Welcome to the ICU in Chester we are a mixed level 2 /3 facility meaning that we use our beds flexibly to deliver the care that the individual patient and the hospital needs.
Level 2 patients have single organ support, (e.g. Inotropes or CPAP alone), while level 3 patients are either intubated or have 2 or more organs supported.
We are limited to maximum bed occupancy of 15 patients in total and no more than 7 level 3 patients at any one time. This is due to nursing and medical staffing ratios, equipment and the way we are funded within the wider critical care network.
Our unit has 21 single rooms and was opened in 2014. The additional rooms are designed to give added capacity in times of national crisis and to “future proof” the unit in case of an increased requirement for critical care services in the coming years.
We hope you will find this a supportive and educationally relevant unit where we endeavour to use our resources to deliver excellent, evidence based and compassionate care alongside an educationally relevant and supportive environment.
Contributions and acknowledgements
Dr Lawrence Wilson
The Department
Consultants
The permanent Medical staff consists of 11 consultants:
Consultant bleeps/voip/ext? VOIP 3381 or 3382
How would consultants like to be contacted? VOIP or mobile
Consultant secretaries
Name
Donna Owen
Georgina Lambert
Ext
5461
2261
Junior Doctors
Minimum 3 on duty 9-5 one of whom is airway trained.
2 juniors 17.00 – 08.00 one of whom is airway trained
Ward Sister
Each shift the senior sister on ICU carries VOIP 2329
Specialist Nurses
Critical care outreach nurses staff the specialist outreach service with medical support from the intensive care unit
Ward Pharmacist
Jos Wicket
Delores Beech
Dieticians/ OT/ Physio
In Patiet Physiotherapy team leader Lisa Davies.
Specialist physiotherapist Sophie Horton
Ward Clerk
Bev Hughes
ICU day
The ICU day follows a predictable pattern
07.30 Night team ensure hand over sheet updated and any patients who need blood tests have had them done
08.00 Day Shift starts Junior - junior hand over
08.30 Night team should aim to be leaving by this time
Day team begin daily reviews of patients / urgent tasks handed over from night
09.00 ICU electronic MDT / board round
Review of current patients:
Day consultants / junior doctors / Senior Nurse / Pharmacy / Physio /Medical students
10.00 End of bed Ward round commences. (Usually 2 teams working from opposite ends of unit
13.00 Lunchtime teaching / meetings
14.00 Continue procedures / reviews etc.
16.00 Micro ward round, start evening consultant ward round
20.00 Night shift starts Junior to Junior hand over
20.30 Day team juniors should be leaving by now
20.30 – 07.30 All patients have medical night review documented, referalls seen and admitted as clinically required, ensure all patients who need investigation or intervention prior to morning round have had necessary tests done. (Most commonly ensure all blood tests sent to lab before 8am so results available for morning ward round
All patients must have a daily review or admission review if first day.
All patients must have discharge summary and ongoing management plan when discharged.
The Nurse staffing is usually divided into 3 teams each with a team leader and then a senior sister overseeing the whole unit.
Decision to admit is consultant intensivist based but they will always liaise with the Senior Sister to check capacity at the time of admission and over the coming 24 hours.
On Calls
There are 2 resident on call rota tiers.
The ICU airway trained tier (often termed 2nd on anaesthetist) who will be an anaesthesia trainee or anaesthesia NCCG permanent member of staff.
The ICU fellow who is either an F2 or trust junior ICU fellow grade and would not normally have advanced airway training.
F2 doctors
4 month rotation educational supervisor will be appointed follow F2 curriculum educational goals
Junior Fellow posts
Usually 1 year posts.
All on call commitment (daytime and out of hours), as part of critical care rota.
2 posts “pure” icm ie non on call daytime hours in critical care also.
4 posts Daytime non on call hours spent in vascular unit- ward and theatre cover.
Fellow posts have 1 “taster” week every 6 months where they are placed in a supranumary fashion in another department. This is tailored to their future career intentions but has included anaesthesia and radiology in the past.
All fellows will be appointed an educational supervisor and will target competancies and assessments mirroring the curriculum for foundation trainees.
They are expected to have a PDP, and regular educational supervisors meetings including a portfolio review.
Fellows have access to study leave and a personal study leave budget in line with training grades
Core Anaesthetic Trainees
3 month rotation as part of 1 year in anaesthesia and critical care.
On call will continue in theatre until ready to hold ICU on call bleep which is normally done in a phased way starting with daytime on call.
Folowsl RCOA basic level competancies for ICM training, (see Annex f in anaesthesia CCT curriculum)
ACCS trainees
6 month rotation as part of 1 year in anaesthesia and critical care.
On call will continue in theatre until ready to hold ICU on call bleep which is normally done in a phased way starting with daytime on call.
Follows RCOA basic level competancies for ICM training, (see Annex f in anaesthesia CCT curriculum)
Annual Leave
Anaesthetic and ACCS trainees book annual leave and not on call requests through the anaesthetic department
Fellows and F2s book annual leave and not on call requests through the ICU fellow trainee who is the nominated rota co-ordinator who works with Dr Young as the consultant supervisor of the F2/Fellow rota.
On call cover is prospective cover meaning annual leave is taken from “normal days” and if leave is needed on a day for which you are scheduled to be on call it is your responsibility to swap that on call with another person on the rota and ensure the rota master is aware of the swap.
Education
Wednesday Intensive Care Medicine Teaching Programme
Anaesthetic Seminar Room at 12.30
Topic to include:
Basic Overviews of the following topics with all welcome:
- Cardiovascular: Basic Physiology, optimisation, inotropes and Goal directed therapy
- Respiratory: Basic Physiology, treatment strategies and “ARDSnet settings”
- Renal failure, renal optimisation and replacement therapy
- Sepsis Overview : Assessment and treatment goals
- CNS: sedation, neuroprotection in brain injury and transfers
- Liver failure. Assessment, prognosis and treatment options
- Nutritional support and feeding strategies
- Microbiology overview
Monthly Morbidity and mortality meetings currently last Tuesday of the month
All trainees are expected to present at least 1 tutorial session and 1 mortality meeting during each 3 month block and 1 Audit per year.
Research
There is an active research programme in the critical care unit and all trainee of all gades are encouraged to participate in screening and recruitment. With this in mind Juniors should aim to have up to date GCP, (Good Clinical Practice), training. This is accessible as free online training through the NIHR website.
Medical Students
Medical students will attend as either a 1 week placement or as a SAMP extended placement.
Dr Ridler and Dr Singh co-ordinate medical student placments and they will receive their timetable and learning objectives directly
What needs to be signed off?
Paperwork requirement for Core ICM blocks.
Background:
Core Anaesthetic Trainees do a 3 month block of ICM, usually in year CT2.
The curriciulum for Core Anaesthetic training is in Annex B.
<http://www.rcoa.ac.uk/careers-training/training-anaesthesia/the-training-curriculum/CCT2010>
The curriculum for the ICM block is unusual because it is not encapsulated in Annex B, which refers to Annex F.
Annex F used to be a long document, with all stages of training mixed in.
The paperwork requirements for ICM blocks were sometimes unclear.
What has changed in July 2014?
Annex F has been completely revised and simplified, and contains a workable set of objectives.
What do you need to do?
Trainees at the start of their ICM block should:
A) Access Annex F <http://www.rcoa.ac.uk/CCT/AnnexF>
B) Print Pages 8 – 11
C) Achieve sign-of for all of the items on pages 10 and 11, supported by appropriate evidence, with their Education Supervisor in ICM
One piece of evidence can support more than one competency.
D) The signed document should of course be uploaded to the e-portfolio when complete.
E) This will be required for an ARCP outcome 1
College Tutors please share this with Education Supervisors and Faculty Tutors in ICM at your hospital.
Additionally:
Trainees may wish to record additional achievements on pages 12-16, but this is not mandatory.
It is advised especially for those who are contemplating a career in ICM