The Great Western Hospital is a new PFI hospital on the outskirts of Swindon, which opened in December 2002. It is immediately adjacent to junction 15 of the M4 and there are frequent direct buses to the station which is on the main Bristol/Bath/London line.
The haematology department provides BCSH level 3 care. There are 4 consultants, 2 trainees in haematology and haematology, blood transfusion and anticoagulant nurses. There is a dedicated 10 bed haematology ward (Dove ward; all side-rooms with en suite facilities), together with a day ward, haematology outpatient facilities, the anticoagulant clinic and the clinical trials office all on the same level. The pathology laboratory, offices and secretaries are on the floor above. Nurses are trained to handle CVCs, cannulate, manage venesections and blood component therapy and administer IV treatments and chemotherapy. There is a nurse led PICC service and the anaesthetic department run a service for insertion and elective removal of central lines. Junior medical support is provided by an F2 trainee who spends four months in the department.
The department works closely with Oxford; clinical oncology, radiotherapy and renal services are provided from Oxford. A therapeutic apheresis service is provided by the National Blood Service in Oxford who also supply blood and blood components. The Oxford Haemophilia Centre provide a reference haemostasis and thrombosis service with the majority of haemophiliacs being cared for through Oxford. 1 of the consultants, Dr Sternberg, works in Oxford 1day each week and has research links there. The Clinical haematology and oncology services are part of the Thames Valley Cancer Network (TVCN) and the department participates in video-conferenced network MDTs.
The Royal Free Hospital, London is currently the preferred referral centre for allogeneic transplantation and one of their consultants does a monthly clinic in Swindon.
There is a combined automated laboratory (chemical pathology and haematology) and a separate blood transfusion laboratory. The main haematology analysers are 2 new ABX machines, currently being installed. The coagulometers are a Sysmex CA-6000 and a Sysmex CA-1500 (recent replacement). The laboratory repertoire is standard. Immunophenotyping goes to Birmingham and cytogenetics to the Wessex Regional laboratory in Salisbury. Blood bank has an Ortho AutoVue, which performs automated blood grouping and antibody screening. Cross-matching is done manually using the Biovue system with use of the electronic cross-match in selected cases. Antenatal antibody quantitation is sent to the National Blood Service reference laboratory in Oxford who liase directly with the obstetricians. There are two transfusion practitioners and an established hospital transfusion team. Bar code technology is in place for patient identification and tracking of blood components.
Both palliative care and pathology medical students from Bristol are taught in the department.
A placement at The Great Western Hospital gives trainees broad experience of district general hospital haematology. Trainees benefit from the links with Oxford, TVCN and London, giving them a view of haematology services outside Bristol and both training and research opportunities. Nurse led services are well developed with a nurse/pharmacist led PCT wide anticoagulant service and nurse led out patient clinics. The department actively participates in a number of clinical trials and is well supported by clinical trials nurses. MDTs are well developed with a local (diagnostic) MDT with both radiology and haematopathology, a marrow morphology MDT and participation in the TVCN lymphoma, myeloma and leukaemia MDTs. Trephines are reported in haematology and the local haematopathologist is always happy to arrange haematopathology teaching. For more senior trainees there are opportunities for exposure to management, for example by attending directorate and Trust meetings (eg Trust board, transfusion committee, LREC etc).