very informal and is between the SHOs, held either on Priory ward, or by arrangement in
the doctors mess in Wotton Lawn. Day on call tends not to be that busy, but you may end up

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clerking an extra patient or two if people are away. There are only 5 SHOs to cover this, so you
generally do one per week. The rota is sorted out by the SHOs so it’s very flexible if you need days
off etc.

Night on call runs from 5pm to 9am and covers inpatients at Wotton Lawn, Charlton Lane, Holly
House, Branchlea Cross and a few others. Very variable in work load, some nights you’ll only be
called in to rewrite a zopiclone, and others you’ll have 6 admissions spread over the sites. If patients
sound very unwell (medically) when you’re called, ask the nursing staff to call a 999 ambulance as
there are very medical facilities at the hospital for fluids/O2 etc. After your on call, you’ll work the
morning at your usual ward job but have the afternoon from 1pm off in lieu.

At the weekend you cover 9am to 9am, and handover is by arrangement, either in Wotton Lawn, or
(as last year), if most people live in Cheltenham, then you can hand over at your/their house. You’ll
be called in for the inevitable round of ward jobs/prescriptions/reviews etc. so it’s probably worth
heading to Wotton Lawn early to do a sweep of the wards. You really need a car for this job as the
sites are both Gloucester and Cheltenham. You don’t get an afternoon off if you work Friday or
Saturday night.

Often, if you haven’t had lots of new admissions, you won’t be too busy during the day, so generally
get to teaching etc. and can spend a bit of time revising for exams etc.




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       Cheltenham                    Sandford Road                                                                                                               Sandford Road
        College


                Off Sandford Road for                                      Off Keynsham Road for                                                                                             Off College Road for St Luke's
            P 1 East Block and West Block P 3 the Oncology Centre                        Keynsham        for
                                                                              P 4 OffPaul's Wing RoadCentre Block P 5 Wing and College Road Wing
                                                                                     St             and

            P Parking is provided on a 'pay on foot' basis Dropping-off is free for 20 minutes at designated drop-off points at all principle building entrances


                                                                    Directory of Wards and Departments
                                                        Building   Floor                                                                            Building   Floor                                               Building    Floor

          Admissions Office                                WB      UG                          Hartpury Suite                                           CR  L2                 Speech & Language Therapy              WB        UG
          Alexandra House                                  CB      All                         Hazleton Ward                                            WB 2nd                 Stoma Care Clinic                      WB UG
          Alstone Ward                                     CR      L4                          Hereford Suite                                           OC 2nd                 Surgical Admissions Unit (SAU)         CB 2nd
          Antenatal Clinic                                 SP      L1                          Highworth Clinic                                         WB UG                  Therapy Unit                           WB        LG
          Appliance Office/Orthotics                       SP      L1                          Intensive Care Unit (ICU)                                CB 1st                 Thoracic Clinic                        WB         G
          Aspen Unit                                       SL      L3                          Kemerton Ward                                            CB 1st                 Tivoli Ward                            CB        G
          Audiology                                        EB       G                          Knightsbridge Ward                                       SL L4                  Vascular Laboratory                    WB       UG
          Avening Ward and Annexe                          CB       G                          Lansdown Suite                                           CB G                   West Block Out Patients                WB G
          Battledown Ward                                  CR      L2                          Lilleybrook Ward                                         OC  G                  Wheelchair Assessment                  SP  G
          Benhall Clinic                                   WB      UG                          Lung Function                                            WB 2nd                 Withington Suite                       WB 2nd
          Bereavement Office                               WB      UG                          Maxillofacial & Orthodontics                             EB  G                  Woodmancote Ward                       SL L3
          Bibury Ward                                      SP      1st                         Medical Assessment Unit (MAU)                            CR L3                  Worcester Suite                        OC OC
          Blood Tests                                      WB       G                          Medical Photography                                      CB G                   X-Ray & Radiology                      CR L2
fold      Breast Care Clinic                               WB      UG                          Montpellier Ward                                         CR L3                                                                           fold
          Cardiac Out Patients                             WB      2nd                         MRI Scanner                                              CR     L1
          Cardiac Ward &                                                                       Neutropaenic Unit                                        OC     1st
                                                           SL       L2
          Coronary Care Unit (CCU)                                                             Nuclear Medicine                                         OC     1st
          Chapel                                         WB UG                                 Ophthalmology (Eye Clinics)                              EB      G
          Chedworth Suite                                CB 1st                                Optometry & Orthoptics                                   EB      G                        Key to abbreviations
          Chedworth Suite Annexe                         OC 1st                                Orthopaedic Admissions Unit                              SP      G              CB        Centre Block
          Colesbourne Clinic                             WB UG                                 Orthopaedic/Fracture Clinic                              CR      L1             CR        College Road Wing
          Cranham Suite                                  SL L4                                 Orthotic Department                                      CR     L1              EB        East Block
          Delivery Unit                                  SP 2nd                                Pacemaker Clinic                                         WB     LG              OC        Oncology Centre
          Dermatology                                    WB 1st                                Pain Clinic Office                                       CB     1st             SL        St Luke's Wing
          Diabetic Clinic                                WB G                                  Palliative Care Office                                   OC     1st             SP        St Paul's Wing
          Dietician/Dietetics                            WB G                                  Pamington Suite                                          CB      G              WB        West Block
          Dixton Ward                                    CR L3                                 Pharmacy                                                 WB     LG              LINC      The Leukaemia and Intensive
          Ear, Nose & Throat (ENT)                       EB  G                                 Prescott Ward                                            CB 2nd                           Chemotherapy Fund
          East Block Out Patients                        EB  G                                 Prestbury Clinic                                         WB 1st                 LG        Lower Ground
          Emergency Department (A&E)                     CR L1                                 Radiotherapy                                             OC G                    G        Ground
          Eye Clinic                                       EB       G                          Rendcomb Ward & Side Rooms                               OC     1st             UG        Upper Ground
          Eyford Day Unit                                  EB      2nd                         Restaurants:            'Blue Spa Cafe'                  WB     UG              1st       First floor
          Fairview Ward                                    EB 1st                                                   'Glasshouse Cafe'                   SP     G               2nd       Second floor
          Family Planning Clinic                           SP L1                               Retail unit:               Newsagent,                                            L1       Level One
                                                                                                                       General & Gifts                  SL     L2
          General Medicine (Out Patients)                  WB G                                                                                                                 L2       Level Two
          General Office                                   WB UG                               Snowshill Ward                                           SP     1st              L3       Level Three
          Guiting Ward                                     CB 2nd                              Special Care Baby Unit (SCBU)                            SP     2nd              L4       Level Four
                                                                                                                                                                                                                              0109 v1

								
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