Welcome to the plastic surgery team, we hope you enjoy your time with us and have a good educational experience. The job tends to be busy; there is plenty of opportunity to attend theatre and clinics.

Contributions and acknowledgements

Mr Jonathan Adamtwaite

Dr Farah Coffey

The department

Consultants

You can contact the consultants via switch, who will put you through to their mobiles.

Sharon Corbett

The team

Angela Hurst Bleep: 2851

Plastic Surgery Clinical Nurse Specialist

Katherine Yates Ext: 5334

Hand Therapist

Junior doctors

3 SpR’s, 3 Juniors below SpR level

Consultant timetable

These vary from week to week.

Mr Fahmy has a satellite clinic in Wrexham on Monday morning, theatre all day Thursday and clinic on Friday morning.

Mr Adamthwaite has a satellite clinic on a Monday morning at Arrowe Park, and clinic on a Wednesday morning. Theatre time varies.

Mr Siddiqui has clinic on a Monday morning and theatre time varies.

Clinic timetable

Consultant led clinics occur in Out Patients 1 throughout the week.

Specialist nurses

Plastic surgery Clinical Nurse Specialist – Ms. Angela Hurst (#2851)

Plastics dressing clinic is Ext 3131

The team also have the support of a specialist nurse who oversees a comprehensive service throughout the unit for both in and outpatient facilities, including trauma co-ordination. The specialist nurse is responsible for our Nurse Led Clinics where patients require complex wound management for pre and post-operative treatment and in addition also provides breast reconstruction follow up care and counselling.

Specialist Nurse clinics:

Hand therapy clinic

Dressings clinic

Ward round

There is not a specific inpatient ward for Plastics. The list of patients is on the computer in the Plastics office (On the corridor opposite T block). Ward rounds are registrar lead and occur daily at 8am, meeting in the Plastics office.

Handover

Referrals

Meditech – Print outs are given to the registrar

AED – Received through bleep #2884 in hours and #2387 out of hours

GP – Received via phone calls or through single point of access

N.B. Any dog/human/cat bite should be admitted for IV antibiotics and washout in theatre normally

Services

Breast reconstruction – accessed via clinic referral

Skin lesion removal – referral from GP or dermatology and reviewed in clinic

Hand trauma – usually via AED

General Plastics,

Lower limb trauma

Elective hands

Education

Theatre – regularly scheduled to assist in theatre with consultants and registrars

Weekly teaching before ward round once a week in the plastics office

Rolling half day

Annual and study leave guidance

Currently Mr Deniz Hassan is the rota master so all annual leave requests must go via him and your supervising consultant. This also applies for study leave.

F2/CST Level day on-call/Ward cover

• Arrive first thing in the morning and bleep the night SHO on 2387 and obtain a handover.
• Update the handover list in the office computer accordingly with existing and new patients.
• Check inpatient blood results, scan reports, X-rays and update the list accordingly.
• Print the required number of handover sheets
• Pick up the plastics on call bleep #2884 in the office
• List discussion in the office at 08:00am regarding existing inpatients and trauma patients with the rest of the team and the registrar on call.
• Go on the registrar led ward round.
• Update the Plastic Surgery Clinical Nurse Specialist on all inpatients and trauma, existing and new via her bleep.
• After the ward round go to the plastics dressing clinic to see if any patients have been booked into the plastics trauma clinic overnight. Finish jobs from the ward round then go down to see A&E patients if there are any waiting.
• Discuss anypatient you see throughout the day and any referral you receive with the registrar on-call if you are unsure of the management plan, as well as any concerns with inpatients.
• When you have finished all jobs and there are no patients to be seen, proceed to your designated clinic or theatre allocated to you on the rota.
• At the end of the on-call, ensure that the handover sheet is up to date and hand over to the evening SHO On call.

Evening and Night F2/CST Level On-call

• Obtain hand over from Plastics Day SHO, ENT SHO and Ortho SHO On-Call at 16:30. Go to the ortho trauma room for ortho handover and to meet the ortho SPR on call for the night.
• Until 20:00, discuss any referral/patient you see with the registrar on-call if unsure of plan for any of the specialities (Ortho/ENT/Plastics).
• From 20:00-08:00 the next morning, discuss all complex cases, anything limb or life threatening and any serious problems with inpatients with the consultant on call. The consultant on call is available via switch and is highlighted on the rota for the week.
• Non-urgent referrals from other hospitals can be asked to attend A&E the next morning at 08:15 or 08:30 for the plastics trauma clinic.
• All cases seen in A&E that do not require immediate admission should be listed for theatre and updated on the computer and notes put into the red tray in the office.
• The evening SHO on-call should ensure that all admissions and trauma TCI is handed over to the night SHO and the night SHO should hand over in the morning to the day SHO, everything from the evening and the night.
• On weekends the night SHO must handover to the plastic surgery registrar on call, via mobile, and attend the ortho trauma metting. This applies on Saturday and Sunday and Monday morning.

Trauma patients

• See patients in A&E prior to discussing them with the registrar on-call.
• Performa full history and examination, document in hand proforma which can be found in A&E.
• Ensure that an X-ray is available, if not, order one.
• Ensure that all trauma patients with open wounds receive antibiotics and have their tetanus status checked/booster given. For human bites check hepatitis status as well. There is a human bite preform in minors.
• If they require surgery:
1. In hours call Angela Hurst and see if there is any space on designated plastics trauma list.
2. If no space, book patient on the Emergency list (with correct site and side) – THB on meditech. Inform theatre 5 if booked onto emergency list.
3. Complete purple form (found in AED) if patient going home.
4. Change AED screen to bed requested plastics in hour or bleep site co-ordinator out of hours and request a bed if required.
5. Inform the patient and keep them NBM if GA is required.
6. In addition, all patients going for surgery prior to leaving A&E must have:
   • A valid consent form, signed and dated (with correct site & side)
   • Site of surgery marked
   • A completed green VTE form
   • TEDS or TINZ prescribed on eMAR if required

If these 4 things are not completed correctly, there will be an unacceptable delay in getting the patient to theatre.

Registrar on-call

• Arrive at 0800am in the morning and obtain a hand over from the Night SHO on bleep 2387.
• Discuss all patients on the list.
• Lead ward round as designated on the rota.
• Attend allocated theatre/clinic sessions.

Outpatient Clinics

• Discuss any cases you are unsure of with a Registrar or Consultant to check that the management plan is appropriate. The discussion must be documented in the clinical notes and in the letter.
• Any patient seen by an SHO that needs listing for surgery or has a complication from previous surgery must be discussed with the Consultant in that clinic.
• Any patient that fails to attend an appointment must have clinical documentation and follow up decided on. Non-malignant/serious or regular non-attenders can be discharged.

Plastic surgery camera SOP

• The department’s camera is for use only in situations where Medical Photography are not available.
• The camera should be handed back to medical photography regularly to download any images taken on to PACS.
• Obtain signed consent from the patient and raise an order via Meditech.

Useful guidelines

There are a number of useful guidelines on the intranet. These are split by speciality of which there is a plastic surgery folder.

http://doclib.xcoch.nhs.uk/Pages/Specialty.aspx