The ACCU in General

Nursing Staff

Like all critical care units in London, recruiting and maintaining nurses is difficult. We have a lot of excellent nurses from all sorts of backgrounds both clinically and geographically and some are not only new to critical care but also new to London!

You will find that the ICU nurses are extremely approachable and they will always be willing to help you and give advice. If you have any problems with the nursing staff please talk to the Band 7 in charge and, if necessary, the consultant on call or Matron if required.

Trainees and Rotas

There are 32 (sometimes more and sometimes less) trainees in 30 rota slots, working within the ACCU and you come from a variety of backgrounds.

There are three rotas:

Two 7-person rotas based on 4E which are staffed with Anaesthesia / ICM trainees (who are airway trained i.e. >6/12 anaesthesia).

One 16 person rota based across 4E and 4F (which will also have some airway trained people who can equally well use their skills during their placement)

Dr Russ Hewson is the consultant with overall responsibility for the trainees and Dr Malgorzata Starczewska is the consultant with responsibility for the trainee rota.

There are some in depth rules covering the rota later on in this guide PLEASE READ THEM

Sick Leave

If you are unable to come to work because of illness you must inform the ICU consultant in charge as early as you can (ext. 45711).

Angela Vai and Shafiul Hoque (ACCU administrators) must also be informed about all sick leave. Extension 40345/6 or angela.vai@bartshealth.nhs.uk or shafiul.hoque@bartshealth.nhs.uk

Do not forget to let Angela and Shaffy know when you have returned to work.

Post

Post for the anaesthesia trainees may be sent to the Anaesthetics Department where you will have a post slot. Please label one of the pigeon holes in the 4E doctors’ office for post delivered to ACCU. Trainee payslips are also delivered to the 4E doctors’ office.

Trust E-mail

You should each obtain a Trust log-in (for computer access and e-mail). It is Trust policy that all employees regularly check their trust email. Important information is often sent by this route and therefore it is YOUR RESPONSIBILITY to check it regularly. We are no longer going to send information (i.e. rota, teaching timetables etc.) to personal email addresses. You can access the trust email from https://webmail.bartshealth.nhs.uk

Alternatively, to sync your smart phone to the trust email system, which some of you may find easier, please follow the following steps:

Go to “settings” select “mail, contacts, calendars”,

Go to “add account”, choose “Exchange”

Put in your email and password (this will need to be updated when you renew your login as and when your are asked to by the Trust computer systems)

Put “mobile.bartshealth.nhs.uk” in server box

Put “live.trust.xblt.nhs.uk” in domain box

Enter your username (not your email address) and password (as above).

Appraisal and Assessment

All trainees who rotate to the RLH ACCU will be allocated a consultant as their educational supervisor. Dr Hewson will allocate supervisors but feel free to discuss problems, clinical or otherwise, with any of the consultants.  You should arrange an appraisal date within two weeks of starting on the ACCU to set some educational objectives for your period on the unit.

We will do an assessment at the end of each three / six month ICU module for each of you and this will be discussed with you and submitted for your ARCP/RITA.

We welcome constructive feedback on the ICU module and you are encouraged to complete a feedback form (anonymously if you wish). We hope that this document helps you to familiarise yourself with the ICU. Let us know if there are other issues which you feel need to be addressed in this document.

Trust grade doctors NOT on a training program and revalidation

It is a statutory requirement to have annual appraisals that form part of your revalidation by the GMC (The ARCP counts for this). Doctors who are in an OOPE/R etc. and working on the ACCU will still be in an ARCP program so this paragraph does not apply to you.

If you are not in a deanery training programme and not receiving an annual ARCP / RITA assessment then you have to undergo formal appraisal once a year. You can do this at the RLH through the Trust PReP system. If you are a Trust Doctor / Clinical Fellow, then this applies to you.

If you only have a 3 or 6 month contract and the period does not cover your revalidation due date or when you are due your annual formal appraisal, you DO NOT need a PReP account (though one will be set up if your contract is extended). At the end of your job, please ask your educational supervisor to use a blank output form (ACCU folder / Trainees / Appraisal OUTPU form) to provide structure to a local assessment of your clinical work, which you could then take to your next employer to confirm your work has been reviewed in a fashion suitable for revalidation.

Early in your placement please contact the Medical Directors Office 020 7377 7329 (or email Revalidation@bartshealth.nhs.uk to get registered on the PReP system if you need to. Make your educational supervisor aware, as they will have to conduct a formal appraisal with you when you finish the post. This is a joint responsibility between you and your supervisor. You risk not being revalidated if this is not completed.

Clinical Governance

Morbidity and Mortality (M+M)

The unit has a rolling programme of clinical governance, which includes a mortality/morbidity meeting and a multi-disciplinary Governance group.

Following a death a summary of the patients ACCU is drafted (this is the same summary used for coroner’s referrals or cremation forms – see later).  This is reviewed the next available Monday and cases of concern/interest identified.

These cases are then allocated to trainees and a presentation of the case should be prepared for the next Monday afternoon.  This should involve relevant results, imaging and data as appropriate.  There is a critical care proforma available at –

I:\surgery_&_anaes\ACCU\M&M

The ICNARC office may be able to help with some of the fields and Angela or Shaffy will help with the notes.

The discussion should involve the whole multi-disciplinary team and the outcome will be recorded.  This may generate some action points that will be fed back into the ACCU Governance group. Any problems please email Dr Nick Bunker.

Incident Reporting and Serious Untoward Incidents (SUI)

The Datix Incident Reporting system can be accessed via the Barts Health intranet homepage- third item on the “I want to” drop-down menu on the right hand side. They should be reported to Nicola Rudkin or Helen Hewitt, the ACCU Matrons.

If you have been involved in an SUI, try and attend the SUI meeting (along with one of the ACCU consultants) it is a useful learning exercise.

NG Tubes

Following some Never Events, the Trust has mandated that all doctors interpreting chest x-rays for confirmation of placement of NG Tubes should have been trained to do so.  The training package and competency test can be accessed at http://bold.bartshealth.nhs.uk/ .  You will need your assignment (payroll) number to create an account.

You must not confirm NG Tube positions on x-rays without having done this training.  If no-one is available to help, apologetically ask the on-call radiology registrar to confirm it for you.

Educational Opportunities

Time Meeting Venue
Monday 16:00 Morbidity and
Mortality meeting (M&M)
ACCU Seminar Room (3&4)
Tuesday
08:00 to 08:30
(compulsory if on shift)
 ACCU Teaching /
Journal Club
4E Doctors Office
Tuesday
12:30 to 13:30
Medical Grand Round Education Centre
Wednesday
08:15 to 09:00
 Trauma Radiology
Meeting
Clinical Radiology
Meeting Room
(1st Floor)
Thursday
08:00 to 08:30
(compulsory if on shift)
ACCU Teaching /
Journal Club
4E Doctors Office
Thursday
12:30 to 13:30
Academic Trauma
Meeting / M&M
ED Seminar Room
(corridor leading from
Resus)

ACCU Teaching and Journal Club

Every Tuesday and Thursday morning at 8am there is either a journal club led by a trainee or a teaching session led by a consultant, allied health professional or senior trainee. This is timetabled and therefore compulsory when on shift. The rota for this can be found on the I drive

I:\surgery_&_anaes\ACCU\Medical Education

Names are allocated to journal club sessions so you must check it to see when you are due to present.

This folder also contains journal club guidelines and a selection of essential papers for you to choose from. Please make sure the paper has not already been done for the current trainee group. If you have another paper that is not in this folder, which you would prefer to present then feel free.

Journal club discussion tends to be most beneficial and interesting if attendees have read the paper in advance so please let the consultant and your colleagues know which paper you plan to present. At least one of the consultants on for the week should be there to chair the session.

Trauma radiology meeting

Excellent sessions run by a consultant radiologist, reviewing interesting trauma images from the preceding week. Obviously this clashes with handover. But it is often worth sending some trainees working standard days (and medical students)

Trauma meeting

Local and external speakers on trauma topics. Once a month M&M: review of all deceased trauma patients.

Critical Care Academic meeting

Usually the last Monday of the month at 5 pm (in ACCU Seminar room 3/4). Publicised on a per-meeting basis.

Other educational opportunities

ICU Follow-up Clinic – First Thursday of the month. Please contact Vishi Verma if interested.

Tracheostomy ward round – Tuesday lunchtime. – Anaesthetist, Max-fax, Physiotherapist, Speech Therapist. All patients in hospital with traches! If interested contact Dr Helen Drewery, consultant anaesthetist.

Critical Care Outreach Team (CCOT) – Join CCOT for a day or half a day (especially useful for junior trainees new to critical care)

HEMS clinical governance days – These occur monthly and are advertised by e-mail

Nursing day – Very useful for those completely new to critical care. Arrange the day before with the nurse in charge in order to be allocated to work with an appropriate nurse and patient.

Echo Training – If you are interested in achieving FEEL / FICE accreditation, current mentors on the ACCU are Dr Lynne Barrass and Julia Hadley. Please speak with one of them.

Audit and Research

Audit

We participate in ICNARC, the National Intensive Care Audit database and almost all the consultants are continually involved in some sort of research, audit or data collection.

Dr Julia Hadley has a list of audit projects being done or ones we need trainee help with for those of you who are interested. Please see her early in the rotation if you want to get involved – It’s probably a good idea to meet your educational supervisor first to make sure that an audit is an appropriate way to spend your time on the ACCU.

If you have your own ideas for audit projects, all the better! Please discuss with Dr Hadley or your educational supervisor who can put you in touch with an appropriate member of the team.

All audits must be registered with the Clinical Effectiveness Unit, via Dr Hadley. Further information about audit activity, results of recent audits and registration forms can be found at

I:\surgery_&_anaes\ACCU\Audit\ACCU clinical audit program

Research

Professor Rupert Pearse, Drs Michael O’Dwyer and John Prowle all hold substantive academic positions within the Medical School. They have a number of PhD and MD students under their supervision and have a broad research portfolio but specialise in Peri-operative Medicine, Genetics in Critical Illness and AKI. If you are interested in discussing research and are considering trying to gain a higher degree at some point during your training they are happy to be contacted to offer help and advice.

Many other consultants are also substantially involved in research (for example Drs Kirwan, Hewson, Zolfaghari, Shirley and Verma hold Honorary Senior Lectureships within the Medical School) so if you have any questions or an idea you want to talk through, ask around, there is likely to be someone who can help you!

There are also a number of portfolio studies taking place on the unit and an active group of research nurses who you will notice wandering around the ACCU, screening patients and keeping you up to date with what projects are on the go. Please let them know if you think there is a patient who may be eligible for a study.

There is a notice board in the 4E Doctors’ office detailing current research activity on the ACCU, which is updated daily by the research team reminding us of the studies we are recruiting for and our recruitment progress.

Projects, Presentations and Funding

If you do a project, audit, data collection etc. whilst on the ACCU and this gets written up and accepted as an abstract somewhere then there are some funds that can support your travel and registration to that meeting.

Applications are open to all members of the ACCU trainees (research and clinical) and assessed on their individual merit but preference will be given to those who do clinical work on the ACCU. There is an upper limit of £600 but we will gladly discuss all applications and can make exceptions.

We appreciate that you may have left the unit by the time your data is presented but as long as the data was collected from the RLH ACCU you are eligible to apply.

Please contact Chris Kirwan or Dan Kennedy if you feel you qualify!