Inside the Ward: An insight into the cogs of Patient care

Have you ever wanted to know what its like to be on ward rounds in an Occupational and Physical therapy hospital?

Bridging Observation with Understanding

Today’s clinical work experience was able to offer me an immersive and all rounded insight into the inner workings of both the on-call doctor’s responsibilities and the daily operations of the nursing department of Royal Buckinghamshire Hospital. As someone aspiring to pursue medicine, this experience provided me with a greater understanding of the roles in the multidisciplinary team, and how they all work together to help provide the best standard of care to patients. Today was a window into the detailed logistical, diagnostic, and interconnected aspects that underpin and determine patient care in a hospital setting.

Split into two distinct halves, my day began by shadowing the doctor on call, which allowed me to gain a first-hand view of patient admission protocols, electronic record systems, along with discharge documentation and filing. The latter focused on the vital, often underestimated, contributions of the nursing team, which revealed the emotional intelligence, and efficiency they needed to manage rehabilitation patients and pharmaceutical stock management.

Diagnostic Investigations During Patient Admission

While shadowing the doctor, I learned about the standard suite of diagnostic tests that are always conducted upon a new inpatient’s arrival to the hospital, prior to full admission. These form a critical baseline from which further clinical decisions may be made if necesary:

• Urine culture – to identify any potential infections or abnormal waste compounds.
• MRSA swab – used for detecting Methicillin-Resistant Staphylococcus aureus, crucial in infection control.
• Thyroid profile – to assess endocrine function, especially for symptoms of fatigue or metabolic irregularities.
• Lipid profile – evaluating cholesterol and triglyceride levels, often relevant in cardiovascular cases.
• Vitamin D levels – frequently checked in cases of musculoskeletal complaints or fatigue.
• HbA1c test – a marker for long-term blood glucose control, especially useful in diabetes monitoring.

While the doctor explained the reasoning behind each of these tests, it helped me understand the systematic and controlled approach that is required to run a successful hospital, and ensure patient and staff safety.

Discharge Documentation and Patient Record keeping

Another critical task I observed was the transcription of patient case details into the hospital’s discharge documentation system. These summaries included some important key data points like:

• Date of Birth (DOB)
• Date and nature of injury
• Diagnosis and admitting consultant
• Social and medical history
• Presenting condition and its progression

This thorough record is vital not only for hospital continuity but also for external communication with general practitioners (GPs) and pharmacists.

An interesting innovation I noted down was the effective use of pre-printed stickers on drug charts to save crucial time. These stickers include the patient’s information and the credentials of the medical professional signing off the medication, eliminating ambiguity caused by illegible handwriting—a simple yet effective solution that enhances accuracy and efficiency, while allowing for more face to face patient time and improving overall care standards.

Electronic Patient Records (EPR) vs. Local Systems: A Cost-Benefit Dilemma

The doctor, who also had experience in other NHS trusts, like Oxford Health NHS foundation and others, where he was able to see the differences between public and private healthcare and how they differ in what EPR systems they use. While 90% of NHS trusts use integrated EPR systems, many private hospitals continue to rely on local databases, due to cost and safety concerns. Setting up and maintaining an EPR requires specialist IT infrastructure and ongoing support, which in most cases is not economically viable for private hospitals.

However this reliance on manual processes and lack of integration with other services means tasks like emailing pharmacies and GPs updated patient prescriptions and information often creates a bottleneck in care coordination. To mitigate this the hospital provides printed copies directly to patients to ensure that vital updates, like medication dosage changes, can reach the appropriate place on time.

Pharmaceutical Stock Management: Manual Logs and Efficiency Gaps

I also had the opportunity to observe how pharmaceutical inventories are managed. Nurses currently document withdrawals from the medicine stock cupboard in a physical logbook, which later must be manually transcribed into a digital spreadsheet—a time-consuming and error-prone process.

I proposed a potential solution involving automation and smart ID:

• Keeping the spreadsheet permanently open on a locked hospital terminal.
• Using ID keyfobs for automatic staff identification and timestamp logging.
• Allowing quick manual entry of only the medication withdrawn.

Mindset in Rehabilitation: Insights from the Nursing Team

One of the most memorable lessons came not from a diagnostic chart, but from a nurse’s wise and empathetic advice regarding patient psychology in rehabilitation settings. She observed that patients in wheelchairs often remain so not solely due to physical limitations, but because of mental barriers.

The emotional landscape of rehabilitation is delicate: when one patient hears another say they’ve seen no progress in six months, it can be deeply demoralising. Nurses frequently remind patients that healing is not a competition—each recovery journey is highly individual, shaped by unique circumstances, medical histories, and personal resilience. This perspective underscored the importance of holistic care, which treats both body and mind.

Clotting Vials and Pre-Surgical Checks

I also observed the use of blood clotting vials, an essential tool in surgical preparation. These tests assess how quickly a patient’s blood coagulates—particularly important for those on anticoagulant therapy. Surgeons may request that such patients temporarily discontinue blood thinners to reduce intraoperative bleeding risks and optimise recovery outcomes. In addition, I was shown the personalised sharps boxes allocated to each patient to ensure safe and hygienic disposal of needles, especially for those undergoing frequent blood draws or injections.

---

A Holistic Glimpse into Healthcare Delivery

Today’s experience offered me a nuanced understanding of both the scientific and human aspects of healthcare delivery. From learning the rationale behind preliminary investigations to recognising systemic inefficiencies in pharmaceutical management, I saw first-hand how every cog in the hospital machinery plays a role in patient wellbeing. Perhaps most profoundly, I witnessed the significance of mindset in healing—an insight that reinforces my motivation to pursue a career in medicine not just as a science, but as a service to humanity.

Today’s work experience was with the Doctor on call, and the Nurse department. The first half I was shadowing the doctor.

I was able to gain a clearer understanding of the base investigations/tests the hospital does before fully admitting a patient to the hospital:

• Urine culture
• MRSA swab for culture
• Throid profile
• Lipid profile
• Vitamin D
• HBA1C

The doctor was also moving the notes about the Urology and MRI scan results of a patient into their respective word document, which is stored on a local drive on the hospital’s server. This form is called the patient discharge form. This has other pieces of information about a patient such as:

1. DOB
2. Date of injury
3. Diagnosis
4. Admitting consultant
5. Social History
6. History of present condition.

Today I was also able to see the stickers that the hospital sometimes uses when signing out medicines in the drug charts. On the sticker was information about the patient and the person signing it out. This way even if the handwriting is debatable to read, the sticker can just be placed on the drug chart, which makes the process much more efficient, and at the same time ensures everyone can read what is written.

The doctor was also explaining the role of EPR’s, and the relationships between wards and pharmacies and GP. TRO’s issued. Most private hospitals use their own local databases to store patient record and not an EPR, mainly because it is not a financially good decision, or worth it to install an EPR, mainly because of the number of patients at the hospital. Especially because to set up an EPR it will take an external IT person to set it up and manage it. However there are some disadvantages to not using an EPR like the 90% of NHS trusts do. For example this bottleneck comes when the hospital has to manually send patient discharge reports to the pharmacy or GP. Many times it has happened that the hospital has sent over the correct reports over to the pharmacy and GP, but when the patient goes to the GP and Pharmacy they say to the patient that the reports have not been sent. Hence a measure the hospital has taken to ease the process is they print out the discharge report and give it to the patient as well, so they are able to hand it to the pharmacy or GP if needed. This needs to be done for every case, but is especially needed if the dosage of a certain medication for example goes up from 5mg to 10 mg during the patient’s stay at the hospital, hence the GP and Pharmacy needs to be aware of this change.

I was also shown the drug stock inventory folder and spreadsheet. This is where anyone who is taking medicines from the stock cupboard needs to write it in a folder, but this creates an inefficiency because then somebody else has to sit down with the folder and a computer and manually update it in the spreadsheet of stocks. I feel like this process could be streamlined a bit more, potentially by making it quicker to log into the computer, or maybe keeping the spreadsheet always open in the background, and just allowing the excel spreadsheet to automatically fill in most details like person signing it out (maybe with a keyfob that can be tapped) and the time it is signed out. The professional signing the medicine out then only has to write the name of the medication being signed out into the spreadsheet.

I was also able to hear a nice piece of advice from one of the nurses. They are saying that some patients stay in their wheelchairs longer than they need to just because of their mindset, and because it is ultimately their own choice. For example rehab especially, if patient 1 talks to patient 2, and they realise that they both have the same diagnosis, but patient 1 has already been here for 6 months and no visible change has occurred, this may make patient 2 feel like “what is the point” if there is no change after 6 months. The advice that the nurses always give the patients is that they should not compare their own condition to others, because everyone is unique, and everyone’s circumstances are different, and healing times can differ significantly.

I was also able to see vials which check to see how long it takes for blood to clot, so it is used to check before a patient might undergo surgery. If the patient is on blood thinners, then the surgeon may request that the patient be taken off blood thinners, so that there is less chance of a complication after surgery, and post-surgery healing can be quicker. Each patient also has their own sharps box, which houses all of the needles used for that patient. Some patients who have had a stroke previously are on blood thinners during their stay at the hospital, to prevent the chances of another stroke happening during their stay.