Aintree Chest Centre
Introduction
The Aintree Chest Centre is one of the largest chest units in the country. It provides a very wide range of diagnostic tests and treatments for all types of chest and lung disorders, and in addition it performs research that aims to find better treatments and ways to deliver those treatments.
The types of conditions that can be treated range from acute pneumonias to chronic chest complaints and from tuberculosis to lung cancer. The department aims to give patients on our unit the highest standard of care at all times and to make their stay with us as comfortable as possible.
We work as a multi-disciplinary team (doctors, nurses, physiotherapists, lung function technicians, managers and secretaries) who together provide an immediate emergency service for acute chest problems as well as a wide range of highly specialised services that we believe to be as expert as any in the country. And the unit joins with the other specialists in the hospital to ensure that each patient is provided with up to date and appropriate care.
Each of the 10 consultants (details below) is a fully accredited specialist in both respiratory and general medicine and in addition each has particular expertise in one or more specific diseases. The combination of seeing large numbers of patients and being active in researching new and better treatments has meant that over the last 25 years, many of the consultants are national or international experts (see more under entries for each consultant below) and indeed many national initiatives have been developed from work led from Aintree .
Aintree is a University hospital and the Chest Centre includes a University Department of the University of Liverpool Medical School. We have three Professors and one Senior Lecturer who are University employees, the remainder of the consultants also have honorary attachments at the University. This means that we investigate aspects of the lung diseases our patients have as well as treating them. We strongly believe that treatments for lung disease will only improve if research is done in this way, and are fully committed to this. Some patients may occasionally be asked to be involved in such research projects, however any research project will be fully explained both verbally and in writing and participation is entirely voluntary.
The unit teaches medical students and nurses and trains younger doctors to be the consultant specialists of the future. And the unit runs seminars, contributes to conferences and supports developments in education and healthcare policy at local, national and international levels.
Our consultants are known nationally for their work in setting clinical standards and their contribution to national organisations and policy making. Doctors come from around the World to spend time with us in the Chest Centre because of our reputation for excellence in clinical standards and in research.
Our nursing services are also first class and for the last 3 years have been accredited as a “Practice Development Unit” – a Department of Health supported initiative that recognises the unit’s ability to be an example to others. In part this is achieved by putting in place systems that ensure that the day to day care given to patients is in line or exceeds national guidelines for best respiratory care.
Above all the department aims to offers a service to people that is
We are keen to encourage current and former patients/relatives to let us know how our service for them could be improved. Four times a year we hold meetings of the Hot Air Group where patient representatives, consultants and staff talk through issues and concerns regarding patient care. And we are always happy to discuss specific issues with patients and relatives as they arise. This should be arranged with the relevant consultant’s secretary or with the ward nursing staff.
Services provided
Outpatient services
The unit runs 22 clinics each week of which 9 are for general chest referrals (especially when the full diagnosis is not yet clear) and 13 are for particular conditions. We have specialist clinics for patients with lung cancer, difficult asthma, tuberculosis, sleep disorders, non-invasive assisted ventilation, scarring lung diseases, oxygen therapy and occupational lung disease. We have other clinics which manage and support patients with other chronic lung conditions. A lot of our patients have these chronic conditions such as Chronic Obstructive Pulmonary Disease (COPD), asthma and bronchiectasis from which they will never recover and it is our aim to help to maintain their quality of life as well as attending to their medical needs. We do this by close working with our Primary Care partners such as General Practitioners, Community Matrons and the other community respiratory teams.
Most clinics are led by the consultants assisted by junior medical staff, and the remainder are led by our specialist nurses eg for oxygen assessments, asthma followup . Specialist nursing staff ( ie nurses with specific additional training and experience) are becoming increasingly important and their role for example in helping the patients (and their relatives) with cancer by speeding up the tests, explaining what it all means, and addressing individual problems is greatly appreciated.
Getting referred to the unit
Most patients are referred by their general practitioner, some are referred from hospital consultants in other hospitals for specialist opinions and therapies, and the remainder are people admitted with serious acute chest illnesses that require follow on care once the acute problem has been resolved. Most patients come from the surrounding area but the unit gets an increasing number of referrals from much further afield .
In patient services
The unit has 90 inpatient beds on wards 14, 15 and 18 within the main tower block at the University Hospital Aintree (Fazakerley) site. Four are set aside for those with the most severe forms of respiratory failure and who need a more intensive level of care . Each of the 18 bedded units has a team of nurses, physiotherapists, pharmacists, junior doctors and consultants. The beds are in well-lit, well equipped, pleasant wards divided into 5 bed bays (single sex) and single rooms. The nursing stations are centrally placed for effective observation and each bed is provided with access to TV and radio.
Patients may be admitted from the accident and emergency Department, following referral by their GP, or electively after an outpatient consultation.
We know that most people would prefer not to be in hospital and so we do our best to get them better and home as fast as possible but without being too hasty for their medical condition. We have several teams of specialist nurses who link between the wards, outpatients and the community services . Examples include the ACTRITE nurse team for COPD who can help as many as 30% of patients admitted acutely unwell to get home with additional support within 48 hours – a service that has been welcomed by patients and been copied by many others in the UK . Our specialist asthma nurses link with the GP practices to help ensure that ongoing care is consistent. And when things are not curable we have specialist palliative care services that can help make the latter stages of life less difficult.
Diagnostic facilities
We have one of the best equipped lung function laboratories in the country which is sited on ward 14 in the Tower Block. In this facility we are able to study in great detail various aspects of the function of the lung (breathing tests). These are done either at rest or sometimes on exercise. Many of the tests we perform are not available at other hospitals within the North West of England, allowing us to make more specialised diagnoses not possible elsewhere.
The Chest Centre is the regional referral centre for sleep related disorders, hence we see patients from all around the Merseyside area for these problems. In the Sleep Laboratory we are able to study breathing problems during sleep, these tests are either done during an overnight stay in the laboratory, or by a patient taking portable equipment home with them for the night. The Chest Centre is also the regional referral centre for patients who require assistance with their breathing (chronic non-invasive ventilation or NIV).
Using cameras we are able to look into and at the lungs. Using sedation and local anaesthetic we are able to look through the nose or mouth into the larger air passages in the lung (a test called a bronchoscopy ) and inside the chest cavity between the ribs (a test called thoracoscopy ). The Chest Centre is the only hospital in the Merseyside area which offers the thoracoscopy test under local anaesthetic and sedation, traditionally this test has always been done under general anaesthetic by a surgeon.
And we have an excellent Xray department where we can get information about the lung using a variety of different X-ray tests that range from ordinary chest X-rays through to more sophisticated CT, MR and PET scans. Importantly we are large enough to have consultant radiologists who specialise in reporting chest disease tests and so offer a greater expertise than could be available in smaller units.
Consultants
We have 11 consultants (listed below), each with particular skills that they use in special clinics and procedures.
Each consultant combines clinical responsibilities, teaching and research but in varying amounts. Over the past 20 years the Aintree Chest Centre has been one of the top producers of respiratory research in the UK . Many of the ways of treating asthma and COPD have arisen following work first done at Aintree and the unit continues to try to be a leader so our patients are always going to get the most up to date treatments. The listing below is a summary of some of their roles and achievements.
The way in which the consultants have developed their expertise has been by constantly questioning how care is delivered and then setting up research to demonstrate what is best. By publishing the results in national and international scientific journals, their works are recognised and debated beyond the hospital. This means that the staff are constantly in demand to lecture and teach others, and from those meetings are able to be up to date with and bring back to Aintree the latest developments for the benefit of our patients.
1. Dr Chris Warburton is clinical director of the unit (he takes clinical managerial responsibility for the smooth running of the unit) and specialises in lung cancer, occupational lung diseases and fibrosis of the lungs. He has been the lead clinician for the Mersey Regional Lung cancer service and has published papers on occupational lung diseases and on problems of hyperventilation. He sits on National bodies with relation to occupational lung disease and lung cancer. He set up the Rapid Access clinics (for anyone for whom lung cancer is suspected) that are able to see patients and perform the tests for diagnosis within 2 weeks and to get patients to formal treatments (if needed) within 2 months thus meeting all the government targets. (PIC).
2. Rob Angus – has particular expertise in the management of patients who require breathing support machines at home and also runs a clinic for the most difficult asthma patients. He has done research into the most effective ways of managing asthma and is often invited to lecture on national and international meetings about asthma. He is also a founding trustee director of Respiratory Education UK – a national charity set up in 1997 based at Aintree that trains nurses and doctors to be experts in respiratory diseases. ( pic )
3. Prof Peter Calverley has been a leading researcher into COPD (also known as chronic bronchitis or emphysema) for 20 years and is the joint editor of the leading textbook on the subject. He has researched extensively into which treatments work best for COPD and how breathlessness can be eased and is much in demand as an expert speaker at international meetings. His work has led to him being elected President of the British Thoracic Society (2006) and he chairs the national committee set up by Dept of Health to provide the best COPD care across the whole of England .
4. Dr Anne Crowther is a specalist within the acute Medical Admissions Unit of the hospital, who also has particular expertise in respiratory diseases and contributes part time to the ward and clinic care of the Chest centre
5. Dr Lisa Davies has specialised in Chronic Obstructive Lung Deaseases (COPD) and has published nationally recognised research about which drugs work best, how to help patients avoid hospital and how to help patients manage their own care. In addition she oversees the special Oxygen service clinics for the most severely affected patients. She has been the Royal College of Physicians tutor (hospital doctor education) and is now the Regional lead for specialist training. She is also editor of Respiratory Medicine: COPD Update – an international journal about respiratory diseases. that helps ensure that patients are on the right
6. Professor Peter Davies contributes to the general respiratory service but is a world expert on tuberculosis and its effects. He has published many papers and is the editor of the major UK textbook on TB. He has strong links with countries of the developing world where TB is even more of a problem than in the UK .
7. Dr John Earis was for many years the leading physician for the unit but in 2007 has taken the role of Director of Medical Education and University Sub-Dean to the hospital overseeing both postgraduate and undergraduate medical training. He continues to provide an outpatient cough clinic – an area in which he has researched and published extensively.
8. Dr Thomas Jagoe is a university senior lecture who has taken a special interest in the problems of weight loss in patients with cancer and severe diseases. He helps to deliver the special rapid access lung cancer service and has made special contributions to the training and education of the medical staff in the unit.
9. Prof Mike Pearson has a clinical interest in how to look after asthma and COPD and also in patients who hyperventilate ( overbreathe ). In the 1990’s he led the production of national Clinical Guidelines describing what best practice should be and in measuring whether the actual care delivered by a hospital is as good as it should be. He was seconded (part time) to the Royal College of Physicians for 10 years where he produced National guidelines for NICE, and national clinical audits for the Healthcare Commission - that have benefited patient care across the country. He has published and lectured widely on Healthcare Quality. In 2006 he returned full time to Liverpool and is setting up similar national projects on healthcare quality from a Liverpool University base.
10. Dr John O’Reilly has special expertise in the problems of respiratory sleep disorders. This is a growing UK problem that needs specialist tests ( Aintree is the regional centre) and then the provision of special ventilators that can completely relieve the symptoms and transform lives. It is a costly service and as well as needing to be clinically expert, he has to organise and ensure the funding is available. He is a member of the British Sleep Society that develops guidelines on how to do this most effectvely .
11. Dr Paul Walker is the most recently appointed member of the team and has particular expertise and training in the problems of chronic lung diseases. He will be taking over the lead role of the lung cancer team which includes not only the Aintree respiratory team but also the specialists from Clatterbridge (chemotherapy and radiotherapy) and Broadgreen (surgery). The intention is to make the Aintree service even more effective
For more information on the work of our department, call Sue Lowe on 0151 529 2601.
Anyone interested in joining one of the patient support/discussion groups should contact the following
The Hot Air Support group
The local British Lung Foundation BreathEasy group
The Formby Branch of Asthma UK
Contact the department on the above number for contact details.
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Aintree University Hospitals NHS Foundation Trust, Aintree House, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL
Tel: 0151 525 5980|
Fax: 0151 525 6086|
Email: info@aintree.nhs.uk
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