We run out-patient services in Clinic 4 every afternoon, Monday through Friday. Please send new referrals to the new referrals office. All the clinics include general appointments but have specialist interests and expertise including:
Mrs Christine Mikelsons
|COPD, sleep and non-invasive ventilation|
Dr James Goldring
|TB and respiratory infection|
General respiratory medicine
General respiratory medicine and pleural disease
||General respiratory medicine|
||Dr James Goldring
||General respiratory medicine and pleural disease|
||Asthma and general respiratory medicine|
The team are, in addition, always happy to provide telephone advice. The respiratory specialist registrars can be reached via switchboard (020 7794 0500) and bleeps 1144, 1816 and 2083.
Our in patient beds are currently on ward 7 South (x33900). We are happy to take over the care of all patients with primary respiratory problems on whichever ward they have been allocated, and attend MAAU daily to facilitate early referral of new admissions to our specialist services. The consultant ward cover is on a rotational ‘attending’ system. To refer patients for our specialist advice, in the first instance, please contact one of the respiratory registrars who carry bleeps 1144, 1816 or 2083.
Our modern lung function laboratory is located on the ground floor, within clinic 14. The lead physiologist is Tina Adamou. In addition to spirometry, facilities include static lung volumes, gas transfer, reversibility studies, bronchial challenge testing, respiratory muscle assessment, sleep studies, hypoxic challenge tests (flight assessment) and capillary blood gas analysis. You can contact lung function on extension 33081. Tests can be requested on IRRIS.
Bronchoscopy is performed on in-patients and as a day case procedure for out-patients within the endoscopy unit on the lower ground floor. We have two lists each week, on Tuesday and Friday mornings. Bronchoscopy is performed with local anaesthetic to the airways, and often intravenous sedation. To arrange an in-patient bronchoscopy please speak to a respiratory registrar (bleeps 1144, 1816 or 2083) and refer on IRRIS. The patient will need to have had a clotting screen performed, and we ask you to insert an intravenous cannula. For out-patient requests the process is similar. More specialised bronchoscopic techniques are offered by Dr Beckles and he can advise, for example, on the suitability of a patient for trans-bronchial needle aspiration of lymph nodes.
We provide, and have expertise in both acute and domiciliary non-invasive ventilation. For a patient who may require NIV acutely, please refer to one of the respiratory registrars (bleeps 1144, 1816 or 2083). Out of hours, the service is covered by the specialist registrar covering respiratory medicine (bleep 1437) and overnight by the cardiology specialist registrar (bleep 2027).
Our specialist respiratory physiotherapy services are involved in both in-patient and out-patient care, with a particular emphasis on patients requiring oxygen therapy, non-invasive ventilation, CPAP, exercise programmes called ‘pulmonary rehabilitation’, sputum clearance and treatment for disordered breathing. In the first instance, contact ext 34068.
Uncomplicated suspected sleep apnoea is currently investigated and managed at the Royal National Throat Nose and Ear Hospital and we do not have the facility at the Royal Free Hospital to perform routine sleep studies. More complex patients, including those with co-existent COPD or possible obesity-related hypoventilation, who may require non-invasive ventilation, are appropriate for referral.
Tuberculosis (TB) nurses
The TB nurses are involved in the care of patients suspected of having, or who do have TB and some other related diseases. They are part of the North Central London TB service, which is based at the Royal Free Hospital. The TB nurses are the case-managers for all the patients with TB at the Royal Free which included notification of all new diagnoses, and an important role in screening people who may have been in contact with TB. This is organised via the TB contact clinics and the nurse-led TB clinics. We provide regional advice for complex cases. The TB nurses can be contacted on 31344, 31346 or aircall 192. Alternatively, referrals in person are welcome at the weekly TB meeting which takes places on Fridays at 12.30 (location available from TB nurses).
Because it can be passed from person to person, people who have been in contact with an infected person may need to be screed for TB.
The Academic Department of Respiratory Medicine has an active research programme with Professor Wedzicha and Dr Hurst performing internationally recognised work on the mechanisms and consequences of exacerbations of COPD. Dr Lipman's interests are TB and HIV related lung disease. A list of recent publications can be found under recent publications. We would be delighted to discuss collaborative projects.
An important part of our work is translational and a model of early access to specialist care for patients with COPD exacerbation that has been employed in research for a number of years is now being trialled in the NHS EPIC (Early Presentation and Intervention in COPD) Service.
We have an active programme of audit and recently completed studies, including non-invasive ventilation and a trust-wide assessment of oxygen prescription. Audit reports are available on the audit page.
Teaching and Students
The Royal Free London NHS Foundation Trust is a teaching hospital and the Hampstead Campus of the Royal Free & University College Medical School (part of University College London) is located on the same site. We view teaching health-care professionals of the future as an important part of our role. Dr Dilworth is sub-dean of the medical school at UCL.
Stop smoking service
The Royal Free stop smoking service offers a friendly, approachable and professional service for in-patients and out-patients. The programme consists of six one-to-one appointments with a specialist stop smoking advisor. The smoking addiction as well as the habit and triggers will be discussed during the sessions. Nicotine replacement therapy (NRT) is offered and behavioural support and individualised advice and encouragement provided.
You can contact the stop smoking service via the hospital switchboard on 020 7794 0500 and extension 33916 or e-mail rfh-tr.RFHfirstname.lastname@example.org.