On 6th May, the Nightingale hospital London discharged its last patients and went into suspended animation in the sincere hope that it would not be needed again.
“In March, I was contacted by the Nightingale’s Medical Director about setting up pathology support for the first new field hospital being established to help the country deal with COVID-19 patients. Simultaneously, laboratories were already heavily involved in supporting the ‘surge’ of ITU capacity in their own hospitals across the public and private sectors in the UK.
The scale of a 100-acre field hospital was daunting, as was the clinical model for the hospital, which anticipated up to 4,000 ITU ventilated patients to deal with in the worst-case scenario. All diagnostics at the hospital were to be highly protocol-driven.
As well as biomedical scientists and pathology managers, the pathology workstream included pathology members of the UK Combined Armed Forces.
Those of us who were brought up on episodes of M*A*S*H might have thought that the Armed Forces have fully equipped hospitals and laboratories in cold storage, ready to be erected in a series of khaki tents when required.
With the nearby London City Airport having become RAF Nightingale, Chinook helicopters and C130 Hercules’ flying past, and many in the conference centre dressed in military uniform, this impression was widespread.
Sadly, this is not the case and while the military do have rapidly deployable laboratories they are designed to support small, mobile military hospitals. The Nightingale London would be linked to the electronic patient records at a nearby teaching hospital. So, the pragmatic requirement was for Point of Care Testing in the wards, and specimen reception and emergency blood transfusion on site, with all testing taking place in established laboratories.
The speed of building of the North and South Ward areas, each able to house 2,000 patients, was awe-inspiring. Also, the procurement, installation and verification of integrated Point of Care Testing devices, building of a safe pathology reception and setting up of IT links with off-site hospital laboratories was equally impressive. Initially just black tape marks on the floor near the Eastern Entrance, by the time the first patients were admitted only nine days later this was a well-stocked, functioning, signposted and fully networked specimen reception and a blood fridge. Key among the clinical needs was the blood gas meters to be in place on the wards with clinical staff trained in their use at induction.
On-site staff were needed to book in samples, provide advice and provide Code Red emergency blood transfusion support for the wards. We were able to call on some experienced Medical Laboratory Assistants from the nearby teaching hospital but, not wanting to take staff from already stretched London hospital services, we also looked for volunteers. We were able to bring on board 11 medical students not yet deployed in the COVID effort who lived within travelling distance.
A significant issue for all pathology services is specimen transport. We were extraordinarily lucky that our motorbike couriers, who normally collect cervical screening samples from all over London, were underutilised at the time.
I am very proud that the majority readily volunteered to support the Nightingale London 24/7. Our fully-trained couriers, with appropriately equipped motorbikes, worked 12-hour shifts to collect from the Nightingale dropping off at the teaching hospital laboratories every 30 minutes without fail.
Along with the specimen reception staff, biomedical and clinical scientists and supervising consultants, these couriers ensured timely pathology services for the field hospital’s critically ill patients.
HSL was privileged to be part of this project which was delivered with such momentum by people volunteering to work towards a common goal.”