The four watches: a small Island approach to COVID-19 in the emergency department

Jones, Alistair Patel Vishal Wainwright James

BackgroundJersey General Hospital is the largest medical facility in the Channel Islands serving a population of 107,800. Our Emergency Department (ED) is the only one in Jersey and it serves 40,000 attendances per year. We had unique challenges during the COVID-19 lockdown given staffing levels, paucity of resources and disruption of strategic links with the NHS. Cancellation of all water and air links left our hospital extremely vulnerable to staff sickness with the inability to access additional workers from the UK or other hospitals. Additionally, overnight a solitary FY2 and 3 nurses staff the department. To combat this, four Watches were created for safe and sustainable cover over a 24 hour period in ED. We are unaware of any other Emergency department in the UK using a similar Watch model.MethodEach Watch consisted of 1 consultant, 2 middle grades, 2 SHOs, 1 Sister, 6 Nurses, 1 HCA, and 2 receptionists. Over 12 weeks, a rota of 12-hour shifts, three days on, three days off were used. Watches did not meet each other to minimise any spread of COVID-19 with handover solely being consultant to consultant. A survey was sent to all staff after the 12 weeks enquiring how it affected morale, the treatment of critically ill patients and how much sick leave was taken in this period. Fifty of sixty people responded to the survey.ResultsOver 12 weeks not a single day of sick leave or isolation was taken. 84% of responders felt the watch system improved morale. 90% agreed it improved the treatment for critically ill patients. 88% want to return to the Watch system if a second wave of COVID-19 occurred. 86% agreed it improved communication and teamwork. 96% agreed the presence of a senior doctor 24h/day had a positive effect on the running of the department.ConclusionA watch based system improved patient and staff safety whilst simultaneously improving staff morale and teamwork during the first wave of COVID-19 at Jersey General Hospital.