Ciaran Coulson is an executive troubleshooter who currently works in Holby City Hospital's emergency department. An experienced emergency physician who worked across the United States, he was brought into the department by the hospital trust after it failed to meet its targets.
Appointment to the emergency department
In May 2019, hospital CEO Henrik Hanssen confronted Clinical Lead Connie Beauchamp about the department's poor performance. She offered to provide him with a proposal, but the hospital trust decided to appoint a troubleshooter instead. (CAS: Series 33, Episode 36)
On 1 June, Ciaran started his first shift in the department and expressed his intent to establish a Rapid Assessment and Treatment system so patients could be treated more efficiently. However, Connie was sceptical and defied him to consult the team before enacting his plan. With a large queue of ambulances waiting outside the building, Ciaran deemed that Connie's patient's injuries were not life-threatening and instructed her to start prioritising the patients outside.
Connie subsequently announced to the team that the RAT system would be implemented, but she quickly abandoned her post to treat patients in cubicles and in resus. Ciaran reprimanded her for ignoring their "agreement", but she claimed that, due to a lack of planning and consultation, his plan was unfeasible. Later, when it transpired that Connie's patient was suffering from a pneumothorax, Ciaran disagreed with her decision to perform a chest drain. Connie snapped at him and insisted that she had clinical authority, but, when she called Hanssen to back her up, he told her otherwise. Once Connie left, Ciaran guided registrar Archie Hudson through using a thoracic decompression catheter, and she successfully stabilised the patient; she thanked him for his help.
That evening, as Connie was leaving, Ciaran assured her that they were both just doing their jobs and maintained that they could work together. She agreed, and he jokingly accused her of "stealing [his] best lines", prompting Connie to retort that she was not known for stealing or surrendering but was rather "renowned for being indefatigable". (CAS: Series 33, Episode 37)
The following week, Connie left Ciaran in charge of the department whilst she attended a discussion panel at the National Conference of Acute Trauma. In admin, he announced that he was initiating a time and motion study where each member of staff had to keep a log of their activities. Archie took issue with his idea and suggested that he was "checking up on [them]", but he averred that he was gathering data to identify areas for improvement. Several hours later, Ciaran approached her and pointed out that she had not initiated her study, but she claimed that she was busy saving lives.
After working together in resus, Archie asserted that the study was flawed as it could not measure the value of certain activities such as speaking to grieving relatives. After she informed him that she completed her study to deny him the satisfaction of calling her out, whilst maintaining that the data was still useful, he revealed that he was using the study to find out which members of staff would struggle to cooperate with him and argued that she "came into line pretty quick". In Connie's office, Ciaran tried to view the data from the study, but the software had become corrupted. He asked consultant Will Noble and Archie if they knew anything about it, and they denied having any knowledge. Will asked him if the loss of the data would result in the study being repeated, and Ciaran opted to trust the staff to do their jobs properly. (CAS: Series 33, Episode 38)
Connie returned from the conference the next day and was dismayed to discover that Ciaran had established a rapport with the other members of staff and moved into her office. She asked him if it was a "permanent arrangement", and he explained that it made sense for him to "be on the front line". However, she later had enough of his occupancy of her office and moved his belongings into the staffroom. Irritated, he promised to report her behaviour to Hanssen. Later that day, following an intubation incident, Ciaran confronted Connie and Archie. Archie attempted to talk through the sequence of events, but Connie interrupted her and claimed that Archie caused a bleed during intubation. Ciaran probed for more information, but Connie continued to speak over Archie and ushered her out of the staffroom. (CAS: Series 33, Episode 39)
On 22 June, Ciaran took issue with sister Lisa "Duffy" Duffin's decision to intervene when a young diabetic girl named Carrie ran into the bus she was riding and urged her to consider precautions and liability on account of her dementia. However, when the girl's foster mother Emma claimed that Duffy saved her life, he allowed her to continue working on the case. In cubicles, Carrie experienced a seizure and was taken back into resus. Ciaran instructed clinical nurse manager Charlie Fairhead and consultant Ethan Hardy to take over her treatment and asserted that they could not afford any more mistakes. Duffy maintained that she gave Carrie the correct concentration of glucose, but Ciaran ignored her rebuttal and ordered her to remain nearby as to ward off any suspicion. Once Carrie was stabilised, he recommended spending the rest of the day coming to a rational decision about her future in the department, and Duffy refused to be "bullied into resigning".
Later that day, after Duffy managed to convince Carrie to accept help with her diabetes, Ciaran apologised to her for jumping to conclusions and praised her "tenacity and patient care". Nevertheless, he claimed that the hospital was no place for sentimentality and reminded her that she was "suffering from" dementia, but Duffy corrected him by stating that she was "living with" the condition. She subsequently decided to quit her job as a sister to assume a non-clinical role in the department. Connie, who was in a meeting for the day, caught wind of the news and confronted Ciaran for his hand in Duffy's resignation, but he assured her that Duffy had his full respect and asserted that he did her a favour. (CAS: Series 33, Episode 40)
On 29 June, after a man was stabbed in the neck by his estranged wife with a key, Will instructed Archie to fetch Connie to help out in resus. However, feeling that Connie was not fit to practise, she decided to get Ciaran instead. Later that day, Archie expressed her concerns to Ciaran about Connie's competency and her scapegoating her. Ciaran asked her to produce a written account of the incident involving Kat Hollis and expressed his appreciation of her speaking out. (CAS: Series 33, Episode 41)
Behind the scenes