Pilgrim Hospital in Boston

Pilgrim Hospital

On Tuesday, the nursing students and I visited Pilgrim Hospital in Boston. This hospital is run by the Lincolnshire Trust of the NHS. This is the same trust that manages the hospital in Grantham, which is where I went with Grace when she broke her finger. The two hospitals are very different. Grantham hospital originated in 1874, while Pilgrim Hospital was built in 1976. The hospital in Grantham is rather small and seems outdated while Pilgrim is large and their equipment seems newer. There have been many rumors that Grantham Hospital was going to close in the past and people who needed a hospital would have to go to Boston. It is about an hour's drive from here to Boston - so if Grantham Hospital closed, people here would have a fairly long way to go to access acute care.

Many of the units At Pilgrim Hospital have not been renovated since the hospital was built and therefore many of the units are under construction now or have plans to be updated soon. I did not want to seem rude, so I did not take any pictures of the hospital But if you think about what a hospital looked like in the 60's and 70's, you should get a picture of what it was like. 

Ian Hamilton, a nurse who has quite a few nursing managers who report to him, was our trusty guide. I would equate his position to a director's position in the US. Ian used to be a construction worker. He was made redundant (which means he was laid off), so he decided to go back to university and become a nurse. I have met Ian during my previous visits to Pilgrim's. John Rice went with us. John is a physical therapist - which are called physiotherapists here - and we all truly enjoyed our visit. 

Ian began by talking about the NHS and fielded many questions from us. We talked about a wide range of topics including differences and similarities between the UK and US health systems. We talked about malpractice, admission of medical errors, and end of life decisions. We learned that in the UK, medical mistakes are openly admitted. If a hospital has done something wrong and it is sued, the case usually settles out of court. The hospital admits it did something wrong and as long as the person suing asks for 6000 pounds or less, the NHS just pays for the error. Most people here understand that errors occur, however, so he says that there really are not a whole lot of malpractice suits brought before the court. We also learned about how people wait to have a medical concern resolved. Ian explained that if a patient has a nonemergent issue (like a hip that needs replaced due to arthritis) that the patient now is supposed to be seen and have treatment initiated within 18 weeks. Before this rule came into place, people would possibly wait years to have nonemergent problems treated. So things are getting at least somewhat better. It is important to remember that since in the past, it could take 2-3 years to get a hip replaced, the fact that it only takes about 18 weeks now is a huge improvement in the eyes of the British. If the wait is not acceptable, the British have the option of purchasing private health insurance and they can usually be seen quicker.

Nursing students in the main lobby of the hospital

As we walked through the hallways, I think the students were amazed by the hospital's surroundings. Patients are commonly in 4 bed wards at this hospital. Except for the pediatric floor, the private rooms are reserved for people who are infected or people who are dying. The TVs are little - maybe 12" screens - and the patients have to pay to watch TV. Each bed has its own TV and headphones, though, so you never heard the TVs while you walked through the hallways. The beds and equipment were newer, but the physical surroundings were quite dated. Ian and the other nurses frequently mentioned how dated the units looked and they often spoke about plans for remodeling.

We also toured an ICU. The unit we saw had about 8 beds all lined up in one big room along one wall with curtains between the beds. It looked like a skills lab in a nursing school in the US. The flowsheets that the nurses use to document assessment data like vital signs, monitor readings, and intake and output were huge. They were probably 2 1/2 x 3 1/2 feet. I am not a good judge of size, but they were huge. When the flow sheets are filed in the patient's medical record they are folded at least 3 - 4 times so they will fit into the chart. Ian commented that it makes their patients' records quite large. They have not moved to electronic medical records yet but plans to go to electronic documentation are also underway. 

Another interesting place we went to was the OB unit. Babies in the UK are mostly delivered by midwives here. The midwife goes to nursing school and then studies midwifery after qualifying as a nurse. The midwife we spoke with just loved her job. Although the unit had not been remodeled since 1976 when it was built, I got the sense that the patients receive excellent care. Very few women have epidurals at this hospital and usually they keep the laboring mother out of bed. They have a pool that can be used during deliveries and moms will go home anywhere from 6 - 24 hours after birth. Pregnancy and birth are seen as normal healthy events and so the doctors are usually not involved unless the woman has a high risk pregnancy or a problem arises during her labor. What I didn't see were rooms that looked like hotels and a lot of fetal monitoring equipment. I was sad we didn't see a woman in labor. Ian said if we heard screaming we would know that we should not go onto the unit. I thought he was being funny, but after hearing about how most women don't have epidurals, I am not so sure if he wasn't being serious. 

We also toured an orthopedic floor - here was something interesting they did. People with orthopedic emergencies are considered "dirty" cases and those with elective surgeries like joint replacements are considered "clean". Therefore, they have divided the unit in half - the trauma cases are on one side and the "clean" cases are on the other to prevent the spread of infection. The stroke unit has just updated their clinical pathway and we also went to the physiotherapy department. All in all it was a fantastic day. This hospital is huge and we saw quite a bit of it. I am very grateful to Ian and his staff for taking the time out of their busy schedules to talk with us. 

The differences between the health system in the US and the UK are pretty amazing. People here overall are happy with the NHS and they are very proud of it. However, Ian did mention that the younger population is now demanding and wanting more. The only thing we all could agree on is that health care is incredibly complex no matter where you are. All I could think about is what will happen to the US over time. Will our hospitals have to "freeze" in time like the hospitals here have? Will Deaconess, St. Mary's and OSF Saint Francis have to stop expanding and remodeling due to the recent changes we are about to undergo? And if so, will the American public be happy with how their hospitals look in the future? I have no doubt that the people in the hospitals here receive good care. But as Ian said, the environment is really important - even Florence Nightingale recognized the importance of the environment. People feel happier and healthier when their environment is clean and uplifting and they receive compassionate care. All I know is that it is essential for every American, especially those involved in health care, to be politically involved right now. The future of healthcare is uncertain at best. Changes need to be made, but we all need to be involved to ensure that the needs of our patients are being met. It is up to us to make a difference - it is good to be a nurse and it is awesome to have this experience as a nurse at this moment in time :)

My nursing students and me in the lobby